NURS 6630 Assignment Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders

NURS 6630 Assignment Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders

Walden University NURS 6630 Assignment Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders-Step-By-Step Guide

 

This guide will demonstrate how to complete the Walden University  NURS 6630 Assignment Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders  assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

 

How to Research and Prepare for NURS 6630 Assignment Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders 

 

Whether one passes or fails an academic assignment such as the Walden University  NURS 6630 Assignment Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders  depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

 

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

 

How to Write the Introduction for NURS 6630 Assignment Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders 

 

The introduction for the Walden University  NURS 6630 Assignment Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders  is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

 

How to Write the Body for NURS 6630 Assignment Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders  

 

After the introduction, move into the main part of the NURS 6630 Assignment Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders  assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

 

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

 

How to Write the Conclusion for NURS 6630 Assignment Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders 

 

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

 

How to Format the References List for NURS 6630 Assignment Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders 

 

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NURS 6630 Assignment Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders

Antipsychotic agents, also called neuroleptic or major tranquilizers, are used primarily to treat schizophrenia. Schizophrenia is characterized primarily by a clear sensory but marked thinking disturbance. Second-generation/ Atypical antipsychotics are widely used due to their broad spectrum of receptor activity since they affect Serotonin, dopamine, and GABA neurotransmitters (de Miranda et al., 2020). Besides, they are better at alleviating negative symptoms and cognitive dysfunction than typical antipsychotics. The purpose of this assignment is to develop a study guide for an antipsychotic agent.

Drug Description

Quetiapine, whose brand name goes by Seroquel, is used in treating schizophrenia. It is FDA-approved for treating schizophrenia, Bipolar disorder, and major depressive disorder (MDD) as an adjunctive treatment (de Miranda et al., 2020).

Non-FDA uses

The non-FDA uses of Seroquel include the treatment of generalized anxiety disorder (GAD), Alcohol Dependence, and Insomnia.

• According to Ansara (2020), Seroquel exhibits efficacy in managing treatment-resistant-GAD as an adjunctive agent. In this case, smaller doses than those prescribed for schizophrenia and bipolar disorder are usually needed for symptom improvement.
• Seroquel has been found to reduce alcohol consumption in heavy drinkers and has the potential for treatment for alcohol dependence, particularly among heavy drinkers (Vatsalya et al., 2020).
• Low doses of quetiapine are usually prescribed for insomnia, although this is a non-FDA use due to potential adverse effects like weight gain and akathisia (Boafo et al., 2020).

Drug classification

Seroquel is an antipsychotic under second-generation antipsychotics.

MOA	Pharmacokinetics	Pharmacodynamics
An antagonist for D2 receptors and serotonin receptors.	Absorption: Bioavailability: 100% Peak plasma time: Immediate release-1.5 hr; extended release-6 hrs	Reduces the hallucinations and delusions associated with schizophrenia by blocking dopamine receptors in the mesolimbic system of the brain.
Acts on dopaminergic D1 and D2 receptors.	Metabolism: Metabolized in the liver by CYP3A4
	Elimination:   Excretion: Urine (73%), feces (20%).

 

Appropriate dosing: 150-750 mg/day (Immediate release); 400-800 mg/day (extended release).

Children <12 years: safety not established.

Children >12 years: Dose range 400-800 mg/day (de Miranda et al., 2020).

Geriatrics: 50-200 mg/day (Immediate); 50 mg/day (Extended)

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Pregnant and breastfeeding women: Not recommended.

Route of Administration:  Orally.

Considerations for dosing alterations: Elderly and patients predisposed to hypotensive reactions.

Half-life:  The time it takes for the concentration of a drug to decrease to half of its initial dose in the body.

• Understanding half-life is important because it determines a drug’s excretion rates and steady-state concentrations. After one half-life has passed, half of the starting drug amount is eliminated from the body (Smith et al., 2018).
• Seroquel has a half-life of 6 hours for immediate release formulation and 7 hours for extended-release formulation.

Side effects/adverse reaction potentials

Seroquel is associated with various adverse effects, including somnolence fatigue, dry mouth, constipation, increased appetite, weight gain, orthostatic hypertension, and dizziness (de Miranda et al., 2020). Neuroleptic malignant syndrome is a possible adverse effect due to the drug’s D2 receptor blockage.

Contraindications for use including significant drug-to-drug interactions

• Currently, no identified FDA contraindications of quetiapine.
• It is contraindicated in patients with documented hypersensitivity.
• However, quetiapine is associated with an increased risk of death in elderly patients with dementia-related psychosis (Osborne et al., 2020).
• Precaution is needed with drugs that prolong QT intervals and patients with prolonged QT intervals.

Contraindications due to drug-to-drug interactions

• Amisulpride
• Goserelin
• Lefamulin
• Leuprolide

Overdose Considerations

Seroquel can be life-threatening if taken in an overdose. Toxicity occurs with levels > 1500 ng/mL.

Supportive care is the mainstay of treatment in an overdose.

Measures for acute toxicity include: Maintaining the airway; Ensuring adequate oxygenation; Ventilation (Osborne et al., 2020).

Gastric lavage and administration of activated charcoal with a laxative can prevent more drug absorption if promptly given.

