Melissa Hinkhouse Advanced Pharmacology NURS-6521N-43 Professor Dr. Vicki Gardin Discussion Board Week 1-Original Post 11/30/2020 I have worked in an outpatient behavioral health clinic for the past seven years with many different providers. I live in a rural community, many patients wait six to twelve months to be seen. Patients being treated for Attention Deficit Disorder must be officially tested before being seen by a Psychologist. For this discussion board post, I have changed the name of my patient to Paul to ensure patient confidentially. The provider I worked with this particular patient will also be referred to as PMHNP to ensure provider confidentiality. Paul was a ten-year-old Caucasian male referred to our clinic diagnosed per DSM criteria, confirmed via Psychologist testing with ADHD. When he saw the Psychologist, he was also diagnosed with mild depression and anxiety. He struggled with concentration, hyperactivity, impulse control, and disorganization. He presented to his appointment with his mother and father, clean, well-nourished, pleasant, interactive with staff, reported no medication allergies, current medication Zyrtec for seasonal allergies. Paul just had his well-child exam and is current on vaccinations and his primary care provider completed lab work to include CBC, CMP, TSH, Vit D, B12, and A1C, all have returned normal. Family history reported father has a history of ADHD (never medicated), brother has a history of depression and anxiety (never medicated treating with psychotherapy), no other significant family history to report. Pauls current weight at his appointment was 30kg. PMHNP spent one hour with Paul and his parents for the initial new patient appointment (Thursday). It was decided Paul would be prescribed Strattera (atomoxetine) 40mg once a day for one week then increase to 80mg once a day. I returned to work on Monday and received a call from Pauls mom, she said he was acting strange. He was tearful, had been in his room with the door closed for most of the weekend, she stated on Sunday she went into his room and he was crying and said he was just thinking about dying and his parents dying. She stated he had already had his meds Sunday so she kept him with her that entire day and made Sunday night a campout night in the Livingroom so he would think it was fun and she could keep a close eye on him. I had a cancelation that morning for him to come to see PMHNP and he was in to see her within twenty minutes and removed from Strattera. His parents decided medications were no longer the route they wanted to try for treatment and a referral was made for psychotherapy. The only medication Paul takes on occasion is Zyrtec which is in an antihistamine drug class, Strattera is a selective norepinephrine reuptake inhibitor; there is no known drug interaction between the two medications. Reflecting on his age and the medication, Strattera has a black box labeled for suicidal ideation with adolescents diagnosed with ADHD (Eli Lilly and Company, 2003). Reviewing Pauls labs, I also do not see that a prior ECG or LFT was complete before starting Strattera. Looking at the Pharmacokinetics of Strattera, it is metabolized in the liver and has been known to cause liver damage. Strattera can also raise blood pressure and has been reported to cause sudden cardiac death (Eli Lilly and Company, 2003). Reviewing Pharmacogenetics and the videos from our resources this week, we should have tested Pauls CYP2D6, as it is essential for metabolization of Strattera and proper dosing (Speed Pharmacology, 2015). As a practitioner, I would have started treatment with an antidepressant, Wellbutrin (Bupropion) is often utilized off label for ADHD and might also assist with the treatment of his depression. Since most antidepressants work by increasing the levels of brain messenger chemicals (neurotransmitters), such as norepinephrine, serotonin, and dopamine, it makes sense that they might have effects similar to other ADHD stimulant and non-stimulant treatments that appear to work by similar mechanisms (Cleveland clinic, 2016). I would have also recommended Psychotherapy to go alongside the medication regimen. As a practicing PMHNP, I plan to focus my areas of focus on adolescents. It will be of the standard of care in my practice for all patients to be properly evaluated and diagnosed via official testing for ADHD and my patient will need to be actively utilizing psychotherapy while undergoing a medication regimen treatment if under my care. I have found through experience involving parents and patients in the treatment plan and education as a mental health case manager to assist with compliance and a more successful outcome for the adolescent. References Cleveland clinic. (2016, July 18). ADHD medications: Strattera, antidepressants & more. Cleveland Clinic. https://my.clevelandclinic.org/health/drugs/12959-attention-deficit-hyperactivity-disorder-adhd-nonstimulant-therapy-stratteraother-adhd-drugs Eli Lilly and Company. (2003). Medication Guide Strattera. www.strattera.com. https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/021411s035lbl.pdf Speed Pharmacology. (2015). Pharmacology Pharmacokinetics (Made Easy) [Video]. https://www.youtube.com/watch?v=NKV5iaUVBUI&t=16s Kyle Johnson Discussion week oneCOLLAPSE Many factors play a role in how medications effects each individual including Pharmacokinetics and pharmacodynamics. According to Rosenthal & Burchum (2018), Pharmacokinetics is the study of drug movement throughout the body(p.4). Whereas Pharmacodynamics is the study of the response from medication entering the body (Rosenthal & Burchum, 2018). As a behavioral health nurse, I have seen patients that have been on antipsychotics for years, and even adolescents placed on their first antipsychotic. Our psychiatrists try and use the newer antipsychotics such as Abilify, Risperdal, or Zyprexa as they are less likely to cause adverse reactions. Even with the atypical antipsychotics, patients can still be sensitive to these medications. One of