The Psychopharmacological Medication Agent
cite all work and provide reference page
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%20can%20be%20found,is%20one%20of%20the%20leading%20causes%20of%20disability
Learning Objectives
Students will:
Assess client factors and history to develop personalized therapy plans for patients with insomnia
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring therapy for insomnia
Assess patient factors and history to develop personalized plans of antipsychotic therapy for patients
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring antipsychotic therapy
Synthesize knowledge of providing care to patients presenting for antipsychotic therapy
Analyze ethical and legal implications related to prescribing antipsychotic therapy to patients across the lifespan
Learning Resources
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.
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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)
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.
Loxapine is an antipsychotic drug used to treat schizophrenia symptoms (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions). In the class of drugs known as conventional antipsychotics, loxapine is included. It reduces the brain's aberrant excitation, which is how it works. Loxapine is available as a pill to be swallowed. Two to four times a day is the typical dosage for this drug. Loxapine should be taken at the same time each day if possible. If you don't understand anything on your prescription label, don't hesitate to contact your doctor or pharmacist for clarification. Loxapine must be taken precisely as prescribed (Popovic et al., 2015). Taking more or less of it than suggested by your doctor is not recommended. For the first 7 to 10 days of your therapy, your doctor will likely start you on a low dose of loxapine and gradually raise your dosage until your symptoms are under control. Your doctor may lower your dosage if your symptoms have been under control for some time. During your loxapine therapy, inform your doctor how you feel. Loxapine may help manage your symptoms but won't heal your illness. Loxapine's full effects may not be felt for many weeks or even months. Even if you're feeling OK, don't stop taking loxapine. Talk to your doctor before stopping loxapine.
Valid and Reliable Research for Non-FDA Uses
Antipsychotics have had a tremendous impact on the mental health system. These medications were used in outpatient clinics, community mental health centers, and mental hospitals in the 1960s. Loxapine, one of these substances, has been used to treat schizophrenia since the mid-1970s and is now extensively utilized in nations like France and Canada. The FDA and EU recently approved loxapine inhalation powder to treat agitation in adults with schizophrenia or bipolar disorder (Cassella et al., 2015).
Drug Classification
An antipsychotic drug called Loxapine is used to treat schizophrenia symptoms. In addition to Loxapine, additional drugs may be utilized. Antipsychotics, 1st Generation, is the generic name for Loxapine. No one knows whether Loxapine is safe or effective for youngsters.
The Medication Mechanism of Action
In addition to acting as a serotonin 5-HT2 antagonist, loxapine is also a dopamine antagonist. Subcortical inhibitory regions in numerous animal species have been reported to shift in excitability when Loxapine is administered, which has been linked to calming effects and a reduction in aggressive behavior in animals.
The Medication Pharmacokinetics
Many pharmacological aspects support the atypical nature of loxapine: Atypical antipsychotics have a higher 5-HT2/D2 ratio and dopamine-2 (D2) serotonin-2A (5-HT2A) receptor binding than traditional antipsychotics (Roncero et al., 2016).
The medication Pharmacodynamics
A subclass of tricyclic antipsychotic drugs known as dibenzoxazepine includes loxapine, a dibenzoxazepine molecule chemically separate from thioxanthenes, butyrophenones, and phenothiazines. Antagonizing dopamine and serotonin receptors may cause a considerable cortical inhibition that results in tranquilization and a reduction in aggressiveness. However, the specific mechanism of action has not been discovered.
Mechanism of Action
Pharmacologically, Loxapine is a tranquilizer for which the precise mechanism of action is unknown; nonetheless, it is hypothesized that through antagonizing dopamine and serotonin receptors, there is a strong cortical inhibition that manifests as tranquilization and aggressiveness reduction.
Appropriate Dosing and Administration Route
Adults—Initially, 20 to 50 milligrams (mg) per day, divided and administered in two to four doses per day for capsules. Your physician may raise your dosage if necessary. For oral dose forms (Loxitane® capsules and solution): Adults—Initially, 10 mg twice daily.
Consult your doctor immediately if you have any of the following symptoms while using this medication: Convulsions (seizures), trouble breathing, a rapid pulse, a high temperature, high or low blood pressure, an increase in perspiration, loss of bladder control, severe mu...
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