Diagnostics and labs monitoring

The prescribing clinician should monitor the patient’s metabolic panel focusing on fasting glucose, cholesterol and triglyceride levels, weight, and blood pressure (before and during treatment). Besides, patients on long-term treatment should have a lens exam every six months for cataract monitoring (Osborne et al., 2020). Leukopenia, neutropenia, and agranulocytosis can occur with Seroquel treatment, and thus a complete blood count (CBC) should be performed during the first few months of treatment (Osborne et al., 2020). In addition, orthostatic vital signs should be monitored in patients vulnerable to hypotension like geriatrics, patients with dehydration, hypovolemia, and those on antihypertensives.

Comorbidities considerations

• Precautions should be taken in patients with hypokalemia, cardiac arrhythmia, and hypomagnesemia. Metabolic panels should be obtained before initiating the drug (Osborne et al., 2020).
• Patients with diabetes mellitus should have their glucose monitored to avoid hyperosmolar coma.

Legal and ethical considerations

• The clinician prescribing Seroquel should uphold beneficence by ensuring that the drug will have the maximum benefit in treating a patient’s psychotic, bipolar, or MDD symptoms. Nonmaleficence should be upheld by considering the drug’s side effects and ensuring that the benefits outweigh the risks.
• The clinician should obtain consent from the patient before initiating treatment with Seroquel and explain the potential benefits and side effects for the patient to make an informed decision.
• Confidentiality of the patient’s health information should be maintained to prevent legal consequences.

Pertinent patient education considerations

The patient should be educated about the drug’s indications, benefits, and side effects. Patients should be informed that the drug can be discontinued if they experience severe side effects and if they have a decrease in WBCs (de Miranda et al., 2020). Besides, they should be educated that abrupt drug discontinuation poses a risk for withdrawal symptoms.

Conclusion

Seroquel is a second-generation antipsychotic, FDA-approved for treating schizophrenia, Bipolar disorder, and MDD. It is also used off-label in treating insomnia, treatment-resistant GAD, and alcohol dependence. Seroquel is an antagonist for D2 receptors and serotonin receptors, which results in reduced psychotic symptoms. Patients on Seroquel should be monitored for cholesterol and triglyceride levels, weight, blood pressure, fasting glucose, cataracts, complete blood count, and orthostatic vital signs. Ethical principles of beneficence, nonmaleficence, confidentiality, and consent should be upheld when prescribing patient Seroquel.

 References

Ansara, E. D. (2020). Management of treatment-resistant generalized anxiety disorder. The mental health clinician, 10(6), 326–334. https://doi.org/10.9740/mhc.2020.11.326

Boafo, A., Greenham, S., Sullivan, M., Bazaid, K., Suntharalingam, S., Silbernagel, L., Magner, K., & Robillard, R. (2020). Medications for sleep disturbance in children and adolescents with depression: a survey of Canadian child and adolescent psychiatrists. Child and adolescent psychiatry and mental health, 14, 10. https://doi.org/10.1186/s13034-020-00316-8

de Miranda, A. S., Ferreira, R. N., Teixeira, A. L., & de Miranda, A. S. (2020). Mood Stabilizers: Quetiapine. NeuroPsychopharmacotherapy, 1-23.

Osborne, V., Davies, M., Evans, A., & Shakir, S. (2020). Observational assessment of safety in Seroquel (OASIS): a specialist cohort event monitoring (SCEM) study in England. Therapeutic advances in psychopharmacology, 10, 2045125320954616. https://doi.org/10.1177/2045125320954616

Smith, D. A., Beaumont, K., Maurer, T. S., & Di, L. (2018). Relevance of Half-Life in Drug Design. Journal of medicinal chemistry, 61(10), 4273–4282. https://doi.org/10.1021/acs.jmedchem.7b00969

Vatsalya, V., Kong, M., Marsano, L. M., Kurlawala, Z., Chandras, K. V., Schwandt, M. L., Ramchandani, V. A., & McClain, C. J. (2020). Interaction of Heavy Drinking Patterns and Depression Severity Predicts Efficacy of Quetiapine Fumarate XR in Lowering Alcohol Intake in Alcohol Use Disorder Patients. Substance abuse: research and treatment, 14, 1178221820955185. https://doi.org/10.1177/1178221820955185

Sample Answer 2 for NURS 6630 Assignment Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders

Mental illness is known to have various negative impacts on patients’ lives. Among them are schizophrenia spectrum and other psychosis disorders (Jester et al.,2023). These illnesses usually result in undesirable symptoms like delusions, hallucinations, disorganized thinking or speech, and disorganized or abnormal motor behaviors. As such, the PMHNPs should possess sufficient knowledge concerning these conditions and their symptoms for accurate diagnosis, treatment, and management. Study guides can play a critical role in enhancing a person’s ability to learn about these conditions and their management using antipsychotic agents. Therefore, the purpose of this assignment is to create a study guide that presents the medication treatment for schizophrenia spectrum and other psychosis disorders.

Drug Description

The chosen medication for this study guide is Quetiapine. This mediation has widely been used in treating schizophrenia (de Miranda et al.,2020). The brand name is Seroquel. The FDA approved this medication to be used in treating schizophrenia, major depressive disorder, and bipolar disorder.

 

Non-FDA uses

Apart from the FDA indications, Seroquel has also been used for non-FDA-approved functions. The non-FDA uses include the following.

