Assignment; Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders

Assignment; Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders

Assignment; Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders

Description

Olanzapine is the selected psychopharmacological medication agent for this study guide.

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Brand name- Zyprexa.

FDA indication uses

  • Treatment of Schizophrenia for persons 13 years and above.
  • Acute treatment of Bipolar I disorder for manic and mixed episodes.
  • Adjunct treatment to Fluoxetine to treat Bipolar I-related depression and treatment-resistant depression (TRD) for patients 10 years and above (Thomas & Saadabadi, 2022).
  • Adjunct to valproate or lithium in the treatment of bipolar I disorder manic or mixed episodes.
  • To reduce olanzapine-induced weight gain in patients with schizophrenia and bipolar I disorder alongside samidorphan (Thomas & Saadabadi, 2022).

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Non-FDA Uses

Acute agitation: IM olanzapine is often used off-label to manage acute agitation in critically ill patients. Tsai et al. (2021) found olanzapine to be effective in minimizing the need for sedatives and antipsychotics with a low risk for QTc prolongation and respiratory depression in acutely agitated patients suffering from neurological injuries.

Delirium:  Atypical antipsychotics like olanzapine have emerged as an alternative to the treatment of delirium with fewer side effects (van der Vorst et al., 2020).

Anorexia nervosa: According to Zareifopoulos and Panayiotakopoulos (2019), Olanzapine increases appetite, which can cause weight gain. The side effect is targeted when treating patients with Anorexia nervosa.

Chemotherapy-induced nausea and vomiting (CINV): Zhang and Ying (2022) found that olanzapine was more effective than metoclopramide in controlling breakthrough CINV among patients with highly emetogenic chemotherapy, and it can become an effective antiemetic agent for breakthrough CINV.

Drug classification: Olanzapine is an antipsychotic agent belonging to second-generation or atypical antipsychotics.

The medication mechanism of action

  • Olanzapine is an antagonist that acts on dopamine and serotonin type 2 receptor sites (Meftah et al., 2020).
  • It also blocks dopamine from potential action at the post-synaptic receptor.
  • It binds loosely to the receptor and dissociates easily, which allows for normal dopamine neurotransmission (Thomas & Saadabadi, 2022).

The medication pharmacokinetics

Absorption: Peak plasma time of 6 hours for oral formulations; 15-45 minutes for short-acting IM; 7 days for extended-release IM.

Distribution: 93% of the drug is Protein-bound.

Metabolism: It is extensively metabolized via direct glucuronidation and CYP450 oxidation (Thomas & Saadabadi, 2022). The drug’s metabolites are inactive.

Excretion: 57% via urine and 30 % through urine.

The medication pharmacodynamics

  • Dopamine’s effect on Dopamine 2 receptors decreases positive symptoms like delusions, hallucinations, and disorganized thought, speech, and behavior (Thomas & Saadabadi, 2022).

Appropriate dosing, administration route, and any considerations for dosing alterations

  • Oral: 5-10 mg/day initial dose; 10-20 mg/day maintenance dose.
  • Short-acting IM Injection – 10mg
  • Extended-release IM: 210mg every 2 weeks; 300mg every 2 weeks; 405mg every 4 weeks (Thomas & Saadabadi, 2022).

Considerations for dosing alterations:

  • Dose adjustment may be necessary for hepatic impairment and caution is needed.
  • Start with 5 mg orally OD for patients with risk factors that may slow olanzapine metabolism (Thomas & Saadabadi, 2022).
  • If dosage adjustments are needed, they should be made at intervals > 24 hrs.

Considerations of use and dosing in specific specialty population

Pediatrics: The safety and effectiveness of olanzapine in children below 13 years is not established.

  • The recommended initial dose for adolescents is lower than that for adults.
  • Adolescents are more prone to side effects likely experiencing more weight gain, increased sedation, and greater elevations in total cholesterol, triglycerides, LDL cholesterol, prolactin, and hepatic aminotransferase levels (Meftah et al., 2020).

Pregnancy: Neonates exposed to antipsychotic drugs including Olanzapine, during the 3rd trimester are at risk for extrapyramidal and withdrawal symptoms after delivery.

