General Psychiatry
Jacintha Cauffield,
Pharm.D., BCPS
Palm Beach Atlantic University
Lloyd L. Gregory School of Pharmacy
West Palm Beach, Florida
Learning Objectives
1. Examine pharmacotherapeutic options for manag-ing major
depression, bipolar disorder, schizophrenia, anxiety disorders, insomnia, and
substance use disorder.
2. S elect a drug used to treat these disorders with respect to its
unique pharmacologic properties, therapeutic uses, adverse effects, and
cognitive and behavioral effects.
3. F ormulate a pharmacotherapeutic treatment plan when presented
with a patient with diagnoses of major depression, bipolar disorder,
schizophrenia, anxiety disorder, insomnia, or substance use disorder.
Self-Assessment Questions
Answers and
explanations to these questions can be found at the end of this chapter.
1. A.B. is a 25-year-old woman who presents to your practice with a
depressed mood that has worsened during the past few weeks. She struggles to
get out of bed in the morning. When she is not sleeping, she is eating. She has
gained 10 lb in the past month. She is worried about her job and does not feel
like she is “pulling her weight,” even though she recently received a glowing
evaluation. She has passive thoughts of harming herself but no definite plan.
Her medical history includes anxiety, gastroesophageal reflux disease, and
hypothyroidism. She currently takes levothyroxine 100 mcg daily, lansoprazole
30 mg every morning, and alprazolam 0.5 mg three times daily for anxiety. Which
medication would best treat her symptoms?
A. Desipramine.
B. Fluoxetine.
C. Mirtazapine.
D. Paroxetine.
2. K .M. is a 56-year-old woman with recurrent major depression,
type 2 diabetes with newly diagnosed neuropathy, obesity, and coronary artery
disease. She currently takes citalopram 40 mg daily, carvedilol 25 mg twice
daily, lisinopril 40 mg daily, and metformin 1000 mg twice daily. She is
tearful during her appointment and continues to have symptoms of depression
despite initial improvement on citalopram. She wants to switch antidepressants.
Which would be most beneficial?
A. Bupropion.
B. Duloxetine.
C. Nortriptyline.
D. Sertraline.
3. L .J. is a 45-year-old man who presents agitated and sweating.
His right eyelid started twitching about 1 hour ago, and he cannot get it to
stop. He developed cold symptoms 2 days ago and began taking dextromethorphan
and pseudoephedrine. His medical history includes depression, hypertension, and
hyperlipidemia. He takes paroxetine 40 mg at bedtime, diltiazem XR 240 mg
daily, and rosuvastatin 10 mg daily. Which combination of medications is most
likely contributing to his current symptoms?
A. Cetirizine and paroxetine.
B. Dextromethorphan and pseudoephedrine.
C. Diltiazem and pseudoephedrine.
D. Paroxetine and dextromethorphan
.
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