How to answer Psychopharmacology case study questions (Solved)

How to answer Psychopharmacology case study questions (Solved)

Psychopharmacology case study prompt
Using the information from the following case study answer these questions.
Case Study
Jeremy Stewart is a 44-year-old married father of three who sees you for a psychiatric evaluation. Jeremy is a professor at a local college, where he teaches art. He also has a small art studio close to campus where he paints. As his psychiatric nurse practitioner, you diagnose Jeremy with bipolar I disorder, most recent episode depressed. When treating a patient for bipolar disorder, you have several medications from which to choose. You decide to start him on Lamictal (lamotrigine).

1. What psychiatric disorders and/or symptoms is Lamictal indicated to treat?
2. What phase of bipolar (manic, mixed, or depressed) is Lamictal most effective in managing?
3. How does Lamictal work and what is the mechanism of action?
4. What is the dosing titration schedule for Lamictal?
5. What are the most serious adverse effects you would educate Jeremy to immediately report to you?
6. Identify any important drug-drug, food-drug, substance-drug, or herb-drug interactions with Lamictal.
7. What is Stevens-Johnson syndrome (SJS)? What are the risk factors for SJS? What are the signs and symptoms of a rash due to SJS versus a benign rash?
8. What are the FDA-approved treatment options for bipolar depression?
9. Compare and contrast these treatment options and describe when you might consider using each of them and why (such as patient symptoms, side effects you want to avoid, or side effects you’d want, and so on).
10. What role do antidepressants have in treating bipolar depression?
11. Provide a link (or upload a PDF) to a clinical practice guideline in the U. S. on the treatment of bipolar depressed phase.

Two resources to include are:
Stahl, S. (2013). Stahl\’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press.

and

Stahl, S. (2017). Essential psychopharmacology prescriber’s guide (6th ed.). New York, NY: Cambridge University Press.

Psychopharmacology questions SOLUTIONS

Question One

Lamictal is prescribed for bipolar disorder maintenance in adults 18 years of age and older to lessen the frequency of manic or depressive episodes.  It is prescribed to delay the occurrence of mood episodes including mixed episodes, hypomania, mania and depression.

Question Two

Lamictel is effective in managing all the three phases of bipolar disorders.  But it is commonly used to lessen the frequency of depressive episodes.

Question Three

Lamotrigine’s method of action is still a mystery. Sodium channels are stabilized by lamotrigine, a triazine, and glutamate is inhibited by this triazine. Lamictel works by inhibiting sodium currents by selectively binding to inactive sodium channels. Binding inhibits the release of glutamate which is an excitatory amino acid.

Question Four

Titration schedules for adults typically include 25 mg/d for weeks 1-2, 50 mg/d for weeks 3-4, and 100 mg/d for week 5. Recommended daily dose: 150-250 mg.

Question Five

I’d tell Jeremy to include weight gain, metabolic dysfunction, drowsiness/somnolence, and akathisia in his list of things to watch out for and report.

Question Six

Many drugs have been reported to interact with lamotrigine.  One of the drugs that interact with lamotrigine includes fluoxetine.  Treatment with fluoxetine leads to a reduced levels of sodium hence using it concomitantly with lamotrigine can increase the risk further. Additionally fluoxetine can cause cancer hence reducing the effectiveness of lamotrigine.  Lamotrigine should not be taken with alcohol as alcohol can increase the side effects related to the nervous subsystem such as difficulty concentrating, dizziness, and drowsiness. Additionally other individuals may experience impairment in thinking and judgment.

Question Seven

Stevens-Johnson Syndrome (SJS) is a life-threatening skin peeling disorder caused by an adverse reaction to drugs or an infection. The disease causes an individual to develop rashes and blisters which then peel off. It affects the skin and the mucus membrane of the mouth eyes and genitalia. There are various risk factors for SJS. They include viral infections, a weakened immune system, a previous history of SJS, and a family history of SJS. Viral infections that can cause the disorder include HIV, hepatitis, herpes or viral pneumonia. Certain medication such as trimethoprim sulphumethaxazole can also cause the disorder. The signs and symptoms of SJS include developing flu like symptoms, appearance of a rash consisting of blemishes that resembles a target i.e. lighter on the outside and darker in the middle. The rash is not normally itchy but spreads very fast. Large blisters will then develop and rapture leaving painful sores. There may be blistering and ulceration on the mouth genitals and the eyes.  In some cases the condition can result into corneal ulceration and vision loss.

Question Eight

The FDA has approved the use of many drugs in the management of bipolar disorders. They include lithium salts, aripiprazole, asenepine, quietipine, olanzapine, fluoxetine, cariprazile, lamotrigine, and risperidone

Question Nine

The various drugs approved for the management of bipolar disorders can only be prescribed in certain phases and depending on the individual patient.  For example lithium is a mood stabilizer.  Lithium is useful in the manic phase of bipolar disorder.  It can also be used to prevent or relive bipolar depression.   Lithium can also be used to prevent future depressive and manic episodes hence it can be prescribed for long periods. In some scenarios the drug can be prescribed to reduce the risk for suicides.  Prozac is a type of selective serotonin reuptake inhibitor often used in the management of bipolar disorder in addition to other mental illness. The drug is used in combination of other atypical antipsychotics the drug is generally preferred in patients with type two bipolar disorder.  It works by altering chemical ratios in the brain.  Prozac is used for short term therapy in managing the depressive state of bipolar disorder.  Prozac cannot be used in the manic phase.

 

Question Ten

Antidepressants are a treatment option for bipolar disorder, but they aren’t always the first line of defense. They are usually used in conjunction with other drugs such as attitude preservative or a neuroleptic. This can help people better control their moods and prevent manic episodes. Depression in bipolar disorder is normally severe and can even cause suicidal thoughts. The antidepressants work by treating the depression in bipolar patients.  They increase the concentration of neurotransmitters in the brain.  Examples of these neurotransmitters are dopamine, norepinephrine and serotonin. These chemicals are regarded as feel good chemicals which can lift the mood of the patient.  This treatment is not recommended as it can trigger the manic phase.

 

References

Bilbul, M., Paparone, P., Kim, A. M., Mutalik, S., & Ernst, C. L. (2020). Psychopharmacology of COVID-19. Psychosomatics, 61(5), 411-427. https://doi.org/10.1016/j.psym.2020.05.006

Carvalho, A. F., Firth, J., & Vieta, E. (2020). Bipolar disorder. New England Journal of Medicine, 383(1), 58-66. https://www.nejm.org/doi/full/10.1056/NEJMra1906193

Hebel, T et al. (2021). Antidepressant effect of repetitive transcranial magnetic stimulation is not impaired by intake of lithium or antiepileptic drugs. European Archives of Psychiatry and Clinical Neuroscience, 1-9. https://doi.org/10.1007/s00406-021-01287-3

Stahl, S. M. (2021). Stahl’s essential psychopharmacology: neuroscientific basis and practical applications. Cambridge university press. https://doi.org/10.1007/s00406-021-01287-3

Vandevelde, A et al. (2021). Common mechanisms involved in manic switch and pain relief induced by lamotrigine: A case report and a literature review. L’encephale. https://doi.org/10.1016/j.encep.2020.10.004

 

Related Posts:

Translate »