Go to this website: https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_04/index.html
Follow these steps:
Decision Point One- Click \”Begin Lithium 300mg\”
Decision Point Two- Click \”Assess rationale for noncompliance….\”
Decision Point Three- Click \” Change Lithium to sustained release …\”
Assignment Paper-
The Assignment: 5 pages
Examine Case Study: An Asian American Woman. Diagnosis-Bipolar Disorder. 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.
-Page 1: Introduction
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.
– Page 2: Decision #1
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.
-Page 3: Decision #2
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.
-Page 4: Decision #3
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.
-Page 5: Conclusion
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.
Pharmacotherapy for Bipolar Disorder
Student’s Name
Institutional Affiliation
Course
Instructor’s Name
Date
Pharmacotherapy for Bipolar Disorder
Introduction
Bipolar disorder is one of the common mental health problems affecting individuals of all ethnic origins. It can disrupt one’s life and have detrimental health impacts if not well managed. The impacts of bipolar disorder may vary from one individual to another based on social factors and personal characters (Akinhanmi et al., 2018). People with bipolar disorder experience myriads of psychological problems such as changes in mood, activity, and energy levels. Patients may also find it difficult to complete their day-to-day activities due to symptoms of the mental disorder. Other symptoms of bipolar disorder include reduced concentration and high and low emotions (Miklowitz, 2019). The high emotions are called mania or hypomania while the low emotions are depression.
The patient presented in the case study is a 26-year-old Asian woman who presents to her first appointment following a 21day hospitalization. The patient was diagnosed with bipolar during her hospitalization. On arriving in the office, the therapist found the patient busy moving from one side of the chair to another and playing with things on the table. The patient is in high moods and does not believe that she has bipolar disorder. She keeps asking the psychiatrist if she truly has bipolar. The patient is in a fantastic mood, also, he admits to being sleeping for only five hours. She states that she hates sleep because it is not fun sleeping. A mental exam revealed that she is oriented to time, person, and event. In that regard, this paper discusses three decisions that can be applied to help the patient improve her bipolar condition.
Decision Point One
The selected decision is to Begin Lithium 300 mg orally BID. This decision was selected because lithium is one of the most widely used and studied drugs for treating bipolar disorder (Baldessarini et al., 2019). The helps in managing and controlling the severity and frequency of mania or hypomania episodes. It also helps prevent or reduce depression in bipolar disorder. Lithium is a mood stabilizer that works in the brain. It is FDA approved for the treatment of Bipolar. It works by regulating the release of chemicals in the brain (Baldessarini et al., 2019). Also, it strengthens the connection in the brain regions that are responsible for regulating the mood, thinking, and behavior of people.
The other two decisions were not selected for one reason or the other. For example, beginning Risperdal 1 mg orally BID was not selected because it was not a good option in the sense that the patient was diagnosed with the CYP2D6*10 allele which slows the metabolism of the drug (Risperdal) (Kim et al., 2018). The patient could have experienced slower clearance of Risperdal if she took the medication, which might have resulted in severe sedation. On the other hand, Seroquel XR 300 mg orally at HS was not selected because it is often associated with suicidal thoughts (Akinhanmi et al., 2018). Also, doctors believe that lithium works better than Seroquel for bipolar.
The therapist expected that the patient would return to the clinic in four weeks. More than 50% of the bipolar disorder symptoms are expected to resolve. The high and low moods that the patient is experiencing would resolve (Miklowitz, 2019). The patient would improve her sleep and would begin to think normally. The actual results did not match most of the expected ones. The patient returned to the clinic in four weeks as expected. However, she is not compliant with her medication as required (Kim et al., 2018). She stated that she had been taking her drug off and on only when she feels like she needs it. Also, there is no improvement in her condition; the presents similar conditions as the ones she manifested on the first day (Miklowitz, 2019). Some of the ethical considerations when dealing with the patient include patient autonomy and non-maleficence (Robinson & Doody, 2022). Non-maleficence and justice and fairness are also important to consider.
Decision Pint Two
The second decision was to assess the rationale for non-compliance to elicit the reason for non-compliance and educate the client on drug effects and pharmacology. This decision was selected because the patient experienced compliance with the drug, hence, there was no improvement (Akinhanmi et al., 2018). Therefore, the patient should receive education about the effects of drug non-compliance and any other relevant pharmacological information. Drug non-adherence can result in worsening of the patient’s symptoms and even further health complications. In cases of non-adherence, the caregiver should assess the reason causing the behavior (Akinhanmi et al., 2018). In most cases, patient education should be administered.
