Oncology, primary care, pharmacy, a cancer center therapist and her husband each receive a tailored section in the MN665 Unit 7 memo, centered on a composite patient's tamoxifen interaction. Searches like "mn 665 unit 7 assignment example", "mn665 unit 7 sample" and "mn665 unit 7 example" land here.
Care Coordination Memo: Choosing an Antidepressant for a Woman Taking Tamoxifen
[Student Name]
Purdue University Global
MN665: PMHNP Diagnosis and Management Across the Lifespan II
Unit 7 Assignment
[Instructor Name]
[Date]
Composite patient written as a model document. Doses are bracketed; nothing here is a prescribing instruction.
Header
To: medical oncologist; primary care clinician; community pharmacist; therapist; husband. From: psychiatric mental health nurse practitioner, outpatient behavioral health clinic. Date: [date]. Re: antidepressant choice during tamoxifen treatment. Consent: the patient signed a release for each recipient named above on [date], and each block below contains only what she agreed to share with that person. Nothing clinical is sent to anyone she has not approved.
Clinical Summary
A composite 57-year-old real estate appraiser has recurrent major depressive disorder. Her current episode began about two months ago, with low mood, early waking, poor concentration at work and withdrawal from friends, and her Hospital Anxiety and Depression Scale depression score is 13, above the score of 11 at which the scale's authors placed definite cases (Zigmond & Snaith, 1983). She has taken tamoxifen for eight months after surgery for hormone receptor-positive breast cancer. She has hot flashes several times a day, which disturb her sleep. Ten years ago, a depressive episode responded well to paroxetine, and she asked to restart it.
Recipient 1: Medical Oncologist
What you need to know. Tamoxifen is converted to its most active form, endoxifen, largely by the liver enzyme CYP2D6. Paroxetine is a strong inhibitor of that enzyme. In a population-based cohort of women aged 66 and older taking tamoxifen, longer overlap with paroxetine was associated with a higher risk of death from breast cancer, and no such risk was seen with other antidepressants (Kelly et al., 2010). Later studies have not all found the same effect, and the question remains debated; the Kelly cohort was also older than our patient. The CPIC guideline advises avoiding strong and moderate CYP2D6 inhibitors in people taking tamoxifen where an alternative exists (Goetz et al., 2018). Because a reasonable alternative exists, we are not restarting paroxetine, even though it helped her before.
We plan to start venlafaxine at a [composite starting dose]. It inhibits CYP2D6 only weakly, it treats depression, and it has been shown to reduce hot flashes in breast cancer survivors (Loprinzi et al., 2000).
What is asked. Please confirm that you see no oncologic reason against venlafaxine and tell us if her tamoxifen plan changes, for example a switch to an aromatase inhibitor, which would change the interaction question. By: before her first dose, planned for [date].
Recipient 2: Primary Care Clinician
What you need to know. She is starting venlafaxine, which can raise blood pressure, particularly at higher doses. Her last reading was 124/78.
What is asked. Please check her blood pressure at her next visit and at three months, and tell us if it rises above 140/90. Please let us know before starting any new medicine that affects serotonin or CYP2D6. By: blood pressure at her visit on [date].
Recipient 3: Community Pharmacist
What you need to know. She takes tamoxifen and will start venlafaxine. Paroxetine, fluoxetine and bupropion are strong CYP2D6 inhibitors and should be avoided while she takes tamoxifen.
What is asked. Please add a flag to her profile against future prescriptions of strong CYP2D6 inhibitors, and call our clinic if one is prescribed by anyone. By: when you fill the first prescription.
Recipient 4: Therapist
What you need to know. Her depression has returned, with early waking and withdrawal from friends. She fears that her cancer will return and that she will not see her first grandchild, due in the spring, and she has said that her depression makes taking tamoxifen every day feel pointless. She has no thoughts of self-harm.
What is asked. Please focus sessions on her fears about recurrence, her withdrawal from friends and her commitment to taking tamoxifen, which is prescribed for years and which depression can undermine. Please tell us if she mentions skipping tamoxifen or any thoughts of self-harm. By: her next psychiatric review on [date].
