solved (I have pretty much answered the questions. Pls elaborate and

(I have pretty much answered the questions. Pls elaborate and make it all come together and find sources. I will attach some other peer’s post for examples/guide.)A 56 yr. old woman signs up with you as his new primary care physician. Her previous diagnosis included hyperlipidemia, hyperglycemia, moderate obesity and hypertension. His medications include: Paroxetine 20 mg for 10 years; Quetiapine 150 mg daily for 2 yrs.; Irbesartan 300 mg daily for 1 yr.; and Atorvastatin 10 mg daily for 1 yr. Labs: FBS = 126, HgbA1C = 6.2, total cholesterol = 200, LDL = 105, HDL = 35, Tg =286. His present height equal 5’9” and weight = 210 lbs. His BP is 140/84. She tells you that about 10 yrs. ago she became depressed and was started on Paroxetine and gained 30lbs after 1 yr. Her mood at that time was much improved and remained that way for about 2 yrs. At that time, Quetiapine was added, and she achieved remission of her depression. Six months after this she gained another 20lbs, developed mild hypertension, hyperglycemia and hyperlipidemia. All other lab including thyroid testing was normal. She tells you that she has a craving for carbohydrates and does little exercise since developing depression about 15 yrs. ago. Questions:1. What advice or modifications to his treatment regimen would you recommend for your new patient? (Discuss a minimum of two). Please support your answer with research-based evidence. = Discontinue Quetiapine and Paxil – taper off for over 1-2 months to decrease withdrawal symptoms – since they are associated with weight gain, diabetes and hyperlipidemia which increases her risk for developing heart disease – currently, considered as prediabetic, mildly increased total cholesterol/LDL/ TG, mildly elevated BP. Weight gain from antipsychotics/antidepressants is believed to be cause by increase appetite. By discontinuing these medications, patient may lose weight which will help reduce blood pressure (which is another risk factor for heart disease), decrease blood sugar and cholesterol. – Continue other medications for now. Will consider adding another blood pressure medication if no improvement after discontinuation of Quetiapine and Paxil, and after weight loss. Consider Metformin if no improvement to blood sugar despite lifestyle change in 3-6 months. – Recommend nonpharmacological intervention strategies first – Encourage healthy diet and exercise to help reduce weight – Recommend referral to nutritionist – Recommend psychotherapy or counseling while adjusting medications to prevent relapse of depression – Assess depression with PHQ-9 routinely= Add Wellbutrin – not associated with weight gain and diabetes – Follow up in 2 weeks on response to medication. Will increase dose as need.2. If you suggested additional medication, look up your state’s prescribing laws. Are PMHNP’s able to prescribe the medication you recommended? In California, PMHNP’s are able to prescribe psychiatric medications.