Advance Pharmacology

Guidelines: Support your responses with scholarly academic references using APA style format. Assigned course reading and online library resources are preferred. Weekly lecture notes are designed as overviews to the topic for the respective week and should not serve as a citation or reference.

In your discussion question response, provide a substantive response that illustrates a well-reasoned and thoughtful response; is factually correct with relevant scholarly citations, references, and examples; demonstrates a clear connection to the readings
In your participation responses to your peers, comments must demonstrate thorough analysis of postings and extend meaningful discussion by building on previous postings.

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Angela is a 54-year-old married woman with three adult children. She has been the office
manager of a small law firm for 20 years and has enjoyed her work until this past year. She has
rheumatoid arthritis with minimal impairment that has been managed well with NSAIDs. She has
been taking conjugated estrogens for 8 years and decided to stop taking them because of her
concern of their risks without sufficient medical benefit. She has tolerated the discontinuation
without difficulty.

At her annual medical checkup appointment, she told her primary care provider that she seemed
to be tired all the time, and she was gaining weight because she had no interest in her usual
exercise activities and had been overeating, not from appetite but out of boredom. She denied
that she and her husband have had marital difficulties beyond the ordinary and she was pleased
with the achievements of her children. She noticed that she has difficulty falling asleep at night
and awakens around 4 a.m. most mornings without her alarm and cannot go back to sleep even
though she still feels tired. She finds little joy in her life but cannot pinpoint any particular
concern. Although she denies suicidal feelings, she does not feel that there is meaning to her life:
“My husband and kids would go on fine if I died and probably wouldn’t miss me that much.”
The primary care provider asks Angela to fill out a Beck’s Depression Scale, which
indicated she has moderate depression.

1. What medication would you first prescribe to this patient?
2. She comes back in 2 weeks and states she has not noticed and change in her mood since starting on the medication. What would be your response?
3. What are the possible problems with the medication you prescribed?
4. How long should you continue the treatment regimen?


1. What medication would you first prescribe to this patient?

For Angela, an adequate first-line pharmacological treatment is a selective serotonin reuptake inhibitor (SSRI). SSRIs are safe, well-tolerated, and have similar actions and interactions, being sertraline (Zoloft) considerably cheaper (Ng, How, and Ng, 2017). I would prescribe sertraline 50 mg orally once a day (Sertraline, 2020).
2. She comes back in 2 weeks and states she has not noticed and change in her mood since starting on the medication. What would be your response?

According to Sertraline (2020), “the full effects of sertraline may take eight to 12 weeks to develop.” I would advise Angela to keep taking her medication as prescribed while informing her that will not notice an immediate improvement. I will give Angela a full prospective of information about the medication.
3. What are the possible problems with the medication you prescribed?

The spur of energy effect of the first few months of treatment may increase the risk for suicidal thoughts. SSRIs may cause some degree of sexual dysfunction. Sertraline interactions include any medication that affects serotonin, other antidepressants and most psychotropic medications, anticoagulants, anticonvulsants, cardiac medications affecting QT interval, and HIV medications (Sertraline, 2020). According to Ng, How, and Ng (2017) common side effects of SSRIs are “ associated with nausea, vomiting and a potential worsening of anxiety, especially during the first week, which should resolve over time as the body adjusts to the medication.”

4. How long should you continue the treatment regimen?

The goal of pharmacological treatment for depression is complete remission, even though depression is a fluctuating chronic condition that is likely to recur. All antidepressants’ discontinuation should be tapered down to avoid discontinuation symptoms that include gastrointestinal complaints, flu-like symptoms, affective symptoms, or anxiety that will dissipate within 2 weeks. If the symptoms are mild, good information, counseling, and reassurance should be enough until discontinuation symptoms subside (Shelton, 2001). The World Health Organization recommends treatment to be discontinued not before 9 to 12 months after depression remission (Duration of antidepressant treatment, 2012).


Ng, C. W., How, C. H., & Ng, Y. P. (2017). Managing depression in primary care. Singapore medical journal, 58(8), 459–466.

Sertraline. (2020). Retrieved from

Shelton R. C. (2001). Steps Following Attainment of Remission: Discontinuation of Antidepressant Therapy. Primary care companion to the Journal of clinical psychiatry, 3(4), 168–174.

Duration of antidepressant treatment. (2012). World Health Organization. Retrieved from

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