Week 7. Psychopharmacologic approach to treat of psychopathology.

Week 7- Psychopharmacologic Treatment of Psychopathology
Case Study: A Caucasian Man with Hip Pain
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Background -A Caucasian Man with Hip Pain
The 43-year-old Caucasian man complaints about hip pain and uses a set of crutches for ambulation, while the patient fell 7 years ago, surgeons were reluctant to do a total hip replacement because of his young age . Subsequently, he was diagnosed with complex regional pain syndrome (CRPS) or reflex sympathetic dystrophy (RSD), but the neurologist pointed out that what was singled out as RSD was closely linked to depression.
Decision Point One
In decision point one, the choice is “Amitriptyline 25 mg po QHS and titrate upward weekly by 25 mg to a max dose of 200 mg per day” Amitriptyline (Elavil) is a tricyclic antidepressant (TCA), which is FDA prescribed for depression and endogenous depression, but is also used to treat neuropathic pain/chronic pain, low back pain/neck pain (Stahl, 2014). Following the administration of Amitriptyline the onset of action depends on the drug response and tolerance.
When considering the patient’s pharmacokinetic and pharmacodynamic processes, some of the factors affecting these processes are age and behavior. As the patient gets older, his mobility is likely to be more restrained and there is lower absorption of drugs when people age. The patient is also downcast and has not fully accepted his situation, one specialist suggested that the patient use a wheelchair, but the patient was not willing to do so. Thus, the interventions when using medications also ought to consider adherence.
One of the goals of treatment when using Amitriptyline is managing neuropathic pain/chronic pain and reducing the symptoms as much as possible (Moore et al., 2015). Amitriptyline boosts neurotransmitters serotonin and norepinephrine/noradrenaline as well as blocks serotonin reuptake pump (Stahl, 2014). Additionally, the onset of therapeutic actions is after 2–4 weeks and higher dosage may be required when the current dosage does not work even after 6-8 weeks (Stahl, 2014). The pain level was 6 out of 10 and as expected the medication helped reduce the symptoms severity.
One other option was “Savella12.5 mg orally once daily on day 1; followed by 12.5 mg BID on day 2 and 3; followed by 25 mg BID on days 4-7; followed by 50 mg BID thereafter”.
Savell (Milnacipran) is a selective serotonin and norepinephrine reuptake inhibitor. The other choice is “Neurontin 300 mg po BEDTIME with weekly increases of 300 mg per day to a max of 2400 mg if needed”. I did not choose Neurontin (gabapentin) eve...