my memorable admissions was a 40 year old female diagnosed with schizophrenia who comes in with command hallucinations to kill herself and is non-med complaint. She has shown to be sensitive to antipsychotics. During this patients stay, her medications were restarted including Risperdal with Cogentin to help combat unwanted side effects such as neck stiffness. Shortly after the medication was restarted the patient became catatonic. Risperdal has been identified as a medication that can cause catatonia (Huang, et al., 2018). Risperdal was quickly discontinued and Ativan was started on this patient. Ativan has been shown to bring patients out of the catatonic state (Sienaert, at al., 2014). After a few days the patient came out of the catatonic state the patients hallucinations came back and the patient tried to hang herself. Zyprexa and Clozaril were started. Shortly after the initiation of these medications the patient started to get better, but not for long. A week after starting the Clozaril the lab called with a critical lab value indicating agranulocytosis with a decreased neutrophil count (Voulgari, et al., 2015). The medication was stopped and the patient was sent to the medical center for further evaluation. After a week the patient was sent back to behavioral health. She was restarted on Zyprexa and Cogentin to good effect and was later discharged. Medications affect each individual differently requiring their providers to monitor them for adverse reactions. With the increased sensitivity with this patient, I would make sure to start any medication change with the lowest possible dose to monitor for side effects. I would choose medications with less potential for adverse reactions such as Zyprexa. I would lean towards choosing a depo preparation as the patient has a tendency to be non-compliant with treatment. References Huang, M. W., Gibson, R. C., Moberg, P. J., & Caroff, S. N. (2018). Antipsychotics for schizophrenia spectrum disorders with catatonic symptoms. The Cochrane Database of Systematic Reviews, 2018(10), CD013100. https://doi.org/10.1002/14651858.CD013100 Rosenthal, L. D., & Burchum, J. R. (2018). Lehnes pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier. Sienaert, P., Dhossche, D. M., Vancampfort, D., De Hert, M., & Gazdag, G. (2014). A clinical review of the treatment of catatonia. Frontiers in psychiatry, 5, 181. https://doi.org/10.3389/fpsyt.2014.00181 Voulgari, C., Giannas, R., Paterakis, G., Kanellou, A., Anagnostopoulos, N., & Pagoni, S. (2015). Clozapine-Induced Late Agranulocytosis and Severe Neutropenia Complicated with Streptococcus pneumonia, Venous Thromboembolism, and Allergic Vasculitis in Treatment-Resistant Female Psychosis. Case reports in medicine, 2015, 703218. https://doi.org/10.1155/2015/703218 2 resources for each discussion, thank you
Why Choose Us
High Quality, 100% Original, and Well-Researched Papers
HireProWriter always ensures that our writers follow all your instructions precisely. You can pick your academic level: high school, college/university, or professional, and we will assign a writer matching your field or discipline
Professional and Experienced Academic Writers
Our Company has a team of professional writers with experience in business articles, academic papers, and research. The majority are native speakers and capable of tackling any task for which you need assistance.
Free Unlimited Revisions
If you think we missed something in your paper, no worries. Send your order for a free revision. We give you up to 10 days to submit the order for review after you have received the final document. You can do this yourself after logging in to your account or get help from our support.
Prompt Delivery and 100% Money-Back-Guarantee
All papers are always delivered on time. If we need an extension to master your paper, we will contact you on time regarding the deadline extension. In case you cannot provide us with more time, a 100% refund is guaranteed.
Original & Confidential
100% plagiarism-free work! We use premium writing tools to check plagiarism. Our professional editors carefully review all quotations in the text. Besides, we guarantee maximum confidentiality in all of our services.
Customer Support 24/7
Our support team is available 24/7. We are dedicated to giving the best customer experience. Feel free to get in touch any time for assistance.
Try it now!
How it works?
Follow these simple steps to get your paper done
Place your order
Fill in the order form and provide all details of your assignment.
Proceed with the payment
Choose the payment system that suits you most.
Receive the final file
Once your paper is ready, we will email it to you.
Our Services
HireProWriter offers all kinds of writing services.
Essays
No matter what kind of academic assistance you need and how urgent it is, you are welcome to choose your academic level and the type of paper at a reasonable cost. HireProWriter takes care of all your educational paper needs with a 24/7 customer care support system.
Admissions
Admission Essays
An admission essay is an essay or other written statement by a candidate, often a potential student enrolling in a college, university, or graduate school. You don't have to worry about writing a presentable college admission essay. You can be assured that through our services, we will write the best admission essay for you.
Editing
Editing and Proofreading
Our Team (academic writers and editors) make the necessary adjustments to your essay/paper so that it is polished. Besides, we format your document by correctly quoting the sources and creating reference lists per the chosen formats (APA, Harvard, MLA, Chicago / Turabian).
Coursework
Revision Support
We value our clients' feedback. Our system is designed to ensure that we deliver quality work through the collaborative efforts of our team and clients. If you need an improvement in your paper, you are free to request a revision. In such a case, your paper will be rechecked by the writer or assigned to an editor. Your Satisfaction is our Concern!