Medication Treatment For Psychosis And Schizophrenia Essay Paper

Medication Treatment For Psychosis And Schizophrenia Essay Paper

Assignment: Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders
Psychosis and schizophrenia greatly impact the brain’s normal processes, which interfere with the ability to think clearly. When symptoms of these disorders are uncontrolled, patients may struggle to function in daily life. However, patients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, you will develop a study guide for an assigned psychotropic agent for treating patients with Schizophrenia Spectrum and Other Psychotic Disorders. You will share your study guide with your colleagues. In sum, these study guides will be a powerful tool in preparing for your course and PMHNP certification exam. Medication Treatment For Psychosis And Schizophrenia Essay Paper

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To prepare for this Assignment:
Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for treatment of patients with Schizophrenia Spectrum and Other Psychotic Disorders.
Research your assigned psychotropic medication agent using the Walden Library. Then, develop an organizational scheme for the important information about the medication.
Review Learning Resource: Utah State University. (n.d.). Creating study guides. https://www.usu.edu/academic-support/test/creating_study_guides
The Assignment
Create a study guide for your assigned psychotropic medication agents. Your study guide should be in the form of an outline with references, and you should incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. Be creative! It should not be in the format of an APA paper. Your guide should be informed by the FDA-approved and Evidenced-Based, Clinical Practice Guidelines Research but also supported by at least three other scholarly resources.

Areas of importance you should address, but are not limited to, are: Medication Treatment For Psychosis And Schizophrenia Essay Paper

Title page
Description of the Psychopharmacological medication agent including brand and generic names and appropriate FDA indication uses
Any supporting, valid and reliable research for non-FDA uses
Drug classification
The medication mechanism of action
The medication pharmacokinetics
The medication pharmacodynamics
Mechanism of Action
Appropriate dosing, administration route, and any considerations for dosing alterations
Considerations of use and dosing in specific specialty populations to consider children, adolescents, elderly, pregnancy, suicidal behaviors, etc.
Definition of Half-life, why half-life is important, and the half-life for your assigned medication
Side effects/adverse reaction potentials
Contraindications for use including significant drug to drug interactions
Overdose Considerations
Diagnostics and labs monitoring
Comorbidities considerations
Legal and ethical considerations
Pertinent patient education considerations
Reference Page
Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting. Medication Treatment For Psychosis And Schizophrenia Essay Paper

By Day 7
You will need to submit your Assignment to two places: the Week 7 Study Guide discussion forum as an attachment and the Week 7 Assignment submission link. Although no responses are required in the discussion forum, a collegial discussion is welcome. You are encouraged to utilize your peers’ submitted guides on their assigned psychotropic medication agent for study.

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Clozapine

Clozapine is classed as an atypical antipsychotic medicine due to the differences in its dopamine receptor binding profile and its effects on dopamine-mediated behaviours compared to more typical antipsychotic medication products. However, Clozapine does not cause catalepsy or block apomorphine-induced stereotypy, despite its high affinity for the D4 receptor and its ability to interfere with dopamine binding to D1, D2, D3, and D5 receptors. Clozapine is more active in limbic than on the dopamine receptors at the striatum, which may explain why Clozapine is less likely to cause extrapyramidal adverse effects than other antipsychotics (De Leon et al., 2018)Medication Treatment For Psychosis And Schizophrenia Essay Paper. The common brand name of Clozapine is Clozaril. The FDA approves using Clozapine for patients with schizophrenia-associated recurrent suicidal behaviour.

Mechanisms of Action

The mechanism by which Clozapine produces its effects is the blockage of serotonin receptors called 5-HT2A and 5-HT2C, as well as dopamine receptors numbered D1-4, with the drug having the greatest affinity for the D4 dopamine receptor. Clozapine can exert its antipsychotic effects because it is both a serotonin and D4 dopamine antagonist (De Leon et al., 2018). It does not induce many extrapyramidal motor symptoms typically seen with D2 dopamine receptor antagonists.

Pharmacokinetics

Clozapine solution and pills (25 mg and 100 mg) are equally bioavailable. Clozapine’s systemic bioavailability is unaffected by food. Therefore, Clozapine can be taken with or without food. Clozapine binds to serum proteins  97% of the time (De Leon et al., 2018). It is not yet clear how Clozapine and other protein-bound medications interact, but it is critical. Only trace levels of unmetabolized Clozapine are found in the urine and faeces of people who take the medication. Urine and faeces excrete around 50 and 30 percent of the given dosage. The demethylated, hydroxylated, and N-oxide derivatives are high in urine and excrement. Pharmacological testing has indicated that the desmethyl metabolite has only limited action, but the hydroxylated and N-oxide derivatives are ineffective Medication Treatment For Psychosis And Schizophrenia Essay Paper.

Pharmacodynamics

Clozapine is a member of the atypical antipsychotics, which are a subclass of second-generation antipsychotics. Antipsychotic medicines are essential in treating primary symptoms of schizophrenia, such as hallucinations and delusions (Funk et al., 2018).  Clozapine is an atypical antipsychotic that works by blocking dopamine and serotonin receptors in the brain. Adverse effects and symptoms of extrapyramidal disorder are reduced because it has a stronger affinity for the dopamine D4 receptor than the dopamine D2 receptor (Mijovic & MacCabe, 2020).  The reduction of clozapine side effects and other extrapyramidal symptoms occurs because Clozapine is a 5-HT1A partial agonist, an M1, M2, M3, and alpha-1 adrenergic-receptor antagonist. M1 and M4 receptors are targeted by norclozapine, a metabolite of Clozapine, which is effective in treating schizophrenia.

