Week 8: Pharmacology for Psychological Disorders

How does an advanced practice nurse determine the best treatment option or pharmacotherapeutic to recommend for patients with psychological disorders?

Much like assessing or recommending pharmacotherapeutics for other conditions or disorders, as an advanced practice nurse, you may encounter a patient who presents with a psychological disorder. Understanding the guiding principles related to treating patients with psychological disorders as well as the effects of pharmacotherapeutics on a patient’s overall health and well-being is critical for the safe and effective delivery of care. NURS 6521N Week 8 Assignment

This week, you examine types of drugs prescribed to patients with psychological disorders. You also examine potential impacts of pharmacotherapeutics used to treat psychological disorders on a patient’s pathophysiology.

Learning Objectives

Students will:

• Evaluate patients for treatment of psychological disorders
• Analyze decisions made throughout the diagnosis and treatment of patients with psychological disorders
• Analyze impacts of pharmacotherapeutics for psychological disorders on patient pathophysiology
• Evaluate patients for treatment of neurological and musculoskeletal disorders
• Analyze decisions made throughout the diagnosis and treatment of patients with neurological and musculoskeletal disorders
• Justify decisions made throughout the diagnosis and treatment of patients with neurological and musculoskeletal disorders

Learning Resources – NURS 6521N Week 8 Assignment

Required Readings (click to expand/reduce)

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

• Chapter 24, “Antipsychotic Agents and Their Use in Schizophrenia” (pp. 231–246)
• Chapter 25, “Antidepressants” (pp. 247–265)
• Chapter 26, “Drugs for Bipolar Disorder” (pp. 267–274)
• Chapter 27, “Sedative-Hypnotic Drugs” (pp. 275–285)
• Chapter 28, “Management of Anxiety Disorders” (pp. 287–292)
• Chapter 29, “Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder” (pp. 293–299)

Required Media (click to expand/reduce)

Laureate Education (Producer). (2019a). Adult geriatric depression [Interactive media file]. Baltimore, MD: Author.

 

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat adult geriatric depression.

Laureate Education (Producer). (2019c). Attention deficit hyperactivity disorder [Interactive media file]. Baltimore, MD: Author.

 

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat attention deficit hyperactivity disorder.

Laureate Education (Producer). (2019d). Bipolar therapy [Interactive media file]. Baltimore, MD: Author.

 

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics for bipolar therapy.

Laureate Education (Producer). (2019g). Generalized anxiety disorder [Interactive media file]. Baltimore, MD: Author.

 

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat generalized anxiety disorder.

Discussion: Decision Making When Treating Psychological Disorders

For this Discussion, you will select an interactive media piece to practice decision making when treating patients with psychological disorders. You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine potential impacts of pharmacotherapeutics on a patient’s pathophysiology.

To Prepare

• Review this week’s interactive media pieces and select one to focus on for this Discussion.
• Reflect on the decision steps in the interactive media pieces, and consider the potential impacts from the administration of the associated pharmacotherapeutics on the patient’s pathophysiology.

By Day 3 of Week 8

Post a brief explanation of the psychological disorder presented and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected. Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.

Sample Discussion Approach

General anxiety disorder (GAD) is a condition characterized by persistent and excessive worrying that is hard to control, causes impairment or distress, and occurs on more days than not for at least six months (Baldwin, Stein and Solomon, 2018). The patient’s symptoms of chest tightness and episodes of shortness of breath as well as occasional feelings of impending doom are consistent with the clinical manifestations of GAD. Some symptoms of GAD include restlessness, a sense of dread, tiredness, a noticeably strong, fast or irregular heartbeat and shortness of breath (National Health Service, 2020). The decision steps I used for this patient include a detailed assessment, acquiring the patient’s medical history and ruling out other causes. Decision point one includes prescribing Zoloft 50 mg orally daily. Sertraline (Zoloft) is a selective serotonin reuptake inhibitor (SSRI) and is the most commonly prescribed prototype antidepressant and it is also indicated for other psychological disorders such as panic disorders and post-traumatic stress disorders (Rosenthal and Burchum, 2018). The results of decision point one include the client returning to the clinic in four weeks, the client informing the provider that he has no symptoms of tightness in chest or shortness of breast, decreased worries about work the past 4 or 5 days and a decrease of HAM-A score from 26 to 18. The next decision point was to not change the drug/dose at this time. After four weeks, the client returns reporting no further decreases in anxiety and is wondering if the medication is not effective for him. Decision point three includes increasing the drug to 75 mg PO daily due to the lack of improvement in symptoms. The patient’s symptoms did not get worse therefore switching to a different prototype drug was unnecessary. SSRIs are safer and better tolerated than tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) and for this specific patient who has no history of taking antidepressants or antianxiety medications, starting with an SSRI is a safer choice. SSRIs work by blocking neuronal reuptake of serotonin, a monoamine neurotransmitter. This blockade causes an increase of activation of postsynaptic 5-HT receptors (Rosenthal and Burchum, 2018). Sertraline is administered orally once daily in the morning or evening, it is highly bound to plasma proteins and undergoes extensive hepatic metabolism (Rosental and Burchum, 2018). It is important to continue monitoring the patient for unusual changes in behavior, anxiety, suicidality or other worsening signs of illness (Singh and Saadabadi, 2020). It is also important to monitor patients at risk for bipolar disorder for symptoms of mania and for abdnomal bleeding, adverse effects of medication use or withdrawal symptoms from abrupt discontinuation of sertraline (Singh and Saadabadi, 2020). The treatment plan for this patient should include continued monitoring for adverse effects and improvement in symptoms. NURS 6521N Week 8 Assignment

References:

Baldwin, D., Stein, M. & Solomon, D. (2018). Generalized anxiety disorders in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. UpToDate. Retrieved from https://www.uptodate.com/contents/generalized-anxiety-disorder-in-adults-epidemiology-pathogenesis-clinical-manifestations-course-assessment-anddiagnosis?search=general%20anxiety%20disorder&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H448541396

National Health Service (2020). Generalised anxiety disorder in adults. Retrieved from https://www.nhs.uk/conditions/generalised-anxiety-disorder/symptoms/

Rosenthal, L. D. & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice  providers. St. Louis, MO: Elsevier.

Singh, H. & Saadabadi, A. (2020). Sertraline. StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK547689/

By Day 6 of Week 8

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different interactive media piece on a psychological disorder, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Submission and Grading Information. NURS 6521N Week 8 Assignment

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Week 8 Discussion Rubric

Post by Day 3 of Week 8 and Respond by Day 6 of Week 8

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Assignment: Decision Tree for Neurological and Musculoskeletal

By Day 7 of Week 8

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