NURS 6630N Week 7: Therapy for Patients With Schizophrenia Essay

NURS 6630N Week 7: Therapy for Patients With Schizophrenia Essay

NURS 6630N Week 7: Therapy for Patients With Schizophrenia Essay

            Antipsychotic medication has been the common and standard method of treatment for patients with Schizophrenia. These medications provide the patients with a therapeutic and safe environment effective in controlling symptoms (Chang et al., 2021). Schizophrenia is a disorder affecting the sensory nerves and also creating a great disturbance in the thinking process. Both generic and non-generic drugs have been important in the treatment of Schizophrenia and other disorders. These antipsychotic drugs are commonly used because of the wide spectrum of receptor activity, especially in stabilizing dopamine and serotine levels in the brain. Again, they are effective in controlling symptoms. Therefore, the purpose of this write-up is to develop a study guide for an antipsychotic drug.

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Drug Description

            Paliperidone Palmitate is a drug used in treating Schizophrenia. Its brand name is Invega Sustenna. This drug is approved by the FDA to treat Schizophrenia and other psychosis disorders. The drug is approved to treat the schizoaffective disorder as either adjunctive therapy or monotherapy.   

Non-FDA uses

Invega Sustenna belongs to the general class of antipsychotics, and its non-FDA uses include the treatment of depression and treating hallucinations.

• According to Kverno & Rozenberg (2021), Invega Sustenna is used in treating depression despite the reviews showing that it has been given a rating of 3.9 out of 10 in treating depression. Lower doses of Invega Sustenna are advised when a patient is suffering from mild depression.
• Invega Sustenna has been found to reduce hallucinations and help patients better think of themselves (Kverno & Rozenberg, 2021).

Drug classification

Invega Sustenna is an atypical antipsychotic.

MOA	Pharmacokinetics	Pharmacodynamics
An antagonist for serotonin (5HT2A), alpha-1 and alpha-2 adrenergic receptors	Absorption: Low water solubility: 1-month PP1M Immediate release-25days; extended release- 49days	Reduces the hallucinations and balances the mood by blocking dopamine receptors in the brain.
Acts on dopamine D2 receptors.	Metabolism: Not metabolized extensively but primarily renally excreted
	Elimination:   Excretion: Urine (90%)

Appropriate dosing: 234 mg/day (Immediate release); 156 mg one week later

Children <12 years: safety not established.

Children >12 years: Dose range 3 mg/day (Kverno & Rozenberg, 2021).

Geriatrics: 234 mg/day (Immediate); 156 mg/day (Extended)

Pregnant and breastfeeding women: Not recommended.

Route of Administration:  Injection in the deltoid muscle.

Considerations for dosing alterations: Patients with renal impairment need dosage adjustment of 156mg/day and 117mg a week later.  

Half-life:  The drugs take longer to dissolve and remain active in the body.

• The half-life determines the extent to which the drug would remain active in the body. The elimination of the drug would commence after the half-life has passed (Smith et al., 2018).
• Invega Sustenna has a half-life of 25 days for immediate release formulation and 49 days for extended-release formulation.

Side effects/adverse reaction potentials

Invega Sustenna is associated with numerous side effects such as injection site reactions, dizziness, drowsiness, abnormal muscle movement, shaking, uncontrolled involuntary movements, and inner restlessness (Kverno & Rozenberg, 2021). The neuroleptic malignant syndrome is rare in patients using this drug but can be serious because of D2 receptor blockage.

Contraindications for use including significant drug-to-drug interactions

• Currently, no identified FDA contraindications of Invega Sustenna.
• It is contraindicated in patients taking blood pressure drugs.
• However, Invega Sustenna is associated risk of death caused by NMS as a side effect (Gopal et al., 2018).
• Pregnant women should also not take the drug.

Contraindications due to drug-to-drug interactions

• Doxepine (Silenor) ·
• Eszopiclone ·
• Lunesta;
• Lemborexant (Dayvigo) ·
• Ramelteon ·
• Rozerem
• Suvorexant (Belsomra) ·
• Zaleplon
• Sonata

Overdose Considerations

• Overdose symptoms include faster heartbeats, fainting, and severe drowsiness. Toxicity levels can cause death in older patients (Preskorn, 2022).
• The patient is required to drink plenty of fluids, especially in hot weather.
• Administration of activated charcoal is also a natural remedy that prevents faster drug absorption in the body and increases its elimination process.

