A Middle-Aged Caucasian Man With Anxiety.

 

Make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature. All decisions have been chosen and highlighted for you see below.
Introduction to the case (1 page)
• Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
The client is a 46-year-old white male who works as a welder at a local steel fabrication factory. He presents today after being referred by his PCP after a trip to the emergency room in which he felt he was having a heart attack. He stated that he felt chest tightness, shortness of breath, and feeling of impending doom. He does have some mild hypertension (which is treated with low sodium diet) and is about 15 lbs. overweight. He had his tonsils removed when he was 8 years old, but his medical history since that time has been unremarkable. Myocardial infarction was ruled out in the ER and his EKG was normal. Remainder of physical exam was WNL.
He admits that he still has problems with tightness in the chest and episodes of shortness of breath- he now terms these “anxiety attacks.” He will also report occasional feelings of impending doom, and the need to “run” or “escape” from wherever he is at.
In your office, he confesses to occasional use of ETOH to combat worries about work. He admits to consuming about 3-4 beers/night. Although he is single, he is attempting to care for aging parents in his home. He reports that the management at his place of employment is harsh, and he fears for his job. You administer the HAM-A, which yields a score of 26.
Client has never been on any type of psychotropic medication.
MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. He is appropriately dressed. Speech is clear, coherent, and goal-directed. Client’s self-reported mood is “bleh” and he does endorse feeling “nervous”. Affect is somewhat blunted, but does brighten several times throughout the clinical interview. Affect broad. Client denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation.

Sample Solution

re which can wind up in a higher demise count, for instance, the Vietnam War. Additionally, he contended they should be important for the military, remain battle ready and apply to the principles of jus in bello. (Frowe (2011), Page 101-3). This proposes Frowe looks for a fair, simply battle between two members keeping away from non-soldier passings, however couldn’t this prompt higher demise rate for warriors, as the two sides have generally equivalent opportunity to win since both utilize comparable strategies? By and by, ostensibly Frowe will contend that warrior can legitimately kill one another, showing this is simply, which is likewise upheld by Vittola, who states: ‘it is legal to draw the sword and use it against evildoers (Begby et al (2006b), Page 309).’ what’s more, Vittola communicates the degree of military strategies utilized, however never arrives at a resolution regardless of whether it’s legitimate to continue these activities, as he continually tracked down a center ground, where it very well may be legal to do things like this yet never consistently (Begby et al (2006b), Page 326-31). This is upheld by Frowe, who estimates the authentic strategies as indicated by proportionality and military need. It relies upon the extent of how much harm done to each other, to pass judgment on the activities after a conflict. For instance, one can’t just nuke the fear based oppressor bunches all through the center east, since it isn’t just relative, it will harm the entire populace, a potentially negative side-effect. All the more critically, the officers should have the right expectation in the thing they will accomplish, forfeiting the expenses for their activities. For instance: if troopers have any desire to execute all detainees of war, they should do it for the right aim and for a noble motivation, corresponding to the mischief done to them. This is upheld by Vittola: ‘not generally legal to execute all soldiers… we should consider… size of the injury incurred by the foe.’ This is additionally upheld by Frowe approach, which is significantly more upright than Vittola’s view however infers similar plans: ‘can’t be rebuffed just for battling.’ This implies one can’t just rebuff another in light of the fact that they have been a warrior. They should be treated as others consciously as could be expected. In any case, the circumstance is heightened on the off chance that killing them can prompt harmony and security, inside the interests, everything being equal. Generally, jus in bello recommends in wars, damage must be utilized against soldiers, never against the blameless. Be that as it may, eventually, the point is to lay out harmony and security inside the ward. As Vittola’s decision: ‘the quest for equity for which he battles and the guard of his country’ is the thing countries ought to be battling for in wars (Begby et al (2006b), Page 332). Hence, albeit the present world has created, we can see not vastly different from the pioneer accounts on fighting and the traditionists, giving one more part of the hypothesis of the simply war. By the by, we can in any case presume that there can’t be one conclusive hypothesis of the simply war hypothesis on account of its normativity.

Jus post bellum
At last, jus post bellum proposes that the moves we ought to make after a conflict (Frowe (2010), Page 208). Vittola, right off the bat, contends after a conflict, it is the obligation of the pioneer to judge how to manage the foe (Begby et al (2006b), Page 332).. Once more, proportionality is stressed. For instance, the Versailles arrangement forced after WWI is tentatively excessively unforgiving, as it was not all Germany’s problem for the conflict. This is upheld by Frowe, who communicates two perspectives in jus post bellum: Moderation and Maximalism, which are very contrasting perspectives. Minimalists recommend a more permissive methodology while maximalist, supporting the a

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