NURS_6630 WEEK 7: STUDY GUIDE FOR MEDICATION TREATMENT SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOSIS DISORDERS ASSIGNMENT PAPER

NURS_6630 WEEK 7: STUDY GUIDE FOR MEDICATION TREATMENT SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOSIS DISORDERS ASSIGNMENT PAPER

NURS_6630 WEEK 7: STUDY GUIDE FOR MEDICATION TREATMENT SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOSIS DISORDERS ASSIGNMENT PAPER

Paliperidone Study guide

Paliperidone Study guide
Drug Description
Paliperidone is the drug of interest. Paliperidone is the generic name. Its brand names include Invega Sustenna, Invega, Invega Trinza, Peridol Od, Palicalm Er, Pacedo Er, and Invega Hafyera. Bramante et al. (2023) note that paliperidone is FDA-approved for the acute management and maintenance treatment of schizophrenia. It can be used as a first-line medication and also in long-term therapy. It is also approved for use alone or with other medications for schizoaffective disorder. Paliperidone is not a controlled drug but is available as a prescription-only drug. It is an off-label medication for bipolar disorder (Mauri et al., 2020).

ORDER A CUSTOM PAPER NOW

Drug Classification
It is a neuroleptic or an atypical antipsychotic medication
Mechanism of Action
Paliperidone and risperidone share a similar mechanism of action. It binds to serotonin type 2 and dopamine type 2 receptors and has central dopaminergic and serotonergic antagonism (Mauri et al., 2020). Reducing dopamine and serotonin activity is associated with symptom relief in conditions managed, such as schizophrenia.
Paliperidone Pharmacokinetics
Absorption and bioavailability, metabolism, and excretion
After injecting the drug, it passes the first-pass metabolism in the liver and has a relative bioavailability of 100% despite the dose or injection site. The mean plasma volume of the drug is thus directly proportional to the dose of the drug administered. The oral bioavailability of the drug is 28% due to its poor water solubility, affecting its absorption and transport (Thimmasetty et al., 2020). Formulations that increase absorption of the drug, such as spray dying, can have been shown to increase the oral bioavailability of the drug. The drug binds to blood plasma and is transported to the brain and other regions. The drug is not metabolized in the liver because no active metabolites are found after administration. A significant amount of unchanged drug (59%) is excreted in the urine, and renal excretion is the major excretion route. However, the drug undergoes biotransformation, such as alcohol dehydrogenation, monohyroxylation of the alicyclic ring, and N-dealkylation, and traces of these compounds can be found in feces. Dose adjustment is not necessary for patients with mild to moderate hepatic impairment. The clearance rate changes by almost half in renal insufficiency; hence, dose adjustment is necessary (de Leon, 2020).
Administration Route
The drug is available as extended-release tablets or injections, and the oral route is preferred unless there are hindrances to oral drug uptake.
Side Effects
The side effects of the medication are related to the mechanism of action and include drowsiness, anxiety, dizziness, lightheadedness, tiredness, drooling, abdominal pain, and weight gain. Rare side effects include akathisia, basal ganglia disease, dystonia dyskinesia, orthostatic hypertension, prolonged QT interval, and tachycardia (Drugs.com, n.d.). Symptoms such as facial tics and uncontrollable muscle movements warrant drug withdrawal. The drug has a black bone warning because it increases the risk of death in patients with dementia-related psychosis. Other precautions include an increased risk for neuroleptic malignant symptoms when used with other antipsychotics, cerebrovascular adverse reactions such as stroke in older adults, and dyslipidemia.
Contraindications
Paliperidone is contraindicated in patients with known hypersensitivity to the drug or risperidone. Hypersensitivity reactions such as angioedema and anaphylactic shock have been reported in these patients.
Half-life
Half-life is the time the body takes to reduce the original amount of drug in plasma by half (Ruben et al., 2019). Half-life dictates medication dosage frequencies as doctors try to ensure a sufficient amount of the drug in the system to assert the pharmacotherapeutic function while avoiding toxicity and or drug accumulation in the body. The administration route and formulation dictate paliperidone half-life. Paliperidone slow-release intramuscular injection formulation has a half-life of 24-49 days (Burkl et al., 2022). Thus, the medication is administered at 234mg IM on the first day and then 156 mg after a week to help reach the therapeutic dose. The patient receives 156mg monthly to maintain the therapeutic dose given the drug’s long half-life. The oral formulation half-life is 23 hours, the deltoid injection region is 84 to 85 days, and the gluteal region is 118-139 days (Burk et al., 2022). Oral doses are given daily, and other doses are adjusted accordingly. Knowledge of paliperidone’s half-life can help nurses and other care providers determine accurate dosing and frequency to avoid drug accumulation, toxicity, and risk for death (Drugs.com, n.d.).
Dosage Considerations
The drug’s dosage depends on the patient’s age and diagnosis. The recommended schizophrenia dose in adults is extended-release tablets of 6mg daily OD and, in adolescents, 3mg OD (Drugs.com, n.d.). In schizoaffective disorder, the recommended dose is 3mg to 12mg OD. The medication can be taken with or without food. The IM dose required first-dose titration with a double dose (In adults, 234mg IM initial, I56 after a week, and 156mg IM monthly) (Drugs.com, n.d.).
Dose Considerations in Special Population
The dose should be adjusted for patients with renal impairment and elderly patients. Dose adjustment is directly proportional to creatinine clearance and is titrated as the creatinine clearance improves and the drug is tolerated (starting with 1.5mg OD and increasing to 3mg OD). Use is discontinued for individuals whose creatinine clearance goes below 10ml/min (Drugs.com). Dose adjustment may be necessary for elderly patients due to their renal problems. Renal function should be assessed and diose adjusted for older adults. Withdrawal syndrome is also observed in neonates when the drug is used in the third trimester of pregnancy (Drugs.com). Monitoring of patients in pregnancy is thus vital
Overdose considerations
The drug’s therapeutic range is wide (20-60ng/ml) (de Leon, 2020). Levels above this can be lethal and cause side effects such as akathisia and dystonia.
Diagnostic /Lab Monitoring
Blood pressure monitoring and creatinine clearance due to the perceived side effects and risk for toxicity
Legal and Ethical Considerations
Drug adherence is important in paliperidone use. It is important to consider the adherence of patients when determining whether to administer oral or IM formulations. IM formulations should always be considered for patients with adherence issues. Use when driving or operating machinery should be avoided.
Pertinent patient education consideration
Patient education on adherence is significant for the drug’s potency. The drug is a high risk for somnolence and should thus be avoided when carrying out high-risk activities such as driving and operating machinery (Drugs.com, n.d.). The medication also causes orthostatic hypotension, and one should avoid rising suddenly from a sitting position first to avoid syncope and accidents.

