Case Study: Josie Bellings, Part 2

It has been six weeks since you first saw Josie. She is in the office for a follow-up visit by herself.

Josie reports, “I think my symptoms are 80% better on medication. But I do still worry and obsess, particularly at work. I am also getting horrible anxiety attacks, where I freeze and am not able to move. It has happened about once a week since my last visit.

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“…. Ah…. I hate to admit this. Ummmm…. This is confidential, right? The last one at work was during a code blue.

“…. But yes, overall, I feel much better. The medication is working in general. It’s just, occasionally that I feel like that. I’m tolerating the medication well but I have noticed dry mouth and a decreased sexual drive. And, um, yeah, you can imagine the friction that is causing in my relationship with Robs.

“So, what I’m thinking is, could I have Xanax? Or maybe Ativan? I know those are really good for anxiety like this. I think they’d really help me.”

From your perspective as Josie’s psychiatric nurse practitioner, answer the following questions in a two- to three-page double-spaced paper (not including the reference page) and in APA format. Include at least three peer-reviewed, evidence-based references.

Compare and contrast at least four medications that Josie could take “as needed.” Please include generic/brand name, pros, and cons for each medication.
Are there any additional questions that you would want to know and/or labs that you would order before prescribing an “as needed” medication?
Which pharmacological treatment would you choose? Please include rationale, starting dose, tapering schedule (if any), how the medication works, major drug/drug interactions, and patient education.
What community and support resources would you provide to Josie?
Would you refer Josie to therapy? If so, what type? Please provide evidence for your decision.

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