• Treatment of insomnia where low doses are usually given
• Treatment of alcohol dependence as heavy drinkers has been observed to reduce their drinking tendencies when using the medication (de Miranda et al.,2020)
• It is also used in the treatment of general anxiety disorder, where lower doses are used.

Drug classification

Seroquel is an antipsychotic under second-generation antipsychotics.

Mechanism of action	Pharmacokinetics	Pharmacodynamics
It is known to act on the dopaminergic D1 and D2 receptors. It is also an antagonist for serotonin receptors and D2 receptors.	Absorption: An immediate and extended release of 1.5 hours and 6 hours, respectively (Peak plasma time)	The medication blocks the dopamine receptors to help lower incidences of delusions and hallucinations caused by schizophrenia.
Acts on dopaminergic D1 and D2 receptors.	Metabolism: The medication metabolism takes place in the liver by CYP3A4 (Badhan & Macfarlane, 2020) Elimination: 20% of elimination is through feces, while 73% is through excretion.

 

Recommended dosing:

• 150-750 mg/day (Immediate release); 400-800 mg/day (extended-release).
• Children below twelve years: No safety has been established.
• Children above twelve years: 400-800 mg/day
• Not recommended for breastfeeding and pregnant women
• Geriatrics: 50-200 mg/day (Immediate); 50 mg/day (Extended) (de Miranda et al.,2020)

Route of Administration:  The medication is taken through the mouth

Dosing alterations consideration: individuals susceptible to hypotensive reactions and the elderly.

Half-life:  This is the time which is taken by a medication’s concentration to reduced by half of the original concentration in the body. It is important to understand the half-life of medication since it dictates the steady-state concentration and excretion. The half-life for Seroquel is six hours for immediate release and seven hours for extended-release (de Miranda et al.,2020).

 

Side Effects and Possible Adverse Reactions

The medication is connected to various side effects and possible adverse reactions, which might be a concern to patients. It is important that a patient is educated regarding the same. They are illustrated below.

Contraindications For Use Including Significant Drug-To-Drug Interactions

            The medication is contraindicated for patients with hypersensitivity. The medication has been shown to pause and increase mortality risk in elderly individuals displaying dementia-connected psychosis. It may interact with medication that, leads to prolonged QT intervals. The medication specifically interacts with Leuprolide, Lefamulin, Goserelin, and Amisupride (Oruch et al.,2020).

Overdose Considerations

• The medication can lead to death in cases of overdose. Indeed, toxicity may happen with levels higher than 1500 ng/mL.
• Supportive care has widely been used in treating Seroquel overdose.
• Measures for acute toxicity include ventilation, sufficient oxygenation, and maintaining the airway (Oruch et al.,2020).
• Gastric lavage and administration of activated charcoal with a laxative can also help in stopping the absorption of the drug if administered.

Diagnostics and labs monitoring

Comorbidities considerations

• Practitioners should monitor the blood glucose levels of patients with diabetes mellitus to limit the chances of hyperosmolar coma (Osborne et al.,2020).
• Practitioners should be careful with individuals with hypomagnesemia, cardiac arrhythmia, and hypokalemia and should get a metabolic panel before they can start administering the medication.

Legal and ethical considerations

• Health practitioners have to uphold the patient’s health information confidentiality as a way of preventing legal issues (Limandri, 2019)
• It is also important to uphold beneficence by ensuring that administered medication leads to optimum benefits when treating the approved indications for the medication.
• The practitioners should also consider the side effects of the medication and ensure that the expected benefits outweigh the potential risks hence upholding nonmaleficence.
• Consent is also required. Therefore, the health practitioners should obtain consent from the patients and ensure that the patient is well informed regarding the potential side effects and adverse effects of Seroquel.

Pertinent Patient Education Considerations

It is important to explore pertinent patient education considerations when administering Seroquel. As such, the practitioner has to educate the patient regarding various aspects, such as side effects, potential benefits, and indications. The patients should be educated on the need to adhere to the medication regimen and ensure that they see they visit the facility in case of any adverse effects or reactions (de Miranda et al.,2020).

. In addition, the patient also needs to be informed of the instances when the medication can be discontinued.

Conclusion

This study guide has explored the use of Seroquel, which is an FDA-approved medication for treating schizophrenia, major depressive disorder, and bipolar disorder. The medication also has various non-FDA-approved uses, such as the treatment of insomnia and generalized anxiety disorder. The guideline has also explored various aspects such as indications for use, contraindication, potential side effects and adverse reactions, diagnostics and lab monitoring, and various ethical principles to consider.

 

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References

 

Badhan, R. K., & Macfarlane, H. (2020). Quetiapine dose optimisation during gestation: A pharmacokinetic modelling study. Journal of Pharmacy and Pharmacology, 72(5), 670–681. https://doi.org/10.1111/jphp.13236

de Miranda, A. S., Ferreira, R. N., Teixeira, A. L., & de Miranda, A. S. (2020). Mood Stabilizers: Quetiapine. NeuroPsychopharmacotherapy, 1-23.

