Step 1: Choose one of the following vulnerable patients to create a Medication Guide for the patient: · Patient 1: 26-year-old female with a diagnosis of major depressive disorder and social anxiety disorder who is increasing in isolation and poor self-care. She is in her third trimester of pregnancy.

Step 1: Choose one of the following vulnerable patients to create a Medication Guide for the patient:

· Patient 1: 26-year-old female with a diagnosis of major depressive disorder and social anxiety disorder who is increasing in isolation and poor self-care. She is in her third trimester of pregnancy.

· Patient 2: 16-year-old male with a diagnosis of major depressive disorder, severe. He has seen a therapist weekly for the past 6 months and has had minimal change in symptoms. He has expressed thoughts of wanting to die.

· Patient 3: 72-year-old male with diagnosis of major depressive disorder and panic disorder. He has cardiac history and takes antihypertensive medications.

· Patient 4: 8-year-old Asian female with a diagnosis of severe depressive disorder presents to the office with a report of worsening symptoms. She has never taken psychotropic medication before.

Step 2: Create a Medication Guide for a patient. In your guide, you should provide the following specific instructions for the patient:

· Describe the chosen classification of medications, from the classification category, for your chosen vulnerable patient. Explain your rationale for your choice.

· Explain what dose you would start the chosen medication with and the frequency.

· Discuss how the medication works to treat their symptoms.

· Explain how long they should take the medication.

· Discuss the typical or common side effects of the medication.

· Explain the urgent or emergent considerations for the patient taking the medication.

The Medication Guide should also include:

· Directions you would provide the patient on how to take the prescribed medication

· Instructions on what the patient should do if a medication dose is missed

· List of any other medications, over-the-counter medications, and/or supplements/herbals the patient should avoid while taking the prescribed medication

· List of foods the patient should avoid when taking this medication

· Date when the patient should return for follow-up visit with you

· Discussion about the legal and ethical considerations for the medication being prescribed

· Answers in consideration of Social Determinants of Health on how you would:

· Assist the patient who cannot not afford to pay financially for the medication you are recommending/prescribing; and/or

· Has difficulty with transportation that impacts their ability to present for regular appointments with you

· Discuss how financial hardship and lack of transportation could relate to Social Determinants of Health, as well as why they are important considerations for you as a prescriber.

· Resources to use

· https://www.apa.org/depression-guideline/adults

· https://www.apa.org/depression-guideline/older-adults

· https://www.apa.org/depression-guideline/children-and-adolescents

Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and proper punctuation	5 to >4.0 ptsExcellentUses correct grammar, spelling, and punctuation with no errors. 4 to >3.0 ptsGoodContains a couple (one or two) grammar, spelling, and punctuation errors. 3 to >1.0 ptsFairContains several (three or four) grammar, spelling, and punctuation errors. 1 to >0 ptsPoorContains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.	5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting: The submission contains an APA format for title page, citations, and Reference List.

 

• Classification: Selective Serotonin Reuptake Inhibitor (SSRI).
• Chosen Medication: Sertraline (Zoloft).
• Rationale: SSRIs are the first-line pharmacological treatment for MDD and SAD during pregnancy. Sertraline is specifically preferred because it has decades of historical safety data in pregnancy and, importantly for this patient, the lowest known concentration in breast milk, making it the safest option for the upcoming postpartum and breastfeeding period. 
  Pfizer +4

• Starting Dose: 25 mg taken orally once daily.
• Frequency: Once daily, preferably at the same time each morning or evening.
• Titration: After one week, the dose may be increased to 50 mg daily based on clinical response and tolerability. 
  Pfizer +2

• Duration: Antidepressants typically take 4 to 8 weeks to reach full effect. To prevent a relapse of depression, the medication should be continued for at least 6 to 12 months after the patient begins feeling better.
• Common Side Effects: Nausea, upset stomach, headache, sweating, and changes in sleep patterns (insomnia or drowsiness). Most side effects are mild and often improve after the first 1–2 weeks of treatment.
• Neonatal Considerations: Exposure in the third trimester carries a small risk of Postnatal Adaptation Syndrome (PNAS), where the newborn may experience temporary irritability or mild breathing issues that usually resolve within 48 hours. 
  Cleveland Clinic +4

• Serotonin Syndrome: High fever, severe tremors, confusion, or rapid heartbeat.
• Worsening Mood: Any new or sudden thoughts of self-harm or suicide.
• Allergic Reaction: Rash, hives, or swelling of the face and throat. 
  Mayo Clinic +1

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• How to Take: Take the tablet with food to minimize stomach upset. Do not stop taking this medication abruptly, as it can cause “discontinuation syndrome” (flu-like symptoms and anxiety).
• Missed Dose: If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed one. Never double the dose to catch up.
• What to Avoid:
  • Medications: Avoid NSAIDs like Ibuprofen (Advil) as they can increase bleeding risks.
  • Supplements: Avoid St. John’s Wort, which can lead to dangerous serotonin levels.
  • Substances: Avoid alcohol, as it can worsen depression and increase the sedative effects of the medication.
• Follow-up Visit: Return for a follow-up in 1 to 2 weeks to monitor for early side effects and initial mood changes. 
  National Institutes of Health (.gov) +3

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• Financial Assistance: If the patient cannot afford the medication, the nurse can facilitate the use of generic sertraline (which is cost-effective) or refer her to Prescription Assistance Programs.
• Transportation Support: To address transportation barriers, the nurse can offer telehealth appointments or provide information on community travel vouchers and mobile health clinics.
• Importance of SDOH: Financial hardship and lack of transportation are critical SDOH that lead to “no-shows” and poor adherence to treatment. Addressing these ensures the patient can access the care necessary for both her own health and the health of her unborn child.