Recipient 5: Her Husband
What you need to know. Your wife's depression has come back, and she is starting a new medicine for it. We chose this one instead of the one that helped her before because the old one can weaken her breast cancer medicine.
What to watch for. Tell us if she seems more hopeless, stops taking her cancer pill, or says she would be better off dead. Some people feel a little dizzy or sick to their stomach in the first week; it usually passes. She should not stop the new medicine suddenly.
Whom to call. Our clinic at [number] during the day, or 988, the Suicide and Crisis Lifeline, at any hour.
Rationale
The antidepressant decision was shared with oncology before the first prescription, not after, for three reasons. First, the drug that treats her cancer is the one affected, and a change in her cancer plan would change our choice. Second, depression can itself undermine treatment she is meant to take for years, so her oncologist has a stake in treating it well. Third, an interaction flagged in advance can be prevented, while one discovered later can only be reported.
References
Goetz, M. P., Sangkuhl, K., Guchelaar, H.-J., Schwab, M., Province, M., Whirl-Carrillo, M., Symmans, W. F., McLeod, H. L., Ratain, M. J., Zembutsu, H., Gaedigk, A., van Schaik, R. H., Ingle, J. N., Caudle, K. E., & Klein, T. E. (2018). Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for CYP2D6 and tamoxifen therapy. Clinical Pharmacology & Therapeutics, 103(5), 770-777. https://doi.org/10.1002/cpt.1007
Kelly, C. M., Juurlink, D. N., Gomes, T., Duong-Hua, M., Pritchard, K. I., Austin, P. C., & Paszat, L. F. (2010). Selective serotonin reuptake inhibitors and breast cancer mortality in women receiving tamoxifen: A population based cohort study. BMJ, 340, c693. https://doi.org/10.1136/bmj.c693
Loprinzi, C. L., Kugler, J. W., Sloan, J. A., Mailliard, J. A., LaVasseur, B. I., Barton, D. L., Novotny, P. J., Dakhil, S. R., Rodger, K., Rummans, T. A., & Christensen, B. J. (2000). Venlafaxine in management of hot flashes in survivors of breast cancer: A randomised controlled trial. The Lancet, 356(9247), 2059-2063. https://doi.org/10.1016/S0140-6736(00)03403-6
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67(6), 361-370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
How this MN665 Unit 7 example is structured
Recipients are ordered by how much their own work depends on this memo, so oncology comes first: the interaction concerns the drug that treats her cancer, and depression is itself a known threat to taking tamoxifen for the years it is prescribed. Each block is written for its reader. The oncologist gets pharmacology and citations; the primary care clinician gets blood pressure monitoring, since venlafaxine can raise it; the therapist gets the treatment goals and the date of the next psychiatric review; her husband gets what to watch for and whom to call. Nothing clinical is sent to anyone she has not approved, and the memo says so in its header. Every request carries a date, and the rationale explains why the antidepressant decision was shared with oncology before the first prescription rather than after.
Get an MN665 Unit 7 example written to your instructions
Name every clinician and family member your MN665 Unit 7 case involves, including any your prompt leaves implied, then forward the case with the rubric. Built to your instructions, the free first custom memo arrives in 24-48h, telling each recipient what they need to know, what the plan needs from them and by when. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
MN665 Unit 7 questions, answered
Who should receive a care coordination memo?
Everyone whose work the psychiatric plan affects or depends on, and no one the patient has not approved. In this case that means oncology, primary care, the pharmacist, the therapist and, with consent, her husband. Say why each is included. A memo sent to a long list without reasons suggests the recipients were chosen by habit rather than by need.
How much clinical detail should each recipient get?
Only what that person needs to act. The oncologist needs the pharmacology; a family member needs warning signs and a phone number. Tailoring detail protects privacy and makes each block readable. If you are unsure, ask what the recipient would do with the information, and leave out anything that would not change their actions.
Should the memo propose changes to another clinician's treatment?
It can raise questions and share evidence, but decisions about tamoxifen or blood pressure medication belong to the clinicians who prescribe them. Phrase requests as questions with dates, explain what the plan requires, and record the answer when it comes. Graders reward a memo that respects those boundaries while still making the concern impossible to miss.