Jester, D. J., Thomas, M. L., Sturm, E. T., Harvey, P. D., Keshavan, M., Davis, B. J., … & Jeste, D. V. (2023). Review of major social determinants of health in schizophrenia-spectrum psychotic disorders: I. Clinical outcomes. Schizophrenia Bulletin, 49(4), 837–850. https://doi.org/10.1093/schbul/sbad023

Limandri, B. J. (2019). Ethical Reasoning in Prescribing and Monitoring Psychotropic Medications. Journal of Psychosocial Nursing and Mental Health Services, 57(1), 7-10. https://doi.org/10.3928/02793695-20181212-03

Oruch, R., Pryme, I., Fasmer, O., & Lund, A. (2020). Quetiapine: An objective evaluation of pharmacology, clinical uses and intoxication. EC Pharmacol Toxicol, 8, 1-26. https://elibrary.ru/item.asp?id=42474663

Osborne, V., Davies, M., Evans, A., & Shakir, S. (2020). Observational assessment of safety in Seroquel (OASIS): a specialist cohort event monitoring (SCEM) study in England. Therapeutic advances in psychopharmacology, 10, 2045125320954616. https://doi.org/10.1177/2045125320954616

Sample Answer 3 for NURS 6630 Assignment Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders

Case: An elderly widow who just lost her spouse.

Subjective: A patient presents to your primary care office today with the chief complaint of insomnia. The patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression before her husband’s death. She is awake, alert, and oriented x3. The patient normally sees PCP once or twice a year. The patient denies any suicidal ideations. The patient arrived at the office today by private vehicle. The patient currently takes the following medications:

1. Metformin 500mg BID
2. Januvia 100mg daily
3. Losartan 100mg daily
4. HCTZ 25mg daily
5. Sertraline 100mg daily

Current weight: 88 kg

Current height: 64 inches

Temp: 98.6 degrees F

BP: 132/86

Introduction

Major depressive disorder (MDD), sometimes referred to as clinical depression, lasts for at least two weeks and is characterized by a persistently depressed mood, low self-esteem, and a lack of interest in or enjoyment from typically enjoyable activities (Sartorius et al., 2022). A person’s work or school life, eating and sleeping patterns, general health, and family and personal relationships are all significantly impacted by significant depression (National Institute of Mental Health (2021). A major depressive episode typically manifests as an all-encompassing low mood and the inability to derive pleasure from previously enjoyable activities (American Psychiatric Association, 2013). People who are depressed may obsess over or dwell on thoughts and feelings of worthlessness, unwarranted guilt or regret, hopelessness, or helplessness (American Psychiatric Association, 2013). Poor memory and concentration, withdrawal from social interactions and activities decreased sex drive, irritability, and suicidal thoughts are some additional symptoms of depression (Everaert et al., 2022). Commonly, insomnia causes a person to wake up very early and find it difficult to fall back asleep.

Assessment Questions & Rationale

The patient’s health history reveals been diagnosed with a serious mental health illness, and the daily intake of medication Zoloft 100 mg daily. Despite this medical history, it is vital to re-examine the mental health of the patient using the Geriatric Depression Scale (GDS). The Geriatric Depression Scale is a self-report tool for assessing depression in older adults (American Psychological Association, 2020). Users of GDS reply using a binary system (Yes/No). This tool, which was initially designed as a 30-item instrument, can be completed in 5–7 minutes, making it perfect for individuals who find it difficult to focus for extended periods of time or who are easily fatigued (American Psychological Association, 2020). Repeating the mental status examination is necessary because it is essential to the diagnosis of mental health illness (Andreas et al., 2017).

After re-examining the patient’s mental health, I will ask her the following three questions:

1. Are you taking your drugs as directed by your doctor?

Rationale: Treatment for depression disorders is challenging because it takes weeks to assess the therapeutic effects of prescribed drugs, determine whether dosage modifications are necessary, or switch to a different medication, and this necessitates additional time to assess potential side effects. When non-compliance is involved, managing depression can be difficult. Research has indicated that there is a correlation between “lower adherence and higher medication costs, medications not covered by insurance, patient perceptions of medication not being necessary, and patient fears of side effects (Lee et al., 2010).

2. Which of your regular medications are new?

• Rationale: Losartan is linked to “decreased REM and daytime sedation—and insomnia can occur since the proportion of REM sleep declines noticeably with age” (Lie et al., 2015). Research reveals that 10-20% of users of SSRI (Zoloft) experience agitation, insomnia, mild tremor, and impulsivity (Lie et al., 2013). Depression has also been connected to thiazide diuretics (Calati et al 2013). It is crucial to determine whether the drugs listed above or their dosage have recently changed.

3. Have you made any dietary or environmental changes that may be causing you to sleep less?

Caffeine is commonly consumed in care homes; however, excessive consumption or exposure to the elderly or those with psychiatric disorders can exacerbate or cause anxiety and insomnia. Hence, caffeine consumption should be evaluated (Bélanger et al., 2012). Elderly people are more likely than the general population to experience nocturnal awakenings and sleep fragmentation, so it’s critical to evaluate the patient’s sleeping environment and habits (Bélanger et al., 2012). For example, modifications to the patient’s living space brought on by her husband’s passing should be assessed.

Apart from gathering the patient’s subjective input, it’s crucial to communicate with the patient’s guardians, siblings, children, and primary care physician, and inquire about the following matters:

1. Has the patient’s mood changed at all?
2. Are there any indications of worry?
3. Has the patient’s living situation changed in any way since losing her husband? If yes, what kind of surroundings does she live in?

The aforementioned questions aid the practitioner in identifying additional risk factors that could contribute to insomnia, particularly in older patients who may find it more difficult to express their symptoms and emotions clearly for a variety of age-related reasons.

