| Course | PA 536 Behavioral Medicine II |
|---|---|
| Week | 2 |
| Paper type | Agent selection memo |
| Length | About 760 words, 4 pages |
| Format | Memo with APA 7 citations |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 536 Week 2
Memorandum
To: Supervising physician, Lakeside Family Medicine
From: PA student, behavioral medicine rotation
Date: April 7, 2026
Re: First antidepressant for D.K.: fluoxetine or bupropion, and what each obliges us to keep doing
The Choice
I recommend restarting fluoxetine at 20 mg each morning for D.K., a 41-year-old with type 1 diabetes and a third episode of major depression scoring 17 on the PHQ-9. Fluoxetine brought D.K. to full recovery in the second episode six years ago without problems. Bupropion is the alternative I considered seriously. Both are reasonable first choices on efficacy and acceptability, which differ only modestly across the common antidepressants (Cipriani et al., 2018). The choice therefore turns on what each obliges D.K. and this clinic to keep doing in the months after today. That matters more than usual here, because depression is about twice as common in adults with diabetes as in those without and tends to recur (Anderson et al., 2001), so whatever we start may be with D.K. for a long time.
Both Options on the Page First
Fluoxetine obliges: a phone or portal check at two weeks for agitation, sleep change and any new thoughts of self-harm; a visit at four to six weeks with a repeat PHQ-9 and a decision about raising to 40 mg; monthly refills that D.K. collects in person, since the pharmacy is on the commute; and a conversation at each visit about sexual side effects, which D.K. reported last time and which can quietly end adherence.
Bupropion would oblige: the same two-week contact and four-to-six-week visit; a monthly refill; and one further standing duty that fluoxetine does not create. Bupropion lowers the seizure threshold, and D.K. had a severe low blood sugar two years ago that ended with glucagon from a coworker. Hypoglycemia can itself provoke seizures. Every visit would then need a review of lows below 54 mg/dL from the sensor download, and any new severe low would reopen the choice.
The Same Measures on Both
Table 1
Standing Obligations of Each Option
| Measure | Fluoxetine | Bupropion |
|---|---|---|
| Contacts in first 6 weeks | 2 (call at 2 weeks, visit at 4 to 6) | 2, plus a sensor review of lows at each |
| Collection by D.K. | Monthly refill | Monthly refill |
| Recurring conversation | Sexual side effects | Lows below 54 mg/dL and any seizure warning signs |
| Interaction with insulin needs | Small; appetite change possible | Small; appetite may fall |
| Prior response in this person | Full recovery in 2020 | None known |
Note. Note. Obligations are those of this clinic and this patient, not general prescribing guidance.
How It Gets Undone
If fluoxetine fails or is not tolerated, stopping it is gentle: its long half-life spreads the decline over weeks, so withdrawal effects are uncommon after a short course. If bupropion were chosen and stopped, the decline would be faster but usually uneventful. Neither choice closes off the other later. If fluoxetine leaves a partial response, an augmentation or a switch remains open, and a large trial of next steps after an incomplete first response gives us data for that conversation (Mohamed et al., 2017).
There is one further point about undoing. If D.K. later wants to return to driving a route or develops a new medical problem, the record of why fluoxetine was chosen will let whoever is prescribing then see which of today's reasons still apply. A choice that is written down with its reasons can be revisited without starting from nothing.
What Stays in This Setting
Everything above can be managed in this clinic. D.K. sees us every three months for diabetes in any case, so the four-to-six-week visit adds one appointment, not a new relationship. The two-week check can be done by our nurse by phone between 1:30 and 3:00 p.m., after D.K.'s shift at the bus depot ends. If D.K. reports any thought of self-harm, the visit becomes urgent and our protocol for same-day evaluation applies; D.K. denied such thoughts today.
What does not stay here: if D.K. develops psychotic symptoms, mania or a suicide attempt, care moves to the county behavioral health center, and the memo does not try to plan for those within the family practice. A severe low blood sugar would also change the plan, but it would be managed here as a diabetes problem first.
Requested Action
Please co-sign an order for fluoxetine 20 mg daily, a nurse call on April 21 and a visit in the week of May 4. I will note in the chart that bupropion was considered and why it was not chosen, so a future switch starts from that record.
