Respond to Stephanie and Heidi and provide recommendations for alternative drug treatments to address the patient’s pathophysiology.
Bipolar disorder is a psychiatric condition, with depressive symptoms and regular intermittent episodes (Gordovez, & McMahon, 2020). The onset of the disease is in early childhood, and it is continued lifelong. There is a suicidal risk in this disorder, and the patient can also harm others. This disorder cannot be treated with antidepressant therapy alone. Both pharmacologic and non-pharmacologic treatments can treat bipolar disorder. Pharmacologic treatment reduces the symptoms with tolerability and acceptable safety. The procedure is based on the mental health of the patients. Drugs used to treat acute symptoms are Divalproex, lithium, aripiprazole, carbamazepine, and ziprasidone. Quetiapine therapy, olanzapine combined with fluoxetine, is used to treat depression (Baldessarini, Tondo, & Vázquez, 2019).
Pharmacological therapy has adverse effects such as weight gain, nausea, vomiting, headache, fatigue, rashes, sedation, hair loss, dizziness, hyperglycemia, leukopenia, and polycystic ovary syndrome. Lithium can cause fatal renal failure during long term therapy. Olanzapine therapy is followed by weight gain, dyslipidemia, and diabetes. Ziprasidone and aripiprazole are associated with hyperglycemia.
The adverse effect of medications should be controlled during long-term treatment. Many drugs cause more weight gain and dyslipidemia than others. But, before administering the medications, cardiometabolic factors should be accessed to avoid metabolic syndrome. The dosage of prescribed drugs during long term care should be tracked every 3-6 months. The blood test should also be performed every 3-6 months to check the presence of any other dysfunction due to medicines’ side effects. If lithium is used for the treatment, then the patient should be reviewed for renal impairment by a urine test for electrolytes, creatinine, and urea. Thyroid-stimulating hormone (TSH), and calcium should also be monitored. If treated with carbamazepine, perform liver function test, urine test, and complete blood count (CBC). If Divalproex is given, then regularly check weight, menstrual history, and CBC.
Baldessarini, R. J., Tondo, L., & Vázquez, G. H. (2019). Pharmacological treatment of adult bipolar disorder. Molecular psychiatry, 24(2), 198-217.
Culpepper L. (2014). The diagnosis and treatment of bipolar disorder: decision-making in primary care. The primary care companion for CNS disorders, 16(3), PCC.13r01609. doi:10.4088/PCC.13r01609
Gordovez, F. J. A., & McMahon, F. J. (2020). The genetics of bipolar disorder. Molecular Psychiatry, 1-16.
Heidie: Main Discussion Post
The psychological disorder that I chose for the discussion was generalized anxiety disorder. The patient presents with chest tightness, shortness of breath, and feeling of impending doom. The patient was medically cleared in the emergency department (ED) for any type of cardiac event and past medical history consists only of hypertension which is controlled by a low sodium diet. The patient completed the Hamilton Anxiety Rating Scale (HAM-A) questionnaire and scored a 26. The purpose of the HAM-A is to assess the severity and symptoms of anxiety (Thompson, 2015, p. 601). A score of 26 indicates moderate to severe anxiety (Thompson, 2015, p. 601).
The first initial treatment plan selected was to start the patient on Zoloft 50mg. According to Rosenthal & Burchum (2018), selective serotonin reuptake inhibitors (SSRI’s) can be used for all anxiety disorders. After four weeks the patient came back and reported no tightness in chest or shortness of breath, felt he had a decrease in worrying, and new HAM-A score was an 18. The next step in treatment plan was to increase Zoloft to 75mg. The patient came back four weeks after that and reported a further reduction in symptoms and new HAM-A score of 10. The third decision was to continue Zoloft 75mg since the patient had more than a 50% reduction in symptoms and was not experiencing any side effects.
Zoloft is an SSRI that has an off-label use for generalized anxiety disorder and works by inhibiting reuptake of serotonin leading to an increase of serotonin (Singh & Saadabadi, 2020). The recommended initial dose of Zoloft is 50mg (Singh & Saadabadi, 2020). Some adverse effects of Zoloft are syncope, lightheadedness, diarrhea, nausea, sweating, dizziness, confusion, hallucinations, tremor, somnolence, and impotence (Singh & Saadabadi, 2020). Other adverse effects of this medication are that it may inhibit platelet aggregation, prolong the QT interval, and suicide risk can increase (Singh & Saadabadi, 2020). The patient needs educated on the risk of taking blood thinning medications, seeking treatment for any unusual cardiac symptoms, and reporting having suicidal ideations. The patient should be monitored for bleeding risk and take note of any unusual bruising, may need electrocardiograms (EKG’s) to rule out any cardiac side effects, and monitored for manic symptoms. This patient has no other home medications so drug interactions will not take place. The patient also reports drinking 3-4 beers daily and would need to stop that. Drinking alcohol while taking Zoloft can increase the side effects of dizziness, drowsiness, and difficulty concentrating (American Addiction Centers, 2019).
It is important when treating patients with medication that you consider their current medication regimen and what medical problems that they are being treated for to deliver safe, effective patient care.
American Addiction Centers. (2019, October 30). Can you mix alcohol and Zoloft? Retrieved from https://americanaddictioncenters.org/alcoholism-treatment/can-you-mix-alcohol-and-zoloft
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s Pharmacotherapeutics for advanced practice providers. St.Louis, MO: Elsevier.
Singh, H. K., & Saadabadi, A. (2020, March 1). Sertraline – StatPearls – NCBI bookshelf. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK547689/
Thompson, E. (2015). Hamilton rating scale for anxiety (HAM-A). Occupational Medicine, 65(7), 601-601. doi:10.1093/occmed/kqv054