Examine Case Study: A Puerto Rican Woman with Comorbid Addiction. https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_08/index.html. You will be asked to 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.
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.
- Be aware that the writing template and grading rubric require your introduction to end with one sentence that is your thesis statement. See the writing template for format and the grading rubric for details on how you are graded on this statement.
Body of your document
- The body of your document should contain three sections that are labeled as follows: decision #1, decision #2, and decision #3. Each section should address the topics below. In your writing, you should be concise, clear, and thorough. Pharmacokinetics, pharmacodynamics, and specific patient factors must be considered in your writing in order to get full credit.
Decision #1 (1 page)
- Which decision did you select?
- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. *Ethical considerations must be clearly identified/labeled. You can identify them within the decision section (“My ethical considerations are…”), or you can identify them separately in a section labeled “Ethical Considerations.” Either option is acceptable.
Decision #2 (1 page)
- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)
- Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
A Puerto Rican Woman with Comorbid Addiction of ETOH and Gambling
Student’s Name
Institutional Affiliation
Course
Instructor’s Name
Date
Puerto Rican Woman with Comorbid Addiction of ETOH and Gambling
Introduction
Alcoholism and gambling addiction is dangerous combination that can result in significant harm to the patient and their families. People may become addicted to gambling and when it becomes compulsive, it manifests regardless of the financial consequences it causes to the individual (Martinac et al., 2019). Generally, addiction works by stimulating the brain in a manner that makes it to become dependent on the stimuli. There is a significant number of individuals who suffer from alcoholism that is associated with gambling addiction. Although there could be various reasons as to why people may experience both alcoholism and gambling addiction at the same time, researchers have developed an interest in the similarities between the two addictions as the answer (Martinac et al., 2019). The underlying reactions that are triggered in the brain when someone consumes alcohol are very similar to when someone gambles. It is believed that the brain will release dopamine after someone gambles.
The patient in the case study is named Mrs. Maria Perez, a 53-year-old Puerto Rican female. The patient presents to the hospital with comorbidity ETO and gambling. During the interview, the patient admitted that she is suffering from problems with alcohol since the death of her late father. She has suffered from alcoholism since her late 20s. Additionally, the patient admitted that since the opening of a gambling business near her home in the past two years, she has had difficulties maintaining sobriety. Mrs. Perez is developing a concern because she recently borrowed over $50,000 from her retirement account and spent it all on gambling, Mental exam revealed that she is oriented to person, place, time, and event. She does not keep eye contact and demonstrates non-noteworthy mannerisms. She reports her mood as sad but denied hallucinations and delusion. This paper provides the best three decisions to help the patient.
Decision Point One
The selected decision one is Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks. This selection was made because Vivitrol is FDA approved for the treatment of alcohol use disorder (AUD) and opioid use disorder (OUD) (Trick & Foll, 2021). The medication is widely used by physicians for the same. Therefore, it was appropriate for this case. Vivitrol works by blocking the effects of alcohol and opioids over a certain period. It blocks the endorphins released while drinking from binding to their receptors and, in turn, reduces the effects of alcohol and increases the likelihood of long-term abstinence.
For one or two reasons, the other two options were not selected. For instance, Antabuse (disulfiram) is also used to treat alcoholism, however, it is associated with very bad side effects even when a small quantity of alcohol is consumed (Taylor, 2018). Some of these side effects include flushing of the face, headache, nausea, vomiting, chest pain, weakness, blurred vision, mental confusion, sweating, choking, breathing difficulty, and anxiety. Similarly, Campral (acamprosate) may cause diarrhea, nausea, vomiting, gas, stomach pain, loss of appetite, headache, and others. Vivitrol contains naltrexone as the active ingredient. Its non-addictive and non-narcotic features make Vivitrol an effective treatment for OUD and AUD due to its low potential for misuse (Trick & Foll, 2021). Therefore, Vivitrol was prioritized.
The expectation was that the patient would be relieved from the comorbid alcohol disorder and gambling addiction. The rate of alcohol consumption will reduce and the patient will be able to manage her gambling addiction (Martinac et al., 2019). The urge to smoke when the patient fails to drink will end. Additionally, her habit of borrowing money to waste on gambling will also end. The patient is expected to behave in a noteworthy mannerism including the ability to keep eye contact. In the actual result, the patient reported feeling wonderful and has not taken even a drop of alcohol since she began the medication. also, she has left going to the casino frequently. However, she complains of persistent smoking and problems with anxiety. Ethical considerations include beneficence, non-maleficence, and patient autonomy (Haddad & Geiger, 2018). All the decisions must be beneficial and harmless. Patients’ preferences must be respected.