Differential Diagnosis

1. Major Depressive Disorder (Primary): The patient’s previous medical records have already established that she has MDD. Given the recent traumatic events (spouse loss), it’s probable that the patient’s depression has worsened as a result of these events. There is no set time frame for grieving, and symptoms can be both emotional and physical, including difficulty sleeping. To create the treatment plan and manage the patient’s symptoms, a new assessment of the patient’s mental state and an updated GDS are required. Options for non-pharmacological therapy should be taken into account as well.
2. Bipolar Disorder: Although mania and hypomania are distinguishable features of bipolar disorder, physicians point out that depression is the most common clinical presentation because bipolar patients are significantly more likely to see them when they are depressed, particularly in settings for outpatients (Goodwin & Jamison, 2007). As a result, misdiagnosis is frequent and can have serious repercussions, such as treating the patient as though they have unipolar depression (Goodwin & Jamison, 2007). In these situations, numerous researchers note that “treatment guidelines recommend using antidepressants only as adjunct therapy to mood stabilizers for bipolar depression, and standard antidepressant therapy has not been shown to be effective in the treatment of depression episodes in patients with bipolar disorder.

Pharmacological Therapy Options

1. (Primary) Increase Zoloft Dose from 100 mg to 150 mg: Elderly patients with major depressive disorder respond well to sertraline (50–200 mg/day) (Muijsers et al., 2002). Sertraline’s antidepressant effect is unaffected by vascular morbidity, diabetes mellitus, or arthritis of elderly patients with major depressive disorder, so it is preferable to increase the dosage before switching to a different medication (Muijsers et al., 2002). Since the patient’s first dosage of 100 mg, there have been no clear signs of a contraindication. An SSRI called Zoloft works by preventing serotonin receptors (5-HT) from being reabsorbed, which raises serotonin activity and helps with major depressive disorder symptoms(Rosenthal & Burchum, 2018). The medication “undergoes extensive hepatic metabolism followed by elimination in the urine and feces; and is highly bound (99%) to plasma proteins in the blood (Rosenthal & Burchum, 2018). Since the plasma half-life is about one day, starting with the recommended dosage of 25 mg p.o. daily is proper. If this dosage is not causing any side effects, I would ask the patient to return in 28 days.
2. Venlafaxine (a selective norepinephrine reuptake inhibitor or SNRI): If increasing Zoloft does not produce the desired results, I would suggest switching to a different class of SNRI. Due to its “pharmacological profile, which makes it an attractive choice for geriatric patients,” venlafaxine only weakly inhibits the cytochrome P450 system and binds to plasma proteins at a low level, limiting its potential to interact with other medications. More recent antidepressants are “safer for older people and effective for late-life depression. The drug’s (venlafaxine) mechanism of action involves strong inhibition of dopamine reuptake and weak inhibition of NE and 5-HT reuptake; however, it is unclear how these actions relate to therapeutic effects (Rosenthal & Burchum, 2018). Starting with a dose of 25 mg PO, the physician should administer the medication cautiously and request that the patient return in four weeks for further monitoring and assessment. A small percentage of elderly patients experience emergent hypertension, usually at doses greater than 150 mg/day, so it’s crucial to teach the patient how to check their blood pressure while taking this medication.

References

Andreas, S., Schulz, H., Volkert, J., Dehoust, M., Sehner, S., Suling, A., Ausín, B., Canuto, A., Crawford, M., Ronch, C. D., Grassi, L., Hershkovitz, Y., Muñoz, M., Quirk, A., Rotenstein, O., Santos-Olmo, A. B., Shalev, A., Strehle, J., Weber, K., Wegscheider, K., Wittchen, H. & Härter, M. (2017). Prevalence of mental disorders in elderly people: The European MentDis_ICF65+ study. British Journal of Psychiatry, 210(2), 125-131. doi:10.1192/bjp.bp.115.180463.

American Psychological Association (2020). Geriatric Depression Scale (GDS). Retrieved from https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/geriatric-depression on 01/01/2021

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Bélanger, L., Leblanc, M. & Morin, C. M. (2012). Cognitive behavioral therapy for insomnia in older adults. Cognitive and Behavioral Practice, 19(1), 101–115. doi: 10.1016/j.cbpra.2010.10.003.

Calati R, Salvina Signorelli M, Balestri M. (2013). Antidepressants in elderly: Metaregression of double-blind, randomized clinical trials. J Affect Disord.147, 1–8.

Everaert, J., Vrijsen, J. N., Martin-Willett, R., Van de Kraats, L. & Joormann, J. (2022). A meta-analytic review of the relationship between explicit memory bias and depression: Depression features an explicit memory bias that persists beyond a depressive episode. Psychological Bulletin 148 (5–6), 435–463. doi:10.1037/bul0000367.

Goodwin, F. K. & Jamison, K. R. (2007). Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression (2nd ed.). New York: Oxford University Press.

Lee, M. S., Lee, H. Y., Kang, S. G. et al. (2010). Variables influencing antidepressant medication adherence for treating outpatients with depressive disorders. J Affect Disord., 123, 216–221.

Muijsers, R. B., Plosker, G. L., & Noble, S. (2002). Spotlight on sertraline in the management of major depressive disorder in elderly patients. CNS Drugs, 16(11), 789-794. doi:10.2165/00023210-200216110-00011.

National Institute of Mental Health (2021). Depression.  Archived (PDF) from the original on 28 August 2021.

