Go to this website: https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_08/index.html
Follow these steps:
Decision Point One- Click \”Antabuse 250 mg\”
Decision Point Two- Click \”Continue dose of Antabuse and begin Wellbutrin XL 150mg\”
Decision Point Three- Click \”Maintain current doses and refer to counseling for gambling\”
Assignment Paper-
The Assignment: 5 pages
Examine Case Study: 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.
Treating Comorbid Addiction
Name
Institution
Date
Treating Comorbid Addiction
Introduction
The patient case study presents Mrs. Maria Perez who is a 53-years old Puerto Rican female who presents to the clinic with gambling and alcohol use disorder. The patient admits that she has been having alcohol addiction issues since she was 20 years old. For the past 2 years, she notes that she has been having more alcohol since a Casino was established near her home. She claims that she gets high whenever she is gambling and her cigarette smoking has significantly increased over the past 2 years. She also notes her drinking habit has resulted in her gaining weight. She has since gained 7 lb. Moreover, due to her gambling problem, she has a debt of $50,000 from her retirement account, which she borrowed so that she could settle her gambling debts.
The patient’s mental exam indicates that she looks her age. She is alert and oriented to place, time, and event. She has dressed appropriately for the weather and the time of the day. She has a clear, coherent, and goal-oriented speech. During the interview, she avoids eye contact by looking away whenever the therapist looks at her. She has a sad self-reported mood. She denies auditory or visual hallucinations. She denies suicidal ideation. Her insight, judgment, and grossly intact but her impulse control is impaired. The patient’s history of disease and psychosocial history communicate the need to adopt a multifaceted approach, which will not include the use of pharmacological agents but also the use of therapy and counseling.
Decision Point 1 Antabuse (disulfiram) 250 mg orally every Morning
Disulfiram is a disulfide, which is approved by the Federal Drug Agency and is used to treat alcohol use disorder. The drug works through the production of an acute sensitivity towards ethanol. It inhibits the enzyme acetaldehyde dehydrogenase resulting in hangover effects immediately after alcohol consumption. When patients are put on disulfiram, they experience an accumulation of acetaldehyde making the patient experience an increased pulse, nausea, vomiting, facial flushing, hypotension, tachycardia, and when it is severe, cardiovascular collapse (Pedersen et al., 2018).
The other two options of Vivitrol (naltrexone) Injection 380 mg intramuscularly in the gluteal region every four weeks and Campral (acamprosate) 666 mg orally three times/day would be less effective in managing the patient’s condition due to their less tolerable effects. Naltrexone is used for the management of alcohol and nicotine dependence but may show optimal effectiveness especially when the patient experiences a relapse. More so, it has several side effects such as body aches, diarrhea, stomach pain, vomiting, yawning, sweating, fever, and anxiety. Campral is a drug that is used to maintain sobriety among alcohol-dependent adults who no longer drink alcohol (Winslow et al., 2016). This medicine would not be effective since the patient is still alcohol dependent. The drug also promotes suicide ideations and hence would result in the patient hurting herself.
The choice of disulfiram for the management of the patient’s alcohol dependence would be effective in helping the patient deal with her alcohol dependence disorder. Despite the drug having sedative effects, it would be more effective compared to the other two choices. An ethical consideration that would need to be addressed is an addiction to two disorders that need not only medical interventions but a patient’s commitment and willingness to make changes.
Decision Point 2 Continue Dose of Antabuse and begin Wellbutrin XL 150 mg/
After four weeks of being on Antabuse, the client returns to the clinic. She complains about sedation, metallic taste, and fatigue. She claimed that after five days of starting the drug she took one drink and experienced a rapid heartbeat and her face turned red. She also claimed that she continues visiting the casino though her money spending has reduced. However, she notices that cigarette smoking has increased.
The second decision that was adopted was to continue with the current dose of Antabuse and begin Wellbutrin XL 150 mg. The decision to continue with the medication was reached due to its potential to improve the patient’s outcomes as well as its tolerable side effects. Wellbutrin XL 150 mg was chosen based on its pharmacodynamics. The medicine is FDA-approved for smoking cessation (Zawertailo et al., 2018). Bupropion works by enhancing subcortical dopamine as well as norepinephrine effects to mitigate the effects of the nicotine-produced dopamine transmission resulting in a reduction of both nicotine reward and withdrawal experiences (Lyu et al., 2018).