Decision Point Two
The selected decision point two is to add on Valium (diazepam) 5 mg orally TID/PRN/anxiety. This selection was made because Valium (diazepam) is widely used to treat symptoms of anxiety, alcohol withdrawal, and seizures (Taylor, 2018). This medication was introduced because the patient started that she began experiencing anxiety. It is meant to resolve problems of anxiety. Diazepam belongs to a group of medicines called benzodiazepines and works by increasing the levels of a calming chemical in the brain.
Just referring the patient to the counselor without adding Valium was not recommended. It was going to address the gambling issue but omit anxiety that the patient has shown concerns about. Therefore, the option was not selected. Additionally, Chantix (varenicline) was not selected due to serious side effects associated with the drug. It is commonly associated with notoriously weird, vivid dreams, and is believed by many to have darker psychiatric effects (Taylor, 2018). It is also associated with suicidal ideation, which makes it a concern among prescribers.
With the addition of Valium (diazepam) 5 mg orally TID, the patient’s anxiety is expected to disappear. Additionally, other symptoms associated with gambling addiction and alcoholism should disappear (Trick & Foll, 2021). More than 50% of the comorbid symptoms are expected to resolve. In four weeks, the patient returned to the clinic. Mrs. Perez reports that valium helped her a lot and that she had tremendously experienced relief after taking the medication. She compares it to a feeling of a new person and calls it a miracle drug. However, she finds difficulty waiting between the drug administration times and sometimes takes it early. Ethical considerations include giving attention and priority to the patient’s preferences (Haddad & Geiger, 2018). Parents are allowed to make decisions on behalf of the patient, who is still a minor. Beneficence and non-maleficence are also put into consideration.
Decision Point Three
The selected decision three was to continue the current dose of Vivitrol, decrease/taper Valium with the goal of discontinuation in the next 2 weeks and refer the patient to counseling for her ongoing gambling issue. Anxiety is a common side effect of Vivitrol (Trick & Foll, 2021). Continuing the current dose of Vivitrol, while decreasing the Valium with the goal of discontinuation of the drug within the next two weeks will allow the care provider to evaluate whether or not the side effect of anxiety associated with Vivitrol persists.
Regarding the other two options, neither maintaining the current dose nor increasing the dose of Valium would be the best options. Either of the two would just cause further problems to the patient (Taylor, 2018). Medications should never be introduced to treat the side effects of another medication unless the side effects are recognized to be transient. Therefore, the two options were never selected for the reasons above.
With decision three in place, the patient is expected to show significant improvement. more than 80% of the symptoms are expected to resolve in four weeks. The symptoms of alcoholism should disappear in four weeks (Martinac et al., 2019). Those associated with gambling should also disappear. The patient should report tolerance with current medications. Additionally, the anxiety problem is expected to disappear. The patient is expected to recover fully by the end of week four. While the patient receives treatment, certain ethical considerations must be observed. They include the principles of autonomy and consent, beneficence, non-maleficence, and justice (Haddad & Geiger, 2018). The patient’s preference must be respected. All decisions must be beneficial and harmless. The system must be fair.
Conclusion
Alcoholism and gambling disorder is a combination that can significantly ruin the life of the patient. There is a significant number of individuals who suffer from alcoholism that is associated with gambling addiction. Researchers believe there is a connection between alcoholism and gambling addiction. Patients suffering from addiction to ETOH and gambling should receive a proper treatment regimen to help them recover. The patient in the case study is named Mrs. Maria Perez, a 53-year-old Puerto Rican female. The patient presents to the hospital with comorbidity ETO and gambling.
This paper has provided three decisions for the patient. The selected decision one is Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks. The selected decision point two is to add on Valium (diazepam) 5 mg orally TID/PRN/anxiety. The selected decision three was to continue the current dose of Vivitrol, decrease/taper Valium with the goal of discontinuation in the next 2 weeks and refer the patient to counseling for her ongoing gambling issue. The reasons for selecting every decision have been discussed. Ethical considerations include the principles of autonomy and consent, beneficence, non-maleficence, and justice.
References
Haddad, L. M., & Geiger, R. A. (2018). Nursing ethical considerations. https://europepmc.org/article/nbk/nbk526054
Martinac, M., Karlović, D., & Babić, D. (2019). Alcohol and gambling addiction. In Neuroscience of alcohol (pp. 529-535). https://doi.org/10.1016/B978-0-12-813125-1.00054-4
Trick, L., & Foll, B. L. (2021). Pharmacological Treatment of Alcohol Use Disorder. In Textbook of Addiction Treatment (pp. 123-139). Springer, Cham. https://doi.org/10.1007/978-3-030-36391-8_10
Taylor, D. (2018). The Maudsley Prescribing Guidelines in Psychiatry. John Wiley & Sons.