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (1st ed.) St. Louis, MO: Elsevier.

Sartorius, N., Henderson, A. S., Strotzka H, et al. (2022). The ICD-10 classification of mental and behavioural disorders clinical descriptions and diagnostic guidelines. World Health Organization. Archived from the originnal (PDF) on 5 February 2022.

Sample Answer 4 for NURS 6630 Assignment Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders

Mental illness is known to have various negative impacts on patients’ lives. Among them are schizophrenia spectrum and other psychosis disorders (Jester et al.,2023). These illnesses usually result in undesirable symptoms like delusions, hallucinations, disorganized thinking or speech, and disorganized or abnormal motor behaviors. As such, the PMHNPs should possess sufficient knowledge concerning these conditions and their symptoms for accurate diagnosis, treatment, and management. Study guides can play a critical role in enhancing a person’s ability to learn about these conditions and their management using antipsychotic agents. Therefore, the purpose of this assignment is to create a study guide that presents the medication treatment for schizophrenia spectrum and other psychosis disorders.

Drug Description

The chosen medication for this study guide is Quetiapine. This mediation has widely been used in treating schizophrenia (de Miranda et al.,2020). The brand name is Seroquel. The FDA approved this medication to be used in treating schizophrenia, major depressive disorder, and bipolar disorder.

 

Non-FDA uses

Apart from the FDA indications, Seroquel has also been used for non-FDA-approved functions. The non-FDA uses include the following.

• Treatment of insomnia where low doses are usually given
• Treatment of alcohol dependence as heavy drinkers has been observed to reduce their drinking tendencies when using the medication (de Miranda et al.,2020)
• It is also used in the treatment of general anxiety disorder, where lower doses are used.

Drug classification

Seroquel is an antipsychotic under second-generation antipsychotics.

Mechanism of action	Pharmacokinetics	Pharmacodynamics
It is known to act on the dopaminergic D1 and D2 receptors. It is also an antagonist for serotonin receptors and D2 receptors.	Absorption: An immediate and extended release of 1.5 hours and 6 hours, respectively (Peak plasma time)	The medication blocks the dopamine receptors to help lower incidences of delusions and hallucinations caused by schizophrenia.
Acts on dopaminergic D1 and D2 receptors.	Metabolism: The medication metabolism takes place in the liver by CYP3A4 (Badhan & Macfarlane, 2020) Elimination: 20% of elimination is through feces, while 73% is through excretion.

 

Recommended dosing:

• 150-750 mg/day (Immediate release); 400-800 mg/day (extended-release).
• Children below twelve years: No safety has been established.
• Children above twelve years: 400-800 mg/day
• Not recommended for breastfeeding and pregnant women
• Geriatrics: 50-200 mg/day (Immediate); 50 mg/day (Extended) (de Miranda et al.,2020)

Route of Administration:  The medication is taken through the mouth

Dosing alterations consideration: individuals susceptible to hypotensive reactions and the elderly.

Half-life:  This is the time which is taken by a medication’s concentration to reduced by half of the original concentration in the body. It is important to understand the half-life of medication since it dictates the steady-state concentration and excretion. The half-life for Seroquel is six hours for immediate release and seven hours for extended-release (de Miranda et al.,2020).

Side Effects and Possible Adverse Reactions

The medication is connected to various side effects and possible adverse reactions, which might be a concern to patients. It is important that a patient is educated regarding the same. They are illustrated below.

Contraindications For Use Including Significant Drug-To-Drug Interactions

The medication is contraindicated for patients with hypersensitivity. The medication has been shown to pause and increase mortality risk in elderly individuals displaying dementia-connected psychosis. It may interact with medication that, leads to prolonged QT intervals. The medication specifically interacts with Leuprolide, Lefamulin, Goserelin, and Amisupride (Oruch et al.,2020).

Overdose Considerations

• The medication can lead to death in cases of overdose. Indeed, toxicity may happen with levels higher than 1500 ng/mL.
• Supportive care has widely been used in treating Seroquel overdose.
• Measures for acute toxicity include ventilation, sufficient oxygenation, and maintaining the airway (Oruch et al.,2020).
• Gastric lavage and administration of activated charcoal with a laxative can also help in stopping the absorption of the drug if administered.

Diagnostics and labs monitoring

Comorbidities considerations

• Practitioners should monitor the blood glucose levels of patients with diabetes mellitus to limit the chances of hyperosmolar coma (Osborne et al.,2020).
• Practitioners should be careful with individuals with hypomagnesemia, cardiac arrhythmia, and hypokalemia and should get a metabolic panel before they can start administering the medication.

Legal and ethical considerations

• Health practitioners have to uphold the patient’s health information confidentiality as a way of preventing legal issues (Limandri, 2019)
• It is also important to uphold beneficence by ensuring that administered medication leads to optimum benefits when treating the approved indications for the medication.
• The practitioners should also consider the side effects of the medication and ensure that the expected benefits outweigh the potential risks hence upholding nonmaleficence.
• Consent is also required. Therefore, the health practitioners should obtain consent from the patients and ensure that the patient is well informed regarding the potential side effects and adverse effects of Seroquel.

Pertinent Patient Education Considerations

It is important to explore pertinent patient education considerations when administering Seroquel. As such, the practitioner has to educate the patient regarding various aspects, such as side effects, potential benefits, and indications. The patients should be educated on the need to adhere to the medication regimen and ensure that they see they visit the facility in case of any adverse effects or reactions (de Miranda et al.,2020).

