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Treating Patients With Psychosis and Schizophrenia

The Assignment: 5 pages

Examine Case Study: Pakistani Woman With Delusional Thought Processes. 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.
  • Delusional Disorders
    Pakistani Female With Delusional Thought ProcessesDecision Point One

    Start Invega Sustenna 234 mg IM X1 followed by 156 mg IM on day 4 and monthly thereafterRESULTS OF DECISION POINT ONE

    • Client returns to clinic in four weeks
    • A decrease in the PANSS score of 25% (in positive symtpoms) is noted at this visit
    • Client seems to be tolerating medication
    • Her husband has made sure she makes her appointments for injections (one thus far)
    • She has noted a 2-pound weight gain, but it does not seem to be an important point for her
    • She does, however, complain of injection-site pain, telling you that she has trouble sitting for a few hours after the injections and doesn’t like having to walk around for such a long period of time

    Decision Point Two

    Continue same made but instruct administering nurse to begin injections into the deltoid at this visit and moving forwardRESULTS OF DECISION POINT TWO

    • Client returns to clinic in four weeks
    • Her PANNS has been reduced by a total of 50% (in positive symptoms) from the initiation of Invega Sustenna
    • When questioned about injection-site pain, she states it is much better in the arm
    • Her weight has increased by an additional 2.5 pounds (total of 4.5 pounds in a 2-month period). She is somewhat bothered by the weight gain and is afraid that her husband does not like it. He is not present at this visit as she brought herself
    • She likes how she feels on the Invega Sustenna but is wondering if there is another drug like it that would not cause the weight gain

    Decision Point Three

    Continue with the Invega Sustenna. Counsel client on the fact that weight gain from Invega Sustenna is not as much as what other drugs with similar efficacy can cause. Make appointment with a dietician and an exercise physiologist. Follow up in one monthGuidance to Student
    Weight gain can occur with Invega Sustenna. It is modest in nature and can be controlled with proper nutrition and exercise. It is always a good idea to try and control a client’s weight through consultation with a dietician and exercise physiologist (life coach) before switching to another agent when a product is showing efficacy for at least 6 months.Abilify Maintena is a good option for someone who has good response to Abilify oral. Remember that Abilify does not bind to the D2 receptor for a great period of time (such as Invega) and can be less effective in certain individuals. Also, remember that akathisia can be a possible side effect. Once an IM long-acting medication is given, the effects of the drug (both efficacious and untoward effects) can be maintained for a long duration (up to a month or longer). Tolerability and efficacy should be established with oral medication before administering the first injection. Also a disadvantage to Abilify Maintena is that a 2-week overlap of oral therapy is required due to effective blood levels lagging behind the induction dose.Qsymia is a weight loss medication that is a combination of phentermine and topiramate. It is only indicated to treat obesity. This client’s BMI (28.9 kg/M2) does not fit the definition of obesity (BMI >30 Kg/M2- Following from CDC website: Class 1: BMI of 30 to < 35, Class 2: BMI of 35 to < 40, Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as “extreme” or “severe” obesity). There are two things wrong with this therapy option. First, there are only a few occasions where add-on therapy to treat a side effect is acceptable, and weight gain is not one of those scenarios. Secondly, phentermine has a lot of cardiovascular toxicities (such as elevated BP, HR, and increased workload on the heart).

  • Decision #2 (3 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.

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