Dosage and Administration Route

The dosage for clozapine medication varies in children, adults, and adolescents.  For adults, it requires an initial dose of 12.5 mg orally once per day. If the initial dose is well, the dosage is increased to 25-50mg daily. At the end of 2 weeks, the target dose is 300-450mg daily. The dosage in adults must not exceed 900mg/day. If, in any case, the therapy is interrupted for more than 48 hours, the therapy must be reinitiated with the initial dosage of 12.5mg daily. Before initiating clozapine dosage, the absolute neutrophil count (ANC) must be greater than or equal to 1500 / microL. A low starting dose is necessary to reduce the risk of bradycardia, syncope and hypotension. The dosage is gradually reduced over two weeks after drug-related neutropenia is diagnosed. An additional ANC monitoring is required for the first two weeks after initiation of the medication. The dosage for Clozapine in children has not been established. Clozapine must only be used during pregnancy when the need is clear. Children born to these mothers may develop specific symptoms during the first three months of life. The symptoms include stiffness of the neck, drowsiness and difficulty in breathing Medication Treatment For Psychosis And Schizophrenia Essay Paper.

Half-life

The half-life of a drug is the time taken for the administered amount of drug to be reduced by half in the body. A single clozapine dosage of 75mg has a mean half-life of 8 hours. Determining a drug’s half-life is essential in determining plasma concentration and the excretion rates of Clozapine. The half-life of drug matters since a short half-life means the drug means there are many withdrawal problems while a long half-life means there are only a few withdrawal problems.

Contraindications

Clozapine is contraindicated in patients with previous hypersensitivity to it or any drug component. The medication is contraindicated in patients with myeloproliferative disorders, paralytic ileus and uncontrolled epilepsy. It is also contraindicated in patients with severe nervous system depression or comatose since it is an atypical antipsychotic drug. It should never be used with an agent with a potential cause of agranulocytosis.

Side Effects/ Adverse Reaction

The side effects are Orthostatic Hypotension, bradycardia and syncope, myocarditis, and Cardiomyopathy. Schizophrenic elderly patients with dementia have an increased risk of death (Kay et al., 1987). Psychosis Clozapine-induced severe neutropenia can lead to life-threatening infections. Before and during therapy with Clozapine, patients must have a baseline blood absolute neutrophil count (ANC) assessed, as well as regular ANC monitoring. Only the Clozapine Risk Evaluation Mitigation Strategy allows access to Clozapine (REMS). Syncope, orthostatic hypotension, and bradycardia are all linked to the amount of medication taken (Clozapine REMS, 2015). There is a recommended starting dose of 12.5mg. Titrate slowly and give recommended more frequent dosages. Patients with a history of seizures or with risk factors for seizures should be monitored closely. Myocarditis, Cardiomyopathy, and Mitral Valve Incompetence; these conditions can lead to death. If these cardiac reactions are evident, an individual should stop taking the medication and have the heart evaluated. Age-Related Dementia Increases Mortality in the Elderly Clozapine has not been authorized to treat psychosis.

Overdose Consideration

The common symptoms of clozapine overdose are psychosis, coma, tachycardia, hypotension, respiratory depression, and hypersalivation. Aspiration pneumonia, heart arrhythmias, and seizures have been reported. There have been reports of fatal overdoses with Clozapine at more than 2500mg doses. Overdoses of more than 4 g have also been seen in patients. It has no particular antidote. Assure adequate oxygenation and ventilation by establishing and maintaining an airway. The heart rate and vital signs should be monitored. Symptomatic and supportive interventions should be taken. Take into account the likelihood of a combination of drugs being involved. Medication Treatment For Psychosis And Schizophrenia Essay Paper

Diagnostics and Lab Monitoring

Patients should be monitored using their vital signs. Regular testing should be done to diagnose neutropenia and agranulocytosis.

Comorbidities Consideration

Dose reduction of Clozapine is considered in patients with renal or hepatic impairment. Clozapine concentration increases in these patients since it is almost completely metabolized in the liver and excreted by the kidneys.

Legal and Ethical Considerations

Clozapine medication should be administered following the recommended protocols or guidelines. Clozapine is a life-saving medication for many patients.

Patient Education

The patient should be informed to take the medication around the same time each day. The patients should be informed about the drug interactions and the adverse effects of clozapine medication. They should be encouraged to report in case any adverse effect of the medication is experienced Medication Treatment For Psychosis And Schizophrenia Essay Paper

References

Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

De Leon, J., Ruan, C., Schoretsanitis, G., & De las Cuevas, C. (2020). A rational use of Clozapine based on adverse drug reactions, pharmacokinetics, and clinical Pharmacopsychology. Psychotherapy and Psychosomatics, 89(4), 200-214. https://doi.org/10.1159/000507638

Funk, M. C., Beach, S. R., Bostwick, J. R., Celano, C. M., Hasnain, M., Pandurangi, A., Khandai, A., Taylor, A., Levenson, J. L., Riba, M., & Kovacs, R. J. (2018). Resource document on QTc prolongation and psychotropic medications. American Psychiatric Association. https://www.psychiatry.org/File%20Library/Psychiatrists/Directories/Library-and-Archive/resource_documents/Resource-Document-2018-QTc-Prolongation-and-Psychotropic-Med.pdf

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Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276. https://doi.org/10.1093/schbul/13.2.261

Mijovic, A., & MacCabe, J. H. (2020). Clozapine-induced agranulocytosis. Annals of Hematology, 99(11), 2477-2482. https://doi.org/10.1007/s00277-020-04215-y Medication Treatment For Psychosis And Schizophrenia Essay Paper