NU676 Unit 8 Presentation and Peer Critique Post Example

Both Halves of the Exchange: A Written Presentation on Varenicline for a Smoker With Depression, and Two Peer Critiques Using the One-Minute Preceptor

NU676 · Unit 8 Discussion Board Post

Posted by [Student Name]

The patient and classmates' cases are composite; details are bracketed.

My Written Presentation

Mr. [N.], [55], dental lab technician, major depressive disorder, recurrent, in remission on sertraline [100] mg for [two] years. Smokes [20] cigarettes a day for [35] years, first cigarette within [ten] minutes of waking. Has tried nicotine patches twice, relapsing within a month each time. Wants to quit because his lab has banned smoking on the premises and his father had a stroke.

Recommendation: varenicline, starting [one] week before his quit date and titrated to [1] mg twice daily, with weekly counseling for the first month and monitoring of mood at each visit.

Reasoning: in the EAGLES trial, which included a large cohort of smokers with psychiatric disorders, varenicline achieved higher abstinence rates than placebo, nicotine patch and bupropion, and did not significantly increase moderate or severe neuropsychiatric adverse events compared with placebo in either the psychiatric or the non-psychiatric cohort (Anthenelli et al., 2016). His history of depression is a reason to monitor him, not a reason to withhold the most effective option.

Question for readers: would you combine varenicline with a patch from the start, given his two failed patch attempts?

Critique of Classmate A's Presentation

Classmate A presented a [29]-year-old with generalized anxiety and asked whether to start buspirone or an SSRI.

Using the One-Minute Preceptor, which structures teaching around five microskills, getting a commitment, probing for supporting evidence, teaching a general rule, reinforcing what was done well and correcting mistakes (Neher et al., 1992):

1. Commitment: the presentation listed both options without choosing. I would ask, "Which would you start, and why?"

2. Evidence: the history mentioned panic-like episodes, which would favor an SSRI; I would ask whether that finding influenced her thinking.

3. General rule: when a patient has anxiety with panic features, a medication that treats both is usually preferred.

4. Reinforce: the history was thorough, and the GAD-7 was reported with its date.

5. Correct: the substance use history was missing, which matters before choosing any anxiolytic.

Critique of Classmate B's Presentation

Classmate B presented a [72]-year-old with late-onset depression and a recommendation to start mirtazapine.

1. Commitment: clear and well placed at the start.

2. Evidence: the reasoning cited poor sleep and weight loss, both of which mirtazapine may help; that was a strong link.

3. General rule: in older adults, check fall risk and sedation before choosing a sedating antidepressant.

4. Reinforce: the plan included a follow-up date and a rating scale.

5. Correct: there was no mention of screening for cognitive impairment, which is important in late-onset depression.

Reply to Classmate A

Thank you for taking the feedback well. You asked whether committing to an SSRI might be wrong if she prefers to avoid sexual side effects. That is a good reason to choose buspirone, and it is exactly the kind of reasoning a commitment should include (Neher et al., 1992).

References

Anthenelli, R. M., Benowitz, N. L., West, R., St Aubin, L., McRae, T., Lawrence, D., Ascher, J., Russ, C., Krishen, A., & Evins, A. E. (2016). Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): A double-blind, randomised, placebo-controlled clinical trial. The Lancet, 387(10037), 2507-2520. https://doi.org/10.1016/S0140-6736(16)30272-0

Neher, J. O., Gordon, K. C., Meyer, B., & Stevens, N. (1992). A five-step "microskills" model of clinical teaching. The Journal of the American Board of Family Practice, 5(4), 419-424.