What would you tell Peter about the rationale for changing his antidepressant treatment to mirtazapine. What factors might have contributed to the lack of effect with his previous antidepressant? Are there warning signs that you consider to be particular to Peter’s story, and what is the role of the nurse in his ongoing management.

Psychopharmacology & Medication Management in MH Nursing

Scenario

Peter is 57 years old he has lost his job when the local factory where he worked closed two years ago. His mother died 6 months ago. He lives with his wife, Mary and they have been married for thirty years. He has two children who have left home. Ellis (27) is in the Welsh Guards and Angharad (25) lives 200 miles away and is married with a young baby.

Peter has spent more and more time recently sitting in front of the TV smoking around 20 cigarettes per day. His appetite is poor, and he feels that there is no hope for the future. Peter has been diagnosed with depression and was initially prescribed sertraline, however his mood did not improve, and his medication was changed to escitalopram.

At his most recent appointment, Peter asked “what’s the point of getting better? I would be better off dead and my family would be better off without me”. It has been 12 weeks since he started the escitalopram, and his psychiatrist subsequently changed his medication to mirtazapine. You visit Peter at home a few days later, and asks you why his medication has been changed again.

Peter is currently prescribed the following medication:

Mirtazapine 30mg tablet once a day

What would you tell Peter about the rationale for changing his antidepressant treatment to mirtazapine. What factors might have contributed to the lack of effect with his previous antidepressant? Are there warning signs that you consider to be particular to Peter’s story, and what is the role of the nurse in his ongoing management.

Discuss the pharmacodynamic effects of mirtazapine. You should include how this relates to its therapeutic effect, as well as to the adverse (side) effects and interactions with other drugs.

Using the mnemonic ADME discuss the pharmacokinetics of mirtazapine. Consider the practical application of the pharmacokinetics, with regards to dosing and drug interactions.

(Approx. 1000 words)

Last Completed Projects