The other two options that were not chosen are continuing with the current dose of Antabuse and beginning Campral 666 mg orally BID and continuing with the current dose of Antabuse and referring to counseling for ongoing gambling issues. The prescription of Campral 666 mg orally BID would not be effective as the medication is only effective for patients that have quit drinking and the high dosage of 666 mg would have severe adverse effects such as anxiety, depression, insomnia, diarrhea, and flatulence on the patient (Shen, 2018). Counseling for ongoing gambling issues would not facilitate the achievement of the desired outcomes since the patient will still be alcohol dependent hence continuing with the cycle of smoking and gambling. An ethical consideration that would need to be looked into would concern the medicines’ tolerability rates and adverse events as compared to the patient’s health needs.
Decision Point 3 Maintain current Doses and Refer to Counselling for Gambling
After being on a combined dose of Antabuse and Wellbutrin for four weeks, the patient returns to the clinic. She claims that though she still smokes, her smoking rate has dropped to only a couple of cigarettes a day. She also reports that the Antabuse side effects that she was experiencing are gone and she feels much better. More so, she reports that she still visits the casino though does not spend as much money as she was spending in the past.
The third decision that was adopted into the case study was maintaining the current doses as well as referral for counseling and gambling. Despite complaints about sedation, among patients prescribed Antabuse, the drug has been evidenced to manage alcohol disorder symptoms. Therefore, to minimize the sedation effects on the patient, it would be advisable to change the time of administration from morning to evening. The metallic taste that the patient has been experiencing is likely to go away with time. The Food and Drug Agency has not yet approved medications for the treatment of gambling and therefore besides the drugs prescribed for the management of alcohol dependence and cessation of smoking, counseling would be the best choice to treat gambling disorder.
The other two choices of continuing Wellbutrin XL to 300 mg orally daily or continuing Wellbutrin XL at 150 mg orally but discontinuing Antabuse would not be appropriate. No evidence indicates that by increasing the dosage of Wellbutrin, the patient’s symptoms will improve. A higher dosage is likely to result in side effects that are more adverse. More so, Wellbutrin can take as long as 12 weeks before it exerts a full therapeutic effect. The discontinuation of Antabuse at 8 weeks would be so soon since the client needs to be on the drug for longer for the medicine to improve the symptoms. An ethical consideration that would be necessary to consider at this decision point would be patient safety. The clinician needs to design a therapeutic plan, which would improve the patient’s health symptoms while at the same having minimal and tolerable side effects.
Conclusion
The patient’s case study attracts the application of a multifaceted approach to health. The patient who has alcohol use disorder and gambling disorder would need the adoption of both medications to manage her alcohol dependence, reduce her smoking habit, and counseling to help her deal with her gambling issue. Counseling would help her understand herself better, the severity of her health, and the choices available that would promote behavior modification. The choice of medication should be guided by the drug’s safety profile such as tolerable side effects that should go away after some time. It is not recommended to change drugs in the middle of a plan to prevent drug toxicity. The decisions made also demonstrate that increasing dosage does not necessarily result in improved health outcomes. Drugs should be given adequate time to achieve their therapeutic effects on patients before additional decisions is made.
References
Lyu, X., Du, J., Zhan, G., Wu, Y., Su, H., Zhu, Y., … & Fan, X. (2018). Naltrexone and bupropion combination treatment for smoking cessation and weight loss in patients with schizophrenia. Frontiers in Pharmacology, 9, 181.
Pedersen, B., Askgaard, G., Jørgensen, C., Oppedal, K., & Tønnesen, H. (2018). Disulfiram for alcohol use disorder. The Cochrane Database of Systematic Reviews, 2018(9), CD010487. https://doi.org/10.1002/14651858.CD010487.pub2
Shen, W. W. (2018). Anticraving therapy for alcohol use disorder: A clinical review. Neuropsychopharmacology reports, 38(3), 105-116. doi:https://doi.org/10.1002/npr2.12028
Winslow, B. T., Onysko, M., & Hebert, M. (2016). Medications for alcohol use disorder. American family physician, 93(6), 457-465.
Zawertailo, L., Mansoursadeghi-Gilan, T., Zhang, H., Hussain, S., Le Foll, B., & Selby, P. (2018). Varenicline and Bupropion for Long-Term Smoking Cessation (the MATCH Study): Protocol for a Real-World, Pragmatic, Randomized Controlled Trial. JMIR research protocols, 7(10), e10826. https://doi.org/10.2196/10826