Primary care services remain the cornerstone of patient care. In primary care, clinicians need to have the necessary skills to serve their patients appropriately and adequately. The purpose of this week’s post is to highlight primary care medication management in reference to high-level evidence-based resources.
A patient is being seen at your clinic for depression and has been prescribed Zoloft. At today’s visit, she admits to still taking St. John’s Wort. What do you tell her?
Sertraline (Zoloft) when used concomitantly with St. John’s Wort could lead to life-threatening levels of serotonin. The mechanism of action of St. John’s Wort is similar to sertraline in that it is also a selective serotonin reuptake inhibitor. When taken together serotonin levels could go to dangerously high levels and there is a risk of presenting with serotonin syndrome (Peterson & Nguyen, 2021; Rosenthal & Burchum, 2021).
A patient asks if they would benefit from taking Aricept from their mild dementia. What is your response?
Taking Donepezil (Aricept) would be beneficial in ameliorating some of the symptoms of dementia. Donepezil is a cholinesterase inhibitor that is thought to improve nerve function and enhance cognitive and behavioral functionalities in patients with Alzheimer’s dementia. The drug is FDA approved for this but it may not stop the progression of Alzheimer’s (Kumar et al., 2021).
Your patient asks if he or she should take Propranolol at the beginning of a migraine headache. How do you respond?
Propranolol is mostly used as a preventive treatment in the management of migraine attacks. Its efficacy as prophylaxis is quite high but benefits during an acute attack are usually minimal. Treatment Recommendations at the beginning of a migraine headache include NSAIDs and Triptans as the most effective options (Ha & Gonzalez, 2019; Mayans & Walling, 2018)
A patient requires treatment for his ADHD but is drug tested at his job and they have a zero-tolerance policy. Is there a medication he can take to help his attention and focus?
This patient may benefit from the non-stimulant type of medication used for ADHD management. These include alpha-2 agonists such as Guanfacine and Clonidine or a norepinephrine reuptake inhibitor such as atomoxetine (Brown et al., 2018). These drugs are second-line options for treating ADHD and could help his attention and focus. As they are not amphetamine-related compounds, there will be no conflict with his job’s drug policy.
What is the most commonly used dopaminergic drug used for Parkinson’s?
The most commonly used dopaminergic drug is L-DOPA. It is the most potent anti-parkinsonism medication and is considered the gold standard in the management of Parkinson’s disease. The drug relatively improves motor functioning effectively and even works in the advanced stages of the disease (Lee & Yankee, 2021).
What other disorders are many of the Antiepileptic drugs used for? Name 2 of the drugs
Many of the antiepileptic medications are used as mood stabilizers in Mood disorders. Examples of these medications include Valproic acid and Carbamazepine. Their use in mood disorders is in an off-label capacity but they are effective in these disorders all the same (Subbarao et al., 2021).