Increasing lithium to 450 mg orally BID was not recommended because it would worsen the symptoms. The incidences of incompliance would increase leading to even worst symptoms than before. Additionally, the patient would not have the opportunity to understand the impact of non-adherence on her health and overall wellbeing (Akinhanmi et al., 2018). Increasing the Lithium dose would not lead to any improvement. Although switching to Depakote ER 500 mg orally at HS could have been helpful and was the right decision, it could not be implemented at this point (Baldessarini et al., 2019). It was wise to educate the patient first, and then monitor the outcomes for quite a time.
The therapist expected that there would be a significant improvement in the symptoms of bipolar. About 50% of the bipolar disorder symptoms are expected to resolve in four weeks. The psychiatrist expects that the high and low moods will have resolved or reduced by 50% in terms of severity and frequency in the next four weeks (Akinhanmi et al., 2018). Additionally, the patient is expected to improve her sleep. The actual result did not match the expected ones. The patient returned to the clinic in four weeks but complains of nausea and diarrhea. She stopped taking the medications due to the symptoms. During treatment, patient education must be prioritized to improve her knowledge (Robinson & Doody, 2022). Additionally, the patient’s preference is also necessary to consider. Non-maleficence and beneficence are also important to consider.
Decision Point Three
The selected decision three is to change Lithium to sustained-release preparation at the same dose and frequency. At this point, the patient is experiencing nausea and diarrhea, which are common side effects of lithium therapy (Baldessarini et al., 2019). Changing lithium to an extended-release formulation can often prevent these symptoms, while at the same time improving the effectiveness of lithium’s mood-stabilizing properties.
Changing the medication to Depakote ER 500 mg at HS is a good option but only if the sustained release of lithium is not helpful, which is the reason the psychiatrist did not choose it at this point (Baldessarini et al., 2019). Furthermore, lithium is believed to be a good choice to control mania and manage suicidal thoughts. On the other hand, Oxcarbazepine (Trileptal) is an option, but is a second-line therapy and is not appropriate at this stage as the client has not had an adequate trial of first-line agents (Baldessarini et al., 2019). For this reason, it was not selected at this point of care.
The patient is expected to return to the clinic in four weeks with all the symptoms resolved. The manic and depressive symptoms are expected to resolve completely. Her sleep is expected to improve as well (Miklowitz, 2019). Adherence is expected to be good, and no side effect is expected. Various ethical issues must be taken into consideration. For example, the patient must be treated fairly to receive medication and other resources as required. Also, the patient needs to be educated about medication adherence to ensure efficient and effective recovery (Robinson & Doody, 2022). The principles of beneficence and non-maleficence must be put into consideration.
Conclusion
The patient was diagnosed with bipolar disorder. She experiences symptoms of low and high moods. Her sleep pattern is poor and she is no longer interested in sleeping. Patients who have bipolar disorder often experience a series of shifts in mood, behavior, and energy levels. Bipolar disorder affects interfere with concentration and the patient’s ability to carry out daily activities. To help the patient recover from the symptoms, three treatment decisions were applied in 12 weeks. The selected decision is to Begin Lithium 300 mg orally BID. This decision was selected because lithium is one of the most widely used and studied drugs for treating bipolar disorder.
The second decision was to assess the rationale for non-compliance to elicit the reason for non-compliance and educate the client about drug effects and pharmacology. This would help improve drug adherence. The selected decision three is to change Lithium to sustained-release preparation at the same dose and frequency. This decision would help solve the reported side effects. Relevant ethical issues were also considered to improve care. Patient education allowed the patient to gain basic knowledge of her care. other ethical considerations include beneficence, non-maleficence, justice, and fairness.
References
Akinhanmi, M. O., Biernacka, J. M., Strakowski, S. M., McElroy, S. L., Balls Berry, J. E., Merikangas, K. R., … & Frye, M. A. (2018). Racial disparities in bipolar disorder treatment and research: a call to action. Bipolar disorders, 20(6), 506-514. https://doi.org/10.1111/bdi.12638
Baldessarini, R. J., Tondo, L., & Vázquez, G. H. (2019). Pharmacological treatment of adult bipolar disorder. Molecular psychiatry, 24(2), 198-217. https://doi.org/10.1038/s41380-018-0044-2
Kim, M. J., Byeon, J. Y., Kim, Y. H., Kim, S. H., Lee, C. M., Jung, E. H., … & Choi, C. I. (2018). Effect of the CYP2D6* 10 allele on the pharmacokinetics of clomiphene and its active metabolites. Archives of pharmacal research, 41(3), 347-353. https://doi.org/10.1007/s12272-018-1005-7
Miklowitz, D. J. (2019). The bipolar disorder survival guide: What you and your family need to know. Guilford Press.
Robinson, S., & Doody, O. (2022). Nursing & healthcare ethics. Elsevie