21.Wk1DisRe2

DIRECTIONS

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure. (2 paragraphs and 2 sources)

POST

Being a nurse in the psychiatric field my entire career, I have not only come across my fair share of mentally ill people but also have experienced the detrimental consequences of drug addiction. Many addicts come to the behavioral science unit because of what the drugs make them do and act like. Many meth addicts present as paranoid, restless, manic, and have a completely altered mental status, which makes them a danger to themselves and others. Amphetamine causes an excessive release of dopamine, leading to glutamate overflow. The overflow of glutamate damages the gamma-aminobutyric acid (GABA) interneurons; subsequently, the loss of GABA neurons causes glutamate dysregulation in the cortex, thus the development of psychosis (Fluyau, Mitra, & Lothe, 2019). Hambuchen, Berquist, Simecka, McGill, Gunnell, Hendrickson, and Owens (2019) show us that in rats, liver dysfunction reduced METH clearance, increased brain METH concentrations, and enhanced METH effects on locomotor activity in a dose-dependent manner. Addicts with pre-existing conditions such as cardiovascular disease will be more susceptible to having lethal consequences to this addiction, such as a stroke. Genes that influence the propensity to addiction are likely to do so via a series of processes that predict liability to experimentation with drugs, abuse, and conversion to addiction (Zhou, Blandino, Yuan, Shen, Hodgkinson, Virkkunen, Watson, Akil, and Goldman, 2019). In humans, twin and family studies have revealed that negative emotionality, including anxiety and depression, and externalization, including novelty seeking, impulsivity, and response to novel stimuli, are predictors of addictive liability (Zhou et al., 2019)

My plan of care would first consist of ensuring the patient is in a safe environment, whether this be in a psychiatric unit or a rehab facility. Most of these patients tend to sleep for a few days after their last high since this drug increases dopamine and keeps them alert and awake for days typically. Meth users are especially vulnerable to psychosis, either from worsening of symptoms of underlying psychotic illness or induction of new psychotic symptoms during intoxication and withdrawal. If they are not sleeping it off, antipsychotics can be administered to help with the adverse effects the drug will produce, such as hallucinations and paranoia. Samiei, Vahidi, Rezaee, Yaraghchi, and Daneshmand, R. (2016) suggest that Risperidone and Haloperidol are two effective antipsychotic medications for the treatment of positive symptoms. These could still be administered after they are done sleeping it off as the adverse effects of the drug may again present when they are awake and alert. An ideal situation would be to get them into a rehab facility for treatment of meth addiction and to help them develop a plan to remain abstinent.

References

Fluyau, D., Mitra, P., and Lothe, K. (2019). Antipsychotics for Amphetamine Psychosis. A Systematic Review. Frontiers in Psychiatry. Retrieved from:

https://www.frontiersin.org/article/10.3389/fpsyt.2019.00740

Hambuchen, M. D., Berquist, M. D., Simecka, C. M., McGill, M. R., Gunnell, M. G., Hendrickson, H. P., & Owens, S. M. (2019). Effect of Bile Duct Ligation-induced Liver Dysfunction on Methamphetamine Pharmacokinetics and Locomotor Activity in Rats. Journal of Pharmacy & Pharmaceutical Sciences, 22, 301–312. https://doi-org.ezp.waldenulibrary.org/10.18433/jpps30471

Samiei, M., Vahidi, M., Rezaee, O., Yaraghchi, A., & Daneshmand, R. (2016). Methamphetamine-Associated Psychosis and Treatment With Haloperidol and Risperidone: A Pilot Study. Iranian Journal of Psychiatry & Behavioral Sciences, 10(3), 1–6. https://doi-org.ezp.waldenulibrary.org/10.17795/ijpbs-7988

Zhou, Z., Blandino, P., Yuan, Q., Shen, P.-H., Hodgkinson, C. A., Virkkunen, M., Watson, S. J., Akil, H., & Goldman, D. (2019). Exploratory locomotion, a predictor of addiction vulnerability, is oligogenic in rats selected for this phenotype. PNAS Proceedings of the National Academy of Sciences of the United States of America, 116(26), 13107–13115. https://doi-org.ezp.waldenulibrary.org/10.1073/pnas.1820410116