References
Anderson, R. J., Freedland, K. E., Clouse, R. E., & Lustman, P. J. (2001). The prevalence of comorbid depression in adults with diabetes: A meta-analysis. Diabetes Care, 24(6), 1069-1078. https://doi.org/10.2337/diacare.24.6.1069
Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., Leucht, S., Ruhe, H. G., Turner, E. H., Higgins, J. P. T., Egger, M., Takeshima, N., Hayasaka, Y., Imai, H., Shinohara, K., Tajika, A., Ioannidis, J. P. A., & Geddes, J. R. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: A systematic review and network meta-analysis. The Lancet, 391(10128), 1357-1366. https://doi.org/10.1016/S0140-6736(17)32802-7
Mohamed, S., Johnson, G. R., Chen, P., Hicks, P. B., Davis, L. L., Yoon, J., Gleason, T. C., Vertrees, J. E., Weingart, K., Tal, I., Scrymgeour, A., Lawrence, D. D., Planeta, B., Thase, M. E., Huang, G. D., & Zisook, S. (2017). Effect of antidepressant switching vs augmentation on remission among patients with major depressive disorder unresponsive to antidepressant treatment: The VAST-D randomized clinical trial. JAMA, 318(2), 132-145. https://doi.org/10.1001/jama.2017.8036
The Chamberlain PA 536 Week 2 instructions
The second week asks for a short memo to a supervising clinician choosing between two medicines for the course patient. Put the recommendation at the top. The prompt is explicit that the memo should be about consequences after the visit ends, written as standing obligations: checks that have to be repeated, refills the person has to collect, conversations that recur at every appointment. The rejected option must be described by the obligations it would have created, not waved away as unsuitable. Use the same measures for both options so they can be compared. Explain how each choice could be undone if it fails or is not tolerated. Finally, say which parts of the plan this setting can carry and which would need to go elsewhere. Supporting evidence should be cited, and the memo should keep the person's history to the lines that affect the decision.
How the PA 536 Week 2 example is put together
Dated April 7, 2026, the sample goes to the supervising physician at Lakeside Family Medicine. Its first paragraph recommends fluoxetine 20 mg for D.K., notes similar efficacy across common antidepressants (Cipriani et al., 2018) and adds that depression in diabetes tends to recur (Anderson et al., 2001). The options section lists fluoxetine's duties: a nurse call at two weeks, a visit at four to six, monthly refills and a recurring talk about sexual side effects. Bupropion's list adds a review of sensor lows at every visit, because of its effect on seizure threshold and D.K.'s past glucagon rescue. A table holds five identical rows for both drugs. The undoing section covers fluoxetine's long half-life and points to next-step trial data (Mohamed et al., 2017). A setting section assigns the nurse call to the hour after D.K.'s depot shift ends and names what would leave the clinic.
Where the points sit in the PA 536 Week 2 rubric
Points in this memo follow the obligations, not the pharmacology. A memo that makes a sensible choice and then says nothing about the months that follow loses the biggest share, because the week is about what the clinic signs up for. Close behind is a rejected option dismissed in a phrase without its obligations worked out. Faculty then check that both options are measured on the same terms, which a table makes easy to see. Obligations written for clinics in general, rather than for this person's schedule and this setting, cost a further portion. How each option would be undone earns separate credit. Recognizing what the setting cannot carry, and where that care would go, shows judgment. Memo format, a clear request at the end, and cited evidence in APA style take the remaining share.
PA 536 Week 2 help: mistakes that cost points
The usual reason a memo is returned is that it reads as a drug comparison from a textbook, with mechanisms and side effect lists and no mention of who calls the patient in two weeks. Another is a rejected option that gets one sentence. A third buries the recommendation under a full page of history. If your case offers different options, such as sertraline versus mirtazapine for an older adult with poor sleep and weight loss, send the scenario and your section's memo format; the version we write for you would put the choice first, list the standing obligations of each option under identical headings, explain how each could be reversed and say what your clinic setting can manage. Tell us the supervising clinician's role named in your prompt, and the memo will be addressed to that reader.
Get a PA-536 Week 2 example written to your instructions
Send the assignment, the rubric and whatever case material your section issued, and say whether the memo is addressed to a supervising clinician or written for the record. A custom PA-536 Week 2 memo is written into that format and returned inside 24-48h, the first one free.
More PA 536 papers and MPAS samples
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- PA 536 Week 6: Therapy Modality Brief
- PA 536 Week 7: Medical Comorbidity Review
- PA 536 Week 8: Maintenance and Taper Plan
- PA 534 Week 2: Pediatric Vital Sign Norms Table
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- PA 532 Week 2: Surgical Indication Brief
- PA 531 Week 2: Chief Complaint Brief
PA 536 Week 2 questions, answered
Our case gives the two options already. What is left to argue?
Almost all of it. The assignment hands over the field and marks the reasoning, so the work is setting the two side by side under identical questions and saying what the losing one would have required. Sections that supply the options usually also publish the elements they want covered, and those elements are the safest outline available, since each one is a row somebody is reading down.
How much of the person's other history belongs in it?
Only the parts that press on the choice. A memo opening with a full history has spent its length before reaching the comparison, and graders read the comparison. Two or three lines are enough: what else is being treated, what has been tried, what the person has already said they will not keep doing. Anything that does not touch either option belongs out of the document.
Does the memo name a starting dose?
Not unless the assignment calls for one, and even then this course grades the reasoning behind it rather than the number itself. These samples describe what a finished memo contains and how it is marked; they are academic writing, not medical direction, and nothing in one is written to be used with a patient. Send the wording your section published and the example is built to exactly that scope.
Where can I find a free PA 536 Week 2 sample paper?
A complete PA 536 Week 2 memo choosing fluoxetine over bupropion for a patient with type 1 diabetes, with both options set out as obligations, is on this page.
Why is bupropion not chosen in the PA 536 Week 2 sample?
D.K. once had a severe low blood sugar needing glucagon, and bupropion lowers the seizure threshold, so it would add a review of sensor lows at every visit.