Advanced Pharmacology Assignment
Advanced Pharmacology Assignment
Discussion response post Bipolar disorder treatment management. Bipolar disease is a severe biological illness characterized by fluctuations in mood. Bipolar disorder afflicts more than 6.7 million Americans (Rosenthal & Burchum, 2021). Bipolar 1 is characterized by experiences in extreme maniac episodes. The hallmark of treatment is an individualized approach geared towards achieving effective and therapeutic treatment. It is important to consider the role genetics, race, gender, family history, and other extenuating circumstances such as PTSD and stressful events play in the mental and psychological health of patients. Gathering subjective and objective data will also guide the choice of the treatment decisions we make. Advanced Pharmacology Assignment. Thorough review of the patient’s medical history, medication interaction, and list of allergies is also crucial for better treatment outcome. The interactive media reveals that the patient is of a Korean descent and has had genetic testing done because she typically was unresponsive to past medications. One of the findings revealed that the patient is positive for CYP2D6*10 allele, which basically influences the pharmacotherapeutics and pharmacodynamics of how her body processes drugs (Lu et al., 2021). Background Information The client is a 26-year-old woman of Korean descent who presented to her appointment with acute mania. She is post 21 days in-patient hospitalization. She is alert and oriented to person, place, time and event. She is however inappropriately dressed for the appointment where the case study reveals she’s wearing what seemed like an evening gown. She is distracted and playing with items on the table. She reveals she abruptly stopped her lithium; the case study doesn’t tell whether she experienced any side effect from the Lithium, or whether she thought she didn’t need it. Speech is rapid, pressured and tangential, mood is euthymic, while affect is broad. She denies any suicidal ideation, auditory or visual hallucinations. Assessment finding reveals poor insight into disease process and situation as evidenced by stating that “they said I was bipolar, I don’t believe that, do you? I just like to talk, and dance, and sing. Did I tell you that I liked to cook?”. Easily distracted as evidenced by touching and playing with things on the table. Also, The Young Mania Rating Scale (YMRS) where she scored 22 means she is exhibiting extreme mania. YRMS was originally developed in 1978, used to rate the severity of mania in the past 8 hours through a structured interview with the patient and observation, score of <29 shows the person is experiencing extreme mania (Admin, 2018). Treatment plan and medication review T Three groups of medications are used for the treatment of bipolar disease: mood stabilizers, antipsychotics, and antidepressants (Rosenthal & Burchum, 2021). The choices of drugs presented in the interactive media are Lithium, Risperidone, and Seroquel. Lithium is the mainstay therapy for stabilizing moods in bipolar disorder. The patient in the interactive media mentioned that she stopped the medication abruptly, I will first find out why she stopped the medication to rule out unpleasant side effects. I will restart Lithium 300 mg twice daily. Patient teaching has been shown to promote medication adherence.
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Patient will be enlightened that Lithium requires long term treatment, and cannot be stopped even if you feel better. Advanced Pharmacology Assignment. Also, missing doses will increase the risk for relapse. Teach patient that it can take more than two weeks for the full benefits of the medication. Risperidone is an oral antipsychotic drug. It is used to control symptoms during severe maniac episodes. Since this patient had a genetic testing done because she was not responding to treatment, it was found that she is positive for CYP2D6*10 allele which is common with people of Korean descent. According to Lu et al., (2021), people who are positive for the CYP2D6 have higher plasma level of risperidone, more adverse effects and less relieve of symptoms. I will discontinue the Risperidone and start on Olanzapine 10 mg daily which is another anti-psychotic medication and schedule a follow up visit in four weeks. I will also discontinue the Seroquel since it is another anti-psychotic medication used to treat schizophrenia and bipolar disorder, it can also be used to treat major depression when it is added to another anti-depressant medication (WellnowDoctor, 2019). In patients with BD, antidepressants medications are usually combined with a mood stabilizer to achieve a therapeutic effect (Rosenthal & Burchum, 2021). I will start SSRI Prozac 20 mg daily as an initial dose. Cognition Behavior Therapy (CBT): CBT is a type of behavior therapy that can help manage some of the psychotic symptoms associated with bipolar. The goal is to teach patients to manage their thoughts and emotions so that when they come, they recognize them, and don’t buy into them (Gomes et al., 2019). The use of CBT as an adjunct therapy to medications in patients with BD is recommended because of the positive effects observed post-treatment and at follow-up. The benefits include decreased levels of depression and mania, decreased relapse rates, and increased levels of psychosocial functioning (Chiang et al., 2017). New orders Continue Lithium 300 mg twice daily, Olanzapine 10 mg daily, and Prozac 20 mg daily. Referral to Cognitive Behavior therapy. Follow up in one month. Labs: Monitor Lithium level and renal function due to narrow therapeutic index, toxicity and renal impairments. Patient Teaching Teach patient to never stop medication abruptly due to possibility of relapse and withdrawal symptoms. Explain that Lithium has a narrow therapeutic index making it easily toxic to the body. Advice patient to stay hydrated because dehydration can lead to Lithium toxicity. Teach avoiding dehydrating foods like coffee and alcohol. Report any episodes that can lead to dehydration like diarrhea and vomiting. Avoid NSAID due to toxicity to kidney. Keep all lab appointments to help monitor lithium level and renal function. For dry mouth use hard a hard candy or ice chips. Antipsychotic and depressive medication can cause weight gain; eat a healthy diet and exercise. Report any suicidal ideations immediately. It is important for the NP to continue to regularly schedule follow up visits to help monitor the progress of the treatment. Adjustments and modifications can be made to the medication until a therapeutic effect is achieved. Advanced Pharmacology Assignment
