Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Assignment

 Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Assignment

 Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Assignment

Study Guide: Asenapine

Various medications are used to treat schizophrenia spectrum and other psychosis disorders in adult patients. Asenapine is an atypical antipsychotic that can also be used to treat mania and other bipolar disorders. This study guide outlines the pharmacodynamics, pharmacokinetics, ethical and legal considerations, and patient education considerations regarding asenapine.

Description of Asenapine

Asenapine is a second-generation antipsychotic medication. It is a novel atypical antipsychotic that has been used to manage two specific psychotic and mood disorders: schizophrenia and bipolar illness in the manic phase. This medication was approved by FDA in 2009 for use in adults with the above disorders (Carrithers & El-Mallakh, 2020). It is categorized under the drug class dibenzo-oxepino pyrroles under subclass tertiary amines. This medication is commonly sold under the brand name Saphris, Sycrest, and Secuado

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Mechanism of Action of Asenapine

• Asenapine has an affinity to many neuroreceptors: adrenergic, histaminergic, serotonergic, and dopaminergic receptors but with different affinities.
• In neuropsychiatry, it mainly acts as an antagonist at both D2 dopaminergic receptors and 5-HT2 serotonergic receptors.
• The exact mechanism of action is unclear. However, competitive binding to these two receptors causes an efflux of dopamine and serotonin in the synaptic space.

Pharmacokinetics of Asenapine

• Asenapine metabolism is by two pathways: cytochrome P450 and direct glucuronidation
• Glucuronidation is by uridine-diphosphoglucuronate glucuronosyl transferase 1A4 (UGT1A4)
• Various cytochrome P450 isoenzymes also metabolize asenapine: CYP 1A2 (predominant), CYP3A4, and CYP2D6
• This metabolism exerts a first pass effect that deactivates about 95% of this medication
• Bioavailability is determined by the route of administration. The highest bioavailability attained is through the sublingual route (35%)
• The oral route only yields less than 2% into systemic circulation due to the first-pass effect.
• After absorption through sublingual or transdermal routes, asenapine is bound to plasma protein, predominantly albumin (95%). Alfa-1 acid glycoprotein also participates in its transport (Carrithers & El-Mallakh, 2020).
• Maximal plasma concentration is about 4 nanograms per milliliter after one hour after sublingual absorption. These are prolonger with transdermal route
• Excretion is predominantly via the renal system and feces in relatively equal proportions with the sublingual route.

Pharmacodynamics of Asenapine

• Pharmacological effects of asenapine are due to binding to serotonergic receptors than to dopaminergic or other receptors
• Binding to histaminergic receptors can cause sedation and drowsiness
• Antagonistic binding to postsynaptic serotonergic and dopaminergic receptors
• Antidepressant action has been reported through binding to serotoninergic receptors
• Reduction in aggression and aggression is due to binding to dopaminergic receptors
• Asenapine has a lower incidence of extrapyramidal effects due to its low affinity to dopaminergic receptors (Carrithers & El-Mallakh, 2020)
• There are no anticholinergic effects due to no affinity for muscarinic cholinergic receptors
• About 5% under transdermal administration report weight gain as a result of asenapine

Prescription

• Asenapine is available in 2.5 mg, 5 mg, and 10 mg tablets for sublingual tablets (Carrithers & El-Mallakh, 2020).
• The 5mg tablet is the most commonly available. Its dosing is twice daily
• The transdermal patch contains asenapine and other substances such as silicone polymers, backing layers, and transferosomes that aim at improving absorption through this route
• The standard dosing is 3.8 mg/24 hours patch once daily (Carrithers & El-Mallakh, 2020). However, this dose can be increased weekly due to efficacy and tolerability reasons.
• Asenapine is mostly prescribed for adults with schizophrenia and mania. However, those with borderline personality disorder can receive this medication for the management of labile moods and affect
• Dosing considerations are recommended in pediatric, geriatric, and pregnant patients (Williams, 2021)
• Higher risks for adverse effects are seen in the pediatric population such as somnolence nausea, abdominal pain, fatigue, and suicidal ideations (Stepanova et al., 2018)
• Decreased rates of metabolism are an issue with geriatric patients
• Excretion in the breast milk is unknown thus clinicians must prescribe with caution
• Prescription in the third-trimester risks extrapyramidal effects to the unborn fetus thus pregnancy category C. Use of this medication is determined by the benefits that will outweigh this risk.
• Adherence is key to the successful outcomes of drug therapy. Route of demonstration and side effects may affect patient compliance and thus outcomes of therapy

Half-life

Half-life is the time required for the amount of drug in the body to reduce by half when the patient stops taking medication (Stepanova et al., 2018; Karch, 2019).

