NURS 6630 Week 7 Assignment Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders
NURS 6630 Week 7 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.
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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).
[elementor-template id="144964"]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)
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
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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.
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:
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.
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.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:Freudenreich, O., Goff, D. C., & Henderson, D. C. (2016). Antipsychotic drugs. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 72–85). Elsevier.
American Psychiatric Association. (2019). Practice guideline for the treatment of patients with schizophrenia. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Clinical%20Practice%20Guidelines/APA-Draft-Schizophrenia-Treatment-Guideline.pdf
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
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
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
Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/
McClellan, J. & Stock. S. (2013). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. Journal of the American Academy of Child and Adolescent Psychiatry, 52(9), 976–990. https://www.jaacap.org/article/S0890-8567(09)62600-9/pdf
Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia: Results and implications for clinicians. CNS Drugs, 23(8), 649–659. https://doi.org/10.2165/00023210-200923080-00002
Utah State University. (n.d.). Creating study guides. https://www.usu.edu/academic-support/test/creating_study_guides
Medication Resources (click to expand/reduce)
Optional Resources (click to expand/reduce)
ote: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.
amisulpride
aripiprazole
asenapine
brexpiprazole
cariprazine
chlorpromazine
clozapine
flupenthixol
fluphenazine
haloperidol
iloperidone
loxapine
lumateperone
lurasidone
olanzapine
paliperidone
perphenazine
pimavanserin
quetiapine
risperidone
sulpiride
thioridazine
thiothixene
trifluoperazine
ziprasidone
Optional Resources (click to expand/reduce)Week 7: Therapy for Patients With Schizophrenia
According to the Schizophrenia and Related Disorders Alliance of America, approximately 3.5 million people in the United States are diagnosed with schizophrenia (n.d.), and it is one of the leading causes of disability. In practice, patients may present with delusions, hallucinations, disorganized thinking, disorganized or abnormal motor behavior, as well as other negative symptoms that can be disabling for these individuals. Not only are these symptoms one of the most challenging symptom clusters you will encounter, many are associated with other disorders, such as depression, bipolar disorder, and disorders on the schizophrenia spectrum. As a psychiatric nurse practitioner, you must understand the underlying neurobiology of these symptoms to select appropriate therapies and improve outcomes for patients.
This week, as you examine antipsychotic therapies, you explore the assessment and treatment of patients with psychosis and schizophrenia. You also consider ethical and legal implications of these therapies.
Reference:
Schizophrenia and Related Disorders Alliance of America. (n.d.). About schizophrenia.https://sardaa.org/resources/about-schizophrenia/#:~:text=Quick%20Facts%20About%20Schizophrenia.%20Schizophrenia%20
Rubric Detail
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Name: NURS_6630_Week7_Assignment_Rubric
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Excellent
Point range: 90–100 Good
Point range: 80–89 Fair
Point range: 70–79 Poor
Point range: 0–69
Create a study guide, in outline form with references, for your assigned medication. Incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards.
27 (27%) – 30 (30%)
The response is in a well-organized and detailed outline form. Informative and well-designed visual elements are incorporated.
Followed directions correctly by uploading assignment to Gradebook and submitted to the discussion forum area.
24 (24%) – 26 (26%)
The response is in an organized and detailed outline form. Appropriate visual elements are incorporated.
Partially followed directions by uploading assignment to Gradebook but did not submit to the discussion forum area.
21 (21%) – 23 (23%)
The response is in outline form, with some inaccuracies or details missing. Visual elements are somewhat vague or inaccurate.
Partially followed directions by submitting to the discussion forum area but did not upload assignment to Gradebook.
0 (0%) – 20 (20%)
The response is unorganized, not in outline form, or is missing. Visual elements are inaccurate or missing.
Did not follow directions as did not submit to discussion forum area and did not upload assignment to gradebook per late policy.
Study guide completion elements addressed in Week 7 assignment area
45 (45%) – 50 (50%)
The response thoroughly addresses all required content areas.
40 (40%) – 44 (44%)
The response adequately addresses all required content areas. Minor details may be missing.
35 (35%) – 39 (39%)
The response addresses all required content areas, with some inaccuracies or vagueness.
0 (0%) – 34 (34%)
The response vaguely or inaccurately addresses the required content areas. Or, three or more content areas are missing.
Support your guide with references and research providing at least five evidence-based, peer-reviewed journal articles or evidenced-based guidelines. Be sure they are current (no more than 5 years old).
9 (9%) – 10 (10%)
The response is supported by the 5 current, evidence-based resources from the literature.
8 (8%) – 8 (8%)
The response provides at least 4 current, evidence-based resources from the literature that appropriately support the study guide information.
7 (7%) – 7 (7%)
3 evidence-based resources are provided to support the study guide, but they may only provide vague or weak justification.
0 (0%) – 6 (6%)
2 or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence-based.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) grammar, spelling, and punctuation errors.
0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.
5 (5%) – 5 (5%)
Uses correct APA format with no errors.
4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors.
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) APA format errors.
0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors.
Total Points: 100
Name: NURS_6630_Week7_Assignment_Rubric