. In addition, the patient also needs to be informed of the instances when the medication can be discontinued.

Conclusion

This study guide has explored the use of Seroquel, which is an FDA-approved medication for treating schizophrenia, major depressive disorder, and bipolar disorder. The medication also has various non-FDA-approved uses, such as the treatment of insomnia and generalized anxiety disorder. The guideline has also explored various aspects such as indications for use, contraindication, potential side effects and adverse reactions, diagnostics and lab monitoring, and various ethical principles to consider.

 

 

References

 

Badhan, R. K., & Macfarlane, H. (2020). Quetiapine dose optimisation during gestation: A pharmacokinetic modelling study. Journal of Pharmacy and Pharmacology, 72(5), 670–681. https://doi.org/10.1111/jphp.13236

de Miranda, A. S., Ferreira, R. N., Teixeira, A. L., & de Miranda, A. S. (2020). Mood Stabilizers: Quetiapine. NeuroPsychopharmacotherapy, 1-23.

Jester, D. J., Thomas, M. L., Sturm, E. T., Harvey, P. D., Keshavan, M., Davis, B. J., … & Jeste, D. V. (2023). Review of major social determinants of health in schizophrenia-spectrum psychotic disorders: I. Clinical outcomes. Schizophrenia Bulletin, 49(4), 837–850. https://doi.org/10.1093/schbul/sbad023

Limandri, B. J. (2019). Ethical Reasoning in Prescribing and Monitoring Psychotropic Medications. Journal of Psychosocial Nursing and Mental Health Services, 57(1), 7-10. https://doi.org/10.3928/02793695-20181212-03

Oruch, R., Pryme, I., Fasmer, O., & Lund, A. (2020). Quetiapine: An objective evaluation of pharmacology, clinical uses and intoxication. EC Pharmacol Toxicol, 8, 1-26. https://elibrary.ru/item.asp?id=42474663

Osborne, V., Davies, M., Evans, A., & Shakir, S. (2020). Observational assessment of safety in Seroquel (OASIS): a specialist cohort event monitoring (SCEM) study in England. Therapeutic advances in psychopharmacology, 10, 2045125320954616. https://doi.org/10.1177/2045125320954616

Sample Answer 5 for NURS 6630 Assignment Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders

Antipsychotics or neuroleptics are the medications used to treat schizophrenia and psychotic disorders. They are classified into first-generation/typical and second-generation/atypical antipsychotics. Atypical antipsychotics are more effective at alleviating negative symptoms and cognitive dysfunction in schizophrenia. Besides, they are preferred over typical antipsychotics since the latter are associated with Parkinsonian side effects, akathisia, and tardive dyskinesia. The purpose of this assignment is to present a study guide for Invega Sustenna outlining its indications, mechanism of action, dosing, side effects, and legal and ethical considerations.

Drug Description

• Invega Sustenna, also known by its brand name Paliperidone Palmitate is an atypical/ second-generation antipsychotic agent (Minwalla et al., 2021).
• The FDA approves it for the acute and maintenance treatment of schizophrenia and schizoaffective disorder. It is used as a monotherapy for schizoaffective disorder and as an adjunct treatment to antidepressants and mood stabilizers (Emsley & Kilian, 2018).
• It is also used off-label to treat Bipolar disorder. Li et al. (2021) examined the effectiveness, safety profile, and compliance of paliperidone palmitate (once-monthly dose) in treating bipolar I disorder. The study established that paliperidone palmitate might provide a new suitable treatment option in the long-term management of Bipolar I Disorder, particularly for patients with poor compliance with the oral formulation.

Drug Classification

Appropriate dosing

• Oral dose: 3, 6, 9, and 12 mg OD
• IM injectable suspension Extended-release (1-monthly): 39, 78, 117, 156, and 234mg
• IM injectable suspension(3-monthly): 273mg, 410mg, 546mg, and 819mg
• IM injectable suspension (6-monthly) 1,092mg/3.5mL and 1,560mg/5mL

Children: <12 years-Safety and efficacy is not established.

≥12 years (less than 51 kg): 3 mg/day orally initially; max of 6 mg/day.

≥12 years (above 51 kg): 3 mg/day orally initially; max 12 mg/day.

Elderly: The dose should be modified based on kidney function. Renal function should be monitored for changes affecting dosing (Minwalla et al., 2021).

Considerations for dosing alterations:

Dosing considerations should be made for persons with Parkinson’s disease or dementia with Lewy bodies since they are at risk of increased sensitivity to Paliperidone (Minwalla et al., 2021).

Dose reduction in persons with mild kidney impairment with a creatinine clearance (CrCl) >50 to <80mL/min. This is because Paliperidone is majorly eliminated unchanged through the kidney (Shi et al., 2022).

Half-life: The time it takes for a drug’s concentration in the plasma or the total amount in the body to decrease by 50%. After one half-life, a drug’s concentration in the body reaches half of the initial dose (Gunaydin et al., 2018).

• A drug’s elimination half-life is valuable since it provides a precise indication of the time the drug’s effect will persist in a patient. Besides, the half-life shows if the drug’s accumulation would occur with a multiple dosing regimen.