• This concept enables the prescriber to understand the time required for the body to lose half of the medication and adjust the dosing appropriately thus determining the dosing intervals for the drug (Rosenthal & Burchum, 2020). The half-life for asenapine is an average of about 24 hours. This duration ranges between 13 and 40 hours.

Side Effects

The frequency of side effects depends on the route of administration. Sublingual demonstration causes bitter tastes that interfere with compliance. Some patients have reported oral blisters ulcers, peeling, and inflammation due to the sublingual route of administration. Transdermal route causes skin irritation (Carrithers & El-Mallakh, 2020). Other side effects include but are not limited to somnolence, headache, dizziness, fatigue, anxiety, weight gain, dyspepsia, weight gain, akathisia, oral paresthesia, and extrapyramidal effects (Blokdijk, 2018). Of these side effects, somnolence, oral paresthesia, headache, and dizziness are the commonest

Monitoring

• Serum albumin is an important monitoring tool when assessing the risk of adverse effects because this disease is highly protein bound
• Monitoring levels of other medications that can interfere with hepatic metabolisms such as benzodiazepines
• Monitoring for side effects is key to preventing overdoses. Monotiling weight at baseline and biannually is useful
• Plasma glucose monitoring before initiation of therapy is important to rule out preexisting hyperglycemia
• Blood pressure monitoring at baseline and during every visit is important to watch out for hypertension
• Assessment of suicide risk is important, especially among pediatric patients

Contraindications

• This medication is contraindicated in patients with severe liver disease Child-Pugh class C, known hypersensitivity reaction to asenapine, and those with dementia-related psychosis (Carrithers & El-Mallakh, 2020)
• These are absolute contraindications and also the same as backbox warnings from the food and drug administration (FDA)
• Known hypersensitivity reaction from asenapine is an absolute contraindication for the prescription of asenapine
• Elderly patients with dementia-related psychosis risk death from cerebrovascular events such as transient ischemic attack and stroke
• Drug-drug interactions are relative contraindications. Therefore, dose adjustments may be necessary
• Coadministration with amisulpride is an absolute contraindication
• Common drug-drug interactions include but are not limited to alfuzosin, apomorphine, aripiprazole, artemether, atomoxetine, clozapine, clarithromycin, and benzodiazepines

Comorbidities Considerations

• Comorbidities such as liver disease, hypertension, diabetes mellitus, and cardiovascular events such as stroke and TIA are important considerations before the prescription of asenapine
• These comorbidities increase the risk of mortality during asenapine therapy
• Liver disease increases the risk of mortality due to reduced metabolism
• The risk of cardiovascular events is in DM and hypertension

Legal and Ethical Considerations

• Asenapine is approved by FDA for mania and acute management of schizophrenia among adults. However, off-label management such as borderline personality disorder would benefit
• Toxicity due to asenapine would lead to sedation and somnolence thus risk of mortality (Blokdijk, 2018)
• Asenapine is not an over-the-counter medication and requires a prescription from a specialist
• Ethically, clinicians should not withhold prescribing asenapine where there are clear benefits such as lower incidence of weight gain.
• Benevolence should guide the clinician in care planning
• Doing no harm to the patient by ensuring medication safety is ethically justified. Preventing medication errors is thus useful. The risk of suicidal ideations should be assessed before therapy

Patient Education Considerations

• The patient should be educated on how to apply the transdermal patches (Blokdijk, 2018)
• Patients must be made aware of serious adverse effects and report any suicidal ideations
• Patients must be taught weight management strategies
• Self-management should be taught to the patient’s caregivers

Concussion

Asenapine is a newer second-generation antipsychotic that is FDA-approved. It is an antagonist at dopaminergic, serotonergic, histaminergic, and adrenergic receptors. It is given mostly sublingually and transdermally to bypass the first pass effect. Its half-life is about a day and the sublingual dosing is given twice daily. Common side effects include somnolence, oral paresthesia, dizziness, and headache. Caution is taken for patients with severe liver disease, known hyposensitivity, and in a patient with dementia-related psychosis

References

Blokdijk, G. J. (2018). Asenapine Maleate; A Complete Guide. Createspace Independent Publishing Platform.