  • Olanzapine should be used during pregnancy only if the potential benefit outweighs the potential risk to the fetus (Thomas & Saadabadi, 2022).

Nursing mothers: It is recommended that women receiving olanzapine should not breastfeed.

Geriatrics: The presence of factors that might affect pharmacokinetic clearance or increase the pharmacodynamic response to olanzapine should bring about the consideration of a lower starting dose for geriatric patients (Meftah et al., 2020).

Half-life

  • Half-life is the time interval over which an amount of drug in the body is reduced by one-half (Smith et al., 2018).
  • It is a parameter that takes into account drug clearance and its volume of distribution.
  • A drug’ half-life is important since it guides the prescriber in individualizing dosage regimens for patients.
  • Understanding a drug’s half-life is particularly important in determining dosing intervals for chronically-administered drugs, since dosing adjustments may affect a drug’s systemic exposure and plasma fluctuations (Smith et al., 2018).
  • The half-life of Olanzapine ranges from 21 to 54 hours and has a mean of 30 hours.

Side effects/adverse reaction potentials

  • Weight gain: Olanzapine increases weight gain leading to weight gain.
  • Metabolic Changes: Olanzapine is associated with metabolic changes including hyperglycemia, dyslipidemia, and weight gain (Fitzgerald et al., 2021).
  • It reduces insulin sensitivity leading to impaired glucose tolerance and hyperglycemia.
  • Leukopenia, Neutropenia, and Agranulocytosis: Have been reported with Olanzapine.
  • Hyperprolactinemia: Olanzapine may increase prolactin levels.
  • Other common adverse reactions include Postural hypotension, Constipation, Dizziness, Personality disorder, Akathisia, Asthenia, Dry mouth, Dyspepsia, Somnolence, Dizziness, and Tremors (Thomas & Saadabadi, 2022).

Contraindications for use including significant drug-to-drug interactions

  • Dementia-related psychosis: Elderly patients with dementia-related psychosis treated with Olanzapine are at an increased risk of death (Meftah et al., 2020).
  • Contraindicated in patients with documented hypersensitivity to the drug.
  • Co-administration of olanzapine with diazepam potentiates orthostatic hypotension.
  • Carbamazepine therapy causes about a 50% increase in olanzapine clearance (Meftah et al., 2020).
  • Fluvoxamine, a CYP1A2 inhibitor, reduces the clearance of olanzapine.

Overdose Considerations

  • In post-marketing reports of overdose with olanzapine alone, symptoms have been reported in the majority of cases (Đorđević et al., 2022).
  • Symptoms in ≥10% incidence include Agitation/aggressiveness, tachycardia, dysarthria, extrapyramidal symptoms, and reduced level of consciousness (sedation to coma).
  • Peak olanzapine levels are not typically attained until about 6 hours after dosing (Đorđević et al., 2022).
  • Charcoal may be used to treat olanzapine overdose.
  • Acute overdose: Establish and maintain an airway. Ensure adequate oxygenation and ventilation, which may include intubation.
  • There is no specific antidote to olanzapine (Đorđević et al., 2022).

Diagnostics and labs monitoring

  • Patients should be monitored for fasting blood glucose and lipid profiles at the beginning of, and periodically during treatment (Fitzgerald et al., 2021).
  • Patients with a history of leukopenia or drug-induced leukopenia/neutropenia should have their complete blood count monitored frequently during the first few months of therapy (Thomas & Saadabadi, 2022).

Comorbidities considerations

  • Hyperglycemia and Diabetes Mellitus: Prescribers should consider the risks and benefits when prescribing olanzapine to patients with diabetes mellitus or having borderline increased blood glucose levels (Fitzgerald et al., 2021).
  • Seizures: Should be administered cautiously in patients with a history of seizures or with conditions that potentially lower the seizure threshold.

Legal and ethical considerations

Legal and ethical considerations related to the prescription of Olanzapine include beneficence, nonmaleficence, and autonomy.