Diagnostics and labs monitoring

            The prescription of this drug on a patient would prompt the clinicians to carry out various diagnostics and lab tests to ensure that a patient is fit to take the medication. The clinicians could monitor weight, blood pressure, triglyceride, and glucose levels (Preskorn, 2022). Again, the clinician must have attained the patient’s medical history and seen some of the drugs the patient has been using in the past. Leukopenia (low white blood cells), seizures, eye problems, Parkinson’s disease, and dementia might occur after the administration of Invega Sustenna. Therefore, a complete blood count (CBC) needs to be taken from the patient. In addition, clinicians should look at the older population’s vital orthostatic signs vulnerable to hypertension.

Comorbidities considerations

• Precautions should be taken in patients with heart problems and low potassium levels.
• Patients with blood pressure problems should be tested before and after administration.

Legal and ethical considerations

• Clinicians prescribing Invega Sustenna should not apply without any information on the patient as they may disrespect the patient’s autonomy. Again, the clinicians should uphold beneficence by ensuring that the drug will have the maximum benefit in treating a patient’s schizophrenia condition (Ojimba et al., 2019). Nonmaleficence should be considered to ensure that the side effects do not outweigh the benefits.
• Protecting the confidentiality of a patient is key in healthcare practice and in the case of administering this drug.
• The informed consent of the patient should as well be obtained prior to the administration of the drug.

Pertinent patient education considerations

            The clinicians would have to undertake the initiative of teaching the patient about the benefits as well as side effects of the drug. The patient should understand that the drug would alter the white blood cell count and what they should do in case the situation becomes severe (Ojimba et al., 2019). Besides, the patient should also know the time for their second dose to ensure continuity.

Conclusion

            Invega Sustenna is an atypical antipsychotic, an FDA-approved drug for treating Schizophrenia and mood disorders. It is also used to reduce hallucinations. Invega Sustenna is an antagonist for D2 receptors and serotonin receptors. This effect may sometimes result in the reduction of psychotic symptoms. Patients on Invega Sustenna should be monitored for triglyceride levels, complete blood count weight, blood pressure, and vital orthostatic signs. Ethical principles of autonomy, beneficence, nonmaleficence, confidentiality, and consent should be upheld when prescribing patient Invega Sustenna.

References

Aykut, D. S. (2019). Comparison of paliperidone palmitate and second-generation oral antipsychotics in terms of medication adherence, side effects, and quality of life. Journal of Clinical Psychopharmacology, 39(1), 57-62. https://doi.org/10.3390/pharmaceutics14051094

Chang, C. L., Huang, Y. C., & Yang, P. (2021). Improving of Cognition and Quality of Life in Schizophrenia With One-month and Three-month Paliperidone Palmitate Treatment. https://doi.org/10.21203/rs.3.rs-483945/v1

Gopal, S., Pandina, G., Lane, R., Nuamah, I., Remmerie, B., Coppola, D., & Hough, D. (2018). A post-hoc comparison of paliperidone palmitate to oral risperidone during initiation of long-acting risperidone injection in patients with acute Schizophrenia. Innovations in Clinical Neuroscience, 8(8), 26. https://pubmed.ncbi.nlm.nih.gov/21922067

Kverno, K., & Rozenberg, I. (2021). Long-Acting Injectable Antipsychotics in the Treatment of Schizophrenia: Practical Considerations. Journal of Psychosocial Nursing and Mental Health Services, 59(7), 7-12. https://doi.org/10.3928/02793695-20210611-04

Ojimba, C., Oyelakin, A., & Khandaker, T. (2019). Accidental overdose of paliperidone palmitate. Case Reports in Psychiatry, 2019. https://doi.org/10.1155/2019/7406298

Preskorn, S. H. (2022). How Loading Dose Strategies for Depot Paliperidone Can Go Wrong. Journal of Psychiatric Practice®, 28(2), 130-137. doi: 10.1097/PRA.0000000000000615

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NURS-6630N: Week 7: Therapy for Patients With Schizophrenia
Assignment: Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders. Due on 7/17/22
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.