NURS 6521 Week 1 Assignment Ethical and Legal Implications of Prescribing Drugs
NURS 6521 Week 1 Discussion: Pharmacokinetics and Pharmacodynamics Example 4
My patient is an incarcerated 43-year-old Hispanic male with schizophrenia, currently being treated with 20mg of olanzapine once at nighttime. This treatment has effectively treated the positive and negative symptoms of his mental health illness. However, his blood sugar levels have become elevated lately He has no reported history of diabetes nor other known medical conditions. He has a history of methamphetamine and alcohol use. He has gained approximately twenty pounds over the past three months while incarcerated.
It is well documented that patients undergoing treatment with antipsychotics are at an increased risk of gaining weight and developing diabetes mellitus (DM) in comparison to the general population, an approximate eight to ten-fold increased risk according to Jaworski et al. (2021). Holt (2019) noted that among atypical (second generation) antipsychotics, olanzapine has been associated with the highest rate of weight gain and DM (71%) when compared to first generation antipsychotics (p.4).
Among the atypicals, olanzapine is closely followed by risperidone and quetiapine in causing these adverse effects, with the least likely being ziprasidone and aripiprazole (Khandker et al., 2022, p.2). However, the possible causational mechanism of developing DM associated with initiating antipsychotics is still being studied. There is the general belief that it correlates with weight gain, but there is also evidence that suggests that it may be due to a direct decrease in insulin sensitivity and insulin secretory capacity (Holt, 2019, p. 5).
To determine the best course of treatment to take with this patient, it is important to review and balance the control of symptoms, risk of side effects, and the risk of relapse (Khandker et al., 2022, p. 9). Our patient has a history of taking other antipsychotics including Haldol and risperidone, but the patient experienced most benefit of his symptoms with olanzapine. He does not recall having received treatment with either ziprasidone or aripiprazole.
In this case, I would recommend that we adjust his antipsychotic medication to aripiprazole, monitor for therapeutic response, and continue monitoring his blood sugars. We want to avoid having to treat another disease process if it can be avoided which might be accomplished with this adjustment. It is also important to note that it may be necessary to treat him with olanzapine if it is discovered that he is not responded favorably to other treatments or if the patient wishes to continue with his current treatment after being given the risks of benefits of his options.
Please be mindful of plagiarism and APA format, I have included the rubric. Please use my course resources as one of my references as instructed. Please include Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier in the references.