  • Beneficence: The prescriber should prescribe olanzapine if its effectiveness and safety have been established for the patient’s condition and age group.
  • Nonmaleficence: The drug should be prescribed if the potential benefits outweigh the risks to avoid causing harm to the patient.
  • Autonomy: The patient should be educated about the drug’s benefits and risks and allowed to consent if they wish to be on olanzapine therapy.

Pertinent patient education considerations

  • Prescribers should inform patients, their caregivers, and families about the potential benefits and risks associated with treatment with Olanzapine.
  • They should be counseled on its appropriate use.
  • Patients should be advised of the potential risk of hyperglycemia-related adverse reactions.
  • Patients should be informed that weight gain often occurs during treatment with olanzapine (Fitzgerald et al., 2021).
  • Patients should be advised about appropriate care in avoiding overheating and dehydration.
  • Patients should be advised to avoid alcohol while on olanzapine.
  • Patients should be advised to inform their clinician if they become pregnant or intend to become pregnant during olanzapine therapy (Thomas & Saadabadi, 2022).

References

Đorđević, S., Vukčević, N. P., Antunović, M., Kilibarda, V., Ercegović, G. V., Stošić, J. J., & Vučinić, S. (2022). Olanzapine poisoning in patients treated at the National Poison Control Centre in Belgrade, Serbia in 2017 and 2018: a brief review of serum concentrations and clinical symptoms. Arhiv za higijenu rada i toksikologiju73(2), 126–130. https://doi.org/10.2478/aiht-2022-73-3635

Fitzgerald, I., O’Dwyer, S., Brooks, M., Sahm, L., Crowley, E., & Ní Dhubhlaing, C. (2021). Worth the Weight? Olanzapine Prescribing in Schizophrenia. A Review of Weight Gain and Other Cardiometabolic Side Effects of Olanzapine. Frontiers in psychiatry12, 730769. https://doi.org/10.3389/fpsyt.2021.730769

Meftah, A. M., Deckler, E., Citrome, L., & Kantrowitz, J. T. (2020). New discoveries for an old drug: a review of recent olanzapine research. Postgraduate Medicine132(1), 80–90. https://doi.org/10.1080/00325481.2019.1701823

Smith, D. A., Beaumont, K., Maurer, T. S., & Di, L. (2018). Relevance of Half-Life in Drug Design. Journal of medicinal chemistry61(10), 4273–4282. https://doi.org/10.1021/acs.jmedchem.7b00969

Thomas, K., & Saadabadi, A. (2022). Olanzapine. In StatPearls. StatPearls Publishing.

Tsai, Y. V., Fawzy, J. H., Durkin, J. B., Then, J. E., & McGinnis, C. B. (2021). Off-Label Use of Intravenous Olanzapine for Agitation After Neurologic Injury. Hospital Pharmacy, 56(6), 697–701. https://doi.org/10.1177/0018578720946767

van der Vorst, M. J., Neefjes, E. C., Boddaert, M. S., Verdegaal, B. A., Beeker, A., Teunissen, S. C., … & Verheul, H. M. (2020). Olanzapine versus haloperidol for treatment of delirium in patients with advanced cancer: a phase III randomized clinical trial. The oncologist25(3), e570-e577.

Zareifopoulos, N., & Panayiotakopoulos, G. (2019). Treatment Options for Acute Agitation in Psychiatric Patients: Theoretical and Empirical Evidence. Cureus11(11), e6152. https://doi.org/10.7759/cureus.6152

Zhang, X. L., & Ying, J. E. (2022). Olanzapine for the Prevention and Treatment of Chemotherapy-Induced Nausea and Vomiting: A Review to Identify the Best Way to Administer the Drug. Current Oncology (Toronto, Ont.)29(11), 8235–8243. https://doi.org/10.3390/curroncol29110650

BUY A CUSTOM PAPER HERE ON; Assignment; Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders

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.

Resources:

  • Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.
    • Chapter 4, “Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate” (pp. 77-158)
    • Chapter 5, “Targeting Dopamine and Serotonin Receptors for Psychosis, Mood, and Beyond: So-Called “Antipsychotics” (pp. 159-243)
  • 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

Rubic : 

Create 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.

Support 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).

Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

Written 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.

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