References
Bramante, S., Di Salvo, G., Maina, G., & Rosso, G. (2023). Paliperidone palmitate: a breakthrough treatment for schizophrenia? A review of patient adherence levels, healthcare resource utilization, and costs. Neuropsychiatric Disease and Treatment, 519-530. https://doi.org/10.2147/NDT.S374696
Burk, B. G., Donaldson, V., Jackson, C. W., Cates, M. E., & Birur, B. (2022). Paliperidone-associated sialorrhea: a case report with review of current literature. Journal of Clinical Psychopharmacology, 10-1097. https://doi.org/10.1097/JCP.0000000000001588
de Leon, J. (2020). Personalizing dosing of risperidone, paliperidone, and clozapine using therapeutic drug monitoring and pharmacogenetics. Neuropharmacology, 168, 107656. https://doi.org/10.1016/j.neuropharm.2019.05.033
Drugs.com (n.d.). Paliperidone Prescribing Information. https://www.drugs.com/pro/paliperidone.html
Mauri, M. C., Reggiori, A., Minutillo, A., Franco, G., Di Pace, C., Paletta, S., & Cattaneo, D. (2020). Paliperidone LAI and aripiprazole LAI plasma level monitoring in the prophylaxis of bipolar disorder type I with manic predominance. Pharmacopsychiatry, 53(05), 209-219. https://doi.org/10.1055/a-1113-7862
Ruben, M. D., Smith, D. F., FitzGerald, G. A., & Hogenesch, J. B. (2019). Dosing time matters. Science, 365(6453), 547-549. https://doi.org/10.1126/science.aax7621
Thimmasetty, J., Ghosh, T., Nayak, N. S., & Raheem, A. (2021). Oral bioavailability enhancement of paliperidone by the use of cocrystallization and precipitation inhibition. Journal of Pharmaceutical Innovation, 16, 160-169. https://doi.org/10.1007/s12247-020-09428-2

ORDER A PLAGIARISM-FREE PAPER HERE

WEEK 7: STUDY GUIDE FOR MEDICATION TREATMENT SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOSIS DISORDERS ASSIGNMENT PAPER