Invega Sustenna’s half-life includes:

• Oral dose: 23 hrs
• 1-monthly IM: 25-49 days
• 3-monthly IM: 118-139 days
• 6-monthly IM: 148 days (1,092-mg dose); 159 days (1,560-mg dose)

Side effects/adverse reaction potentials

The common side effects of Invega Sustenna are nasal congestion, dry mouth, dizziness, somnolence, fatigue, restlessness, anxiety, and weight gain (Emsley & Kilian, 2018).

Invega Sustenna therapy is also associated with prolonged QTc interval and postural hypotension.

IM formulations are associated with local injection site and hypersensitivity reactions.

Contraindications

Previous hypersensitivity to Invega Sustenna or risperidone (Emsley & Kilian, 2018).

Contraindications due to drug-to-drug interactions

• The dose should be re-evaluated with the initiation or discontinuation of carbamazepine.
• The dose should be re-evaluated with initiation or discontinuation of Divalproex.
• Invega Sustenna can antagonize levodopa and dopamine agonists ((Minwalla et al., 2021).

Overdose Considerations

• Cases of overdose only occur in oral formulations.
• The potential for overdose in IM formulations is low since it is administered by healthcare professionals (Mathews et al., 2019).
• Overdose signs and symptoms: Extrapyramidal symptoms and gait instability.

Diagnostics and Labs Monitoring

• Monitor for hyperglycemia, including polyuria, polydipsia, and polyphagia (Minwalla et al., 2021).
• Monitor WBC- drug causes Leukopenia, neutropenia, and agranulocytosis (Mathews et al., 2019).
• Monitor orthostatic vital signs in persons vulnerable to hypertension.

Comorbidities considerations

• Persons with Parkinson’s disease may have more sensitive to CNS and extrapyramidal effects. Dose considerations should be made (Minwalla et al., 2021).
• Avoid Paliperidone in patients with severe preexisting GI stenosis.
• Caution is needed in persons with a history of seizures or disorders that reduce the seizure threshold.

Legal and ethical considerations

Ethical principles that should be considered when prescribing Paliperidone:

• Autonomy: Seek consent before initiating treatment. The clinician should inform the patient of the drug’s MOA and possible side effects.
• Beneficence: The clinician should ensure that the drug will promote the best possible outcome for the patient.
• Nonmaleficence: The clinician should consider the drug’s side effects and ensure the benefits outweigh the risks (Minwalla et al., 2021).

Pertinent patient education considerations

• Patients should be educated about the drug’s risk of metabolic changes, including how to identify symptoms of hyperglycemia and diabetes mellitus.
• Educate patients on monitoring weight, blood glucose, and cholesterol levels (Minwalla et al., 2021).
• Females of reproductive age should be informed that Paliperidone can affect fertility due to raised levels of prolactin in the serum (Minwalla et al., 2021).
• Treatment compliance should be emphasized to promote the desired treatment outcomes.

Conclusion

Invega sustenna is a second-generation antipsychotic FDA-approved to treat schizophrenia ad schizoaffective disorder. It is also used off-label to manage Bipolar 1Disorder. The drug is available in oral and injection suspension formulations. The injection formulations are administered IM and are usually given 1-monthly, 3-monthly, and 6-monthly. Patients on Invega sustenna should be monitored for hyperglycemia, WBC, and orthostatic vital signs. The clinician should obtain the patient’s consent before initiating treatment and ensure the benefits outweigh the side effects.

References

Emsley, R., & Kilian, S. (2018). Efficacy and safety profile of paliperidone palmitate injections in the management of patients with schizophrenia: an evidence-based review. Neuropsychiatric disease and treatment, 14, 205–223. https://doi.org/10.2147/NDT.S139633

Gunaydin, H., Altman, M. D., Ellis, J. M., Fuller, P., Johnson, S. A., Lahue, B., & Lapointe, B. (2018). Strategy for Extending Half-life in Drug Design and Its Significance. ACS medicinal chemistry letters, 9(6), 528–533. https://doi.org/10.1021/acsmedchemlett.8b00018

Li, K., Liao, Y., Yang, Z., Yang, C., Chen, M., Wu, X., & Gan, Z. (2021). Case Report: Paliperidone Palmitate in the Management of Bipolar I Disorder With Non-compliance. Frontiers in psychiatry, 11, 529672. https://doi.org/10.3389/fpsyt.2020.529672

Mathews, M., Gopal, S., Nuamah, I., Hargarter, L., Savitz, A. J., Kim, E., Tan, W., Soares, B., & Correll, C. U. (2019). Clinical relevance of paliperidone palmitate 3-monthly in treating schizophrenia. Neuropsychiatric disease and treatment, 15, 1365–1379. https://doi.org/10.2147/NDT.S197225

Minwalla, H. D., Wrzesinski, P., Desforges, A., Caskey, J., Wagner, B., Ingraffia, P., … & Urits, I. (2021). Paliperidone to Treat Psychotic Disorders. Neurology International, 13(3), 343-358. https://doi.org/10.3390/neurolint13030035

Shi, J., Wang, D., Tian, Y., Wang, Z., Gao, J., Liu, N., … & Xiang, M. (2022). Comparison of Paliperidone Palmitate from Different Crystallization Processes and Effect on Formulations In Vitro and In Vivo. Pharmaceutics, 14(5), 1094. https://doi.org/10.3390/pharmaceutics14051094

 

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