Carrithers, B., & El-Mallakh, R. S. (2020). Transdermal asenapine in schizophrenia: A systematic review. Patient Preference and Adherence, 14, 1541–1551. https://doi.org/10.2147/ppa.s235104

Karch, A. M. (2019). Focus on nursing pharmacology (8th ed.). Wolters Kluwer Health.

Rosenthal, L., & Burchum, J. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Saunders.

Stepanova, E., Grant, B., & Findling, R. L. (2018). Asenapine treatment in pediatric patients with bipolar I disorders or schizophrenia: A review. Pediatric Drugs, 20(2), 121–134. https://doi.org/10.1007/s40272-017-0274-9

Williams, L. (2021). NURSING 2022 drug handbook. Independently Published.

Xavier Research Press. (2018). Review of the medical use of asenapine (saphris, sycrest). Createspace Independent Publishing Platform.

BUY A CUSTOM- PAPER HERE ON; Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Assignment

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.
Required Readings (click to expand/reduce)

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)

U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm

Note: 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.
FOR THIS ASSIGNMENT I PREFER EITHER CARIPRAZINE OR PALIPERIDONE, PLEASE AND THANKS.
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)

Chakos, M., Patel, J. K., Rosenheck, R., Glick, I. D., Hammer, M. B., Tapp, A., Miller, A. L., & Miller, D. D. (2011). Concomitant psychotropic medication use during treatment of schizophrenia patients: Longitudinal results from the CATIE study. Clinical Schizophrenia & Related Psychoses, 5(3), 124–134. https://doi.org/10.3371/CSRP.5.3.2

Fangfang, S., Stock, E. M., Copeland, L. A., Zeber, J. E., Ahmedani, B. K., & Morissette, S. B. (2014). Polypharmacy with antipsychotic drugs in patients with schizophrenia: Trends in multiple health care systems. American Journal of Health-System Pharmacy, 71(9), 728–738. https://doi.org/10.2146/ajhp130471

Lin, L. A., Rosenheck, R., Sugar, C., & Zbrozek, A. (2015). Comparing antipsychotic treatments for schizophrenia: A health state approach. The Psychiatric Quarterly, 86(1), 107–121. https://doi.org/10.1007/s11126-014-9326-2
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.

Rubric Detail

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Rubric Detail

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Name: NURS_6630_Week7_Assignment_Rubric
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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.–

Excellent

Point range: 90–100 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.
Good

Point range: 80–89 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.
Fair

Point range: 70–79 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.
Poor

Point range: 0–69 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–

Excellent

Point range: 90–100 45 (45%) – 50 (50%)
The response thoroughly addresses all required content areas.
Good

Point range: 80–89 40 (40%) – 44 (44%)
The response adequately addresses all required content areas. Minor details may be missing.
Fair

Point range: 70–79 35 (35%) – 39 (39%)
The response addresses all required content areas, with some inaccuracies or vagueness.
Poor

Point range: 0–69 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).–

Excellent

Point range: 90–100 9 (9%) – 10 (10%)
The response is supported by the 5 current, evidence-based resources from the literature.
Good

Point range: 80–89 8 (8%) – 8 (8%)
The response provides at least 4 current, evidence-based resources from the literature that appropriately support the study guide information.
Fair

Point range: 70–79 7 (7%) – 7 (7%)
3 evidence-based resources are provided to support the study guide, but they may only provide vague or weak justification.
Poor

Point range: 0–69 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–

Excellent

Point range: 90–100 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
Good

Point range: 80–89 4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
Fair

Point range: 70–79 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) grammar, spelling, and punctuation errors.
Poor

Point range: 0–69 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.–

Excellent

Point range: 90–100 5 (5%) – 5 (5%)
Uses correct APA format with no errors.
Good

Point range: 80–89 4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors.
Fair

Point range: 70–79 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) APA format errors.
Poor

Point range: 0–69 0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors.
Total Points: 100
THANK YOU!!!