Case Study For Asian Bipolar Medication Management Discussion

Case Study For Asian Bipolar Medication Management Discussion

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The Assignment: 5 pages ( 5 Peer-reviewed resources )
Week 5 The Assignment: 5 pages

Examine Case Study: An Asian American Woman. Diagnosis-bipolar disorder. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patientâ€s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature. Case Study For Asian Bipolar Medication Management Discussion

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Decision Tree Case Study and My decisions

This case study will serve as the foundation for this weekâ€s Assignment
Bipolar Therapy
Client of Korean Descent/Ancestry
Asian girl
BACKGROUND INFORMATION

The client is a 26-year-old woman of Korean descent who presents to her first appointment following a 21-day hospitalization for onset of acute mania. She was diagnosed with bipolar I disorder.
Upon arrival in your office, she is quite “busy,” playing with things on your desk and shifting from side to side in her chair. She informs you that “they said I was bipolar, I donâ€t believe that, do you? I just like to talk, and dance, and sing. Did I tell you that I liked to cook?”

She weights 110 lbs. and is 5†5”
SUBJECTIVE
Patient reports “fantastic” mood. Reports that she sleeps about 5 hours/night to which she adds “I hate sleep, itâ€s no fun.”
You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits. You find that the patient had genetic testing in the hospital (specifically GeneSight testing) as none of the medications that they were treating her with seemed to work. Case Study For Asian Bipolar Medication Management Discussion

Genetic testing reveals that she is positive for CYP2D6*10 allele.( is a clinically important enzyme that metabolizes numerous therapeutic drugs.)
Patient did well enough on Lithium to be discharged from the hospital but admits she has not been taking it as prescribed. When further questioned on the subject, she provides no additional details.
MENTAL STATUS EXAM
The patient is alert, oriented to person, place, time, and event. She is dressed quite oddly- wearing what appears to be an evening gown to her appointment. Speech is rapid, pressured, tangential. Self-reported mood is euthymic. Affect broad. Patient denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, but insight is clearly impaired. She is currently denying suicidal or homicidal ideation.
The Young Mania Rating Scale (YMRS) score is 22 (The Young Mania Rating Scale (YMRS) is one of the most frequently utilized rating scales to assess manic symptoms. The scale has 11 items and is based on the patientâ€s subjective report of his or her clinical condition . Today the YMRS combines the clients self-report of symptoms of mania over the past 48 hours with the clinician observations during interview (Miller, Johnson & Eisner, 2009) and is now a commonly used tool to screen for manic symptoms and monitor the severity of manic symptoms (Lukasiewicz et al., 2013). Used to assess the severity of manic symptoms, this tool is often used to monitor the progress of interventions ) Case Study For Asian Bipolar Medication Management Discussion

RESOURCES
Chen, R., Wang, H., Shi, J., Shen, K., & Hu, P. (2015). Cytochrome P450 2D6 genotype affects the pharmacokinetics of controlled-release paroxetine in healthy Chinese subjects: comparison of traditional phenotype and activity score systems. European Journal of Clinical Pharmacology, 71(7), 835-841. doi:10.1007/s00228-015-1855-6

Introduction to the case (1 page)
• Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
Choices:
Select what the PMHNP should do:

1) Begin Lithium 300 mg orally BID

2) Begin Risperdal 1 mg orally BID

3) Begin Seroquel XR 300 mg orally at HS

I selected Lithium 300 mg orally BID.
It is critical to note that risperidone is metabolized by the P450 enzyme, in
particular the CYP2D6 (Butler, 2018). Because this client tested positive for
CYP2D6*10, it means that she is a poor metabolizer of risperidone.

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Case Study For Asian Bipolar Medication Management Discussion

RESULTS OF DECISION POINT ONE
• Client returns to clinic in four weeks
• Client informs the PMHNP that she has been taking her drug “off and on” only when she “feels like she needs it”
• Todayâ€s presentation is similar to the first day you met her

Decision #2 (1 page)

Choices for Decision 2:
Select what the PMHNP should do next:
1) Increase Lithium to 450 mg orally BID
2) Assess rationale for non-compliance to elicit reason for non-compliance and educate client re: drug effects, and pharmacology
3) Switch to Depakote ER 500 mg orally at HS

I chose to Assess rationale for non-compliance to elicit reason for non-compliance and educate client re: drug effects, and pharmacology

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

RESULTS OF DECISION POINT TWO
• Client returns to clinic in four weeks
• Client states that the drug makes her nauseated and gives her diarrhea
• Client states that she stops taking it until these symptoms abate, at which point she re-starts only to experience the symptoms again Case Study For Asian Bipolar Medication Management Discussion

Decision #3 (1 page)
Choices for Decision Point Three
Select what the PMHNP should do next:

1) Change to Depakote ER 500 mg at HS
2) Change Lithium to sustained release preparation at same dose and frequency
3) Change to trileptal 300 mg orally BID

I chose to Change Lithium to Sustained release preparation at same dose and frequency

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Case Study For Asian Bipolar Medication Management Discussion

Results of decision 3 : Guidance to Student
In this case, the client is having nausea and diarrhea, classic side effects of lithium therapy. Changing the client to an extended-release formulation can often prevent these symptoms while at the same time affording the client the benefit of lithiumâ€s mood stabilizing properties. Also, lithium is a good choice for control of mania and has also been shown to decrease risk of suicide, which adds to its overall benefits. Depakote may be an option if changing to sustained release lithium does not alleviate the side effects. Oxcarbazpine (Trileptal) is an option, but is a second line therapy and is not appropriate at this stage as the client has not had an adequate trial of first line agents.

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Conclusion (1 page)
• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
Note: Support your rationale with a minimum of five academic resources.

Note: Support your rationale with a minimum of five academic resources. Case Study For Asian Bipolar Medication Management Discussion