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_guidesLinks to an external site.
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.
Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formattingLinks to an external site..
BY DAY 7
You will need to submit your Assignment to two places: the Week 7 Study Guide discussion forum as an attachment and the Week 7 Assignment submission link. Although no responses are required in the discussion forum, a collegial discussion is welcome. You are encouraged to utilize your peers’ submitted guides on their assigned psychotropic medication agent for study.
LEARNING RESOURCES
Required Readings
• 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 schizophreniaLinks to an external site.. 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 clozapineLinks to an external site.. 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 medicationsLinks to an external site.. 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 BulletinLinks to an external site., 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. ChestLinks to an external site., 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 PsychiatryLinks to an external site., 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 DrugsLinks to an external site., 23(8), 649–659. https://doi.org/10.2165/00023210-200923080-00002
• Utah State University. (n.d.). Creating study guidesLinks to an external site.. https://www.usu.edu/academic-support/test/creating_study_guides
Medication Resources
• U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugsLinks to an external site.. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm
Links to an external site.
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.
• 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
• Chakos, M., Patel, J. K., Rosenheck, R., Glick, I. D., Hammer, M. B., Tapp, A., Miller, A. L., & Miller, D. D. (2011). Concomitant psychotropic medication use during treatment of schizophrenia patients: Longitudinal results from the CATIE study. Clinical Schizophrenia & Related PsychosesLinks to an external site., 5(3), 124–134. https://doi.org/10.3371/CSRP.5.3.2
• Fangfang, S., Stock, E. M., Copeland, L. A., Zeber, J. E., Ahmedani, B. K., & Morissette, S. B. (2014). Polypharmacy with antipsychotic drugs in patients with schizophrenia: Trends in multiple health care systems. American Journal of Health-System PharmacyLinks to an external site., 71(9), 728–738. https://doi.org/10.2146/ajhp130471
• Lin, L. A., Rosenheck, R., Sugar, C., & Zbrozek, A. (2015). Comparing antipsychotic treatments for schizophrenia: A health state approach. The Psychiatric QuarterlyLinks to an external site., 86(1), 107–121. https://doi.org/10.1007/s11126-014-9326-2

NURS_6630_Week7_Assignment_Rubric
NURS_6630_Week7_Assignment_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeCreate a study guide, in outline form with references, for your assigned medication. Incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. 30 to >26.0 pts
Excellent Point range: 90–100
The response is in a well-organized and detailed outline form. Informative and well-designed visual elements are incorporated. … Followed directions correctly by uploading assignment to Gradebook and submitted to the discussion forum area. 26 to >23.0 pts
Good Point range: 80–89
The response is in an organized and detailed outline form. Appropriate visual elements are incorporated. … Partially followed directions by uploading assignment to Gradebook but did not submit to the discussion forum area. 23 to >20.0 pts
Fair Point range: 70–79
The response is in outline form, with some inaccuracies or details missing. Visual elements are somewhat vague or inaccurate. … Partially followed directions by submitting to the discussion forum area but did not upload assignment to Gradebook. 20 to >0 pts
Poor Point range: 0–69
The response is unorganized, not in outline form, or is missing. Visual elements are inaccurate or missing. … Did not follow directions as did not submit to discussion forum area and did not upload assignment to gradebook per late policy.
30 pts
This criterion is linked to a Learning OutcomeStudy guide completion elements addressed in Week 7 assignment area 50 to >44.0 pts
Excellent Point range: 90–100
The response thoroughly addresses all required content areas. 44 to >39.0 pts
Good Point range: 80–89
The response adequately addresses all required content areas. Minor details may be missing. 39 to >34.0 pts
Fair Point range: 70–79
The response addresses all required content areas, with some inaccuracies or vagueness. 34 to >0 pts
Poor Point range: 0–69
The response vaguely or inaccurately addresses the required content areas. Or, three or more content areas are missing.
50 pts
This criterion is linked to a Learning OutcomeSupport your guide with references and research providing at least five evidence-based, peer-reviewed journal articles or evidenced-based guidelines. Be sure they are current (no more than 5 years old). 10 to >8.0 pts
Excellent Point range: 90–100
The response is supported by the 5 current, evidence-based resources from the literature. 8 to >7.0 pts
Good Point range: 80–89
The response provides at least 4 current, evidence-based resources from the literature that appropriately support the study guide information. 7 to >6.0 pts
Fair Point range: 70–79
3 evidence-based resources are provided to support the study guide, but they may only provide vague or weak justification. 6 to >0 pts
Poor Point range: 0–69
2 or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence-based.
10 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5 to >4.0 pts
Excellent Point range: 90–100
Uses correct grammar, spelling, and punctuation with no errors. 4 to >3.5 pts
Good Point range: 80–89
Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3.5 to >3.0 pts
Fair Point range: 70–79
Contains several (3 or 4) grammar, spelling, and punctuation errors. 3 to >0 pts
Poor Point range: 0–69
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. 5 to >4.0 pts
Excellent Point range: 90–100
Uses correct APA format with no errors. 4 to >3.5 pts
Good Point range: 80–89
Contains a few (1 or 2) APA format errors. 3.5 to >3.0 pts
Fair Point range: 70–79
Contains several (3 or 4) APA format errors. 3 to >0 pts
Poor Point range: 0–69
Contains many (≥ 5) APA format errors.
5 pts
Total Points: 100
PreviousNext