Patient Medication Guide Essay Assignment Paper

Assignment: Patient Medication Guide – Zyprexa (Olanzapine)

Generic name of the drug: Olanzapine

Brand names: Zyprexa, Zyprexa Relprevv, and Zyprexa Zydis.

Classification:

Olanzapine is a second-generation or atypical antipsychotic medication. Patient Medication Guide Essay Assignment Paper

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Food and Drug Administration (FDA) Approved Uses:

1. Used in the treatment of schizophrenia in patients who are above thirteen years old (Thomas & Saadabadi, 2023).
2. It is used in the treatment of bipolar disorder, especially in treating mixed or manic episodes (Thomas & Saadabadi, 2023).
3. Used in combination with fluoxetine, a selective serotonin reuptake inhibitor (SSRI), in the treatment of patients with episodes of depression that are associated with bipolar I disorder and treatment-resistant depression (Thomas & Saadabadi, 2023). However, its use for depression with fluoxetine is FDA-approved for patients above 10 years (Thomas & Saadabadi, 2023).
4. FDA approved in combination with samidorphan to attenuate olanzapine-induced weight gain in schizophrenia and bipolar I disorder (Thomas & Saadabadi, 2023). Samidorphan is a mu-opioid receptor antagonist that is FDA-approved for the treatment of olanzapine-induced weight gain.

Off-label Uses of Olanzapine:

• Acute agitation
• Anorexia nervosa
• Delirium
• Chemotherapy-induced nausea and vomiting (Thomas & Saadabadi, 2023)Patient Medication Guide Essay Assignment Paper.

Medication Mechanism of Action:

The drug acts primarily on dopamine and serotonin receptors as an antagonist. It is an antagonist at dopamine 2 (D2) receptors in the mesolimbic pathway, inhibiting the actions of dopamine in the post-synaptic receptor (Thomas & Saadabadi, 2023). However, its interaction with D2 receptors is loose, making the drug dissociate easily from the receptor, thus allowing for normal dopamine neurotransmission (Thomas & Saadabadi, 2023). Its action on D2 receptors leads to a reduction in the positive symptoms of schizophrenia, such as delusions, hallucinations, disorganized thought, speech, and behavior (Thomas & Saadabadi, 2023). The medication also acts as an antagonist on serotonin 2A (5HT2A) receptors in the frontal cortex, leading to a decrease in the patient’s negative symptoms of schizophrenia, such as anhedonia, alogia, inattention, avolition, and flat affect (Thomas & Saadabadi, 2023). Its ability to reduce the negative symptoms of schizophrenia increases the drug’s likeability as a medication of choice for the treatment of schizophrenia.

Pharmacokinetics:

Absorption: The drug is administered daily with peak concentrations 6 hours following oral administration and 15 to 45 minutes following intramuscular administration. The drug takes almost a week or seven days to reach a steady state and has an average half-life of 30 hours (20 to 54 hours) (Thomas & Saadabadi, 2023)Patient Medication Guide Essay Assignment Paper.

Half-life definition: Half-life refers to the time that it takes for half of the drug in circulation to be eliminated from the body. In other words, elimination half-life refers to the time required for the concentration of a particular drug to decrease to half of its starting dose in the body (Hallare & Gerriets, 2023). Understanding the half-life determines a drug’s excretion rate and steady-state concentrations (Hallare & Gerriets, 2023). The half-life of drugs helps to dictate the dosing frequencies for medications to ensure steady-state concentrations and, hence, continued effects of the medication.

Distribution: Olanzapine’s volume of distribution is about 1000 liters, and it is distributed widely in the body (Thomas & Saadabadi, 2023). In plasma, it is transported throughout the body bound to albumin and alpha-1 acid glycoprotein (Thomas & Saadabadi, 2023). The drug is transported 93% bound to plasma proteins, leading to a longer duration of action and, hence, a longer elimination half-life.

Metabolism: The medication is extensively metabolized by the liver through glucuronidation and by the cytochrome P450 system largely by CYP1A2 enzyme and to a lesser extent by CYP2D6 enzyme (Thomas & Saadabadi, 2023). Genetic polymorphisms affecting the two cytochrome P450 enzymes that affect the drug’s metabolism do not affect its metabolism.

Excretion: The drug is extracted primarily in urine through the kidneys for 57% of the drug dose and through feces for 30% of the medication (Thomas & Saadabadi, 2023)Patient Medication Guide Essay Assignment Paper.

Pharmacodynamics:

Available Formulations:

The medication is available in tablet and injectable dosages that serve a variety of patients affected by schizophrenia and bipolar I disorder in manic episodes. For the agitated patient who is incapable of taking oral formulations, olanzapine can be administered as an intramuscular injection form drug formulations containing 5mg of olanzapine in 1 mL of injection solution. Oral medication is used in patients who can be compliant with taking the medication orally, and the drug is available in 2.5 mg, 5 mg, 7.5 mg, 10mg, 15 mg, and 20 mg tablets (Thomas & Saadabadi, 2023).

Appropriate Dosing:

In schizophrenia, the medication is administered 5 to 10 mg per day as the starting dose and increased by 5 mg per day at intervals of more than a week (Medscape, n.d.). The maintenance dose of the medication is 10 to 20 mg per day, and the daily dosing should not exceed 20 mg per day (Medscape, n.d.). The intramuscular dosing frequency differs depending on the oral maintenance dose administered to the patient, as a patient taking 20mg per day PO olanzapine will receive an intramuscular (IM) extended-release dose of 300 mg IM every two weeks for 8 weeks, then 300 mg IM every two weeks as opposed to 210 mg IM every 2 weeks or 405 mg IM every four weeks for the first 8 weeks then 150 mg every two weeks or 300 mg every four weeks for patients receiving 10 mg PO (Medscape, n.d.)Patient Medication Guide Essay Assignment Paper.

Bipolar Mania: Monotherapy is given 10 to 15 mg per day PO initially with increments of 5 mg per day every two days. As an adjunct treatment to lithium or sodium valproate, it is given 10mg per day PO. The maintenance dose in bipolar is 5 to 20 mg per day PO (Medscape, n.d.).

Agitation associated with schizophrenia and bipolar mania: Administer IM short-acting olanzapine at 2.5 to 10 mg per dose, with additional doses up to 10 mg two hours after the first dose and four hours after the second dose, not exceeding 30 mg per day (Medscape, n.d.).

Bipolar Depression: In combination with fluoxetine at 5 mg PO in the evening (Medscape, n.d.).

Chemotherapy-associated nausea or vomiting (off-label): Prophylaxis in combination with a serotonin 3 (5HT3) receptor antagonist and dexamethasone at 5 to 10 mg PO daily for three days (Medscape, n.d.).

Considerations for Dosing Alterations:

No dosing alterations are required for renal or hepatic impairment. However, among smokers or tobacco users, there is a need for a 30% increase in the daily dose, given the heightened drug metabolism caused by CYP1A2 induction in smokers (Keepers et al., 2020).

Considerations of use and dosing in Specific Populations:

Children: Not indicated for use in children below 13 years for treatment of schizophrenia or below 10 years in combination with fluoxetine for treatment of depressive episodes in bipolar I disorder.

Elderly: The drug should NOT be used in elderly patients with dementia-related psychosis for risk of increased mortality from increased risk of heart failure, sudden death due to cardiac disease, and pneumonia (Thomas & Saadabadi, 2023)Patient Medication Guide Essay Assignment Paper.

Pregnancy: Evidence of reported extrapyramidal symptoms, feeding disorders, and respiratory distress in neonates exposed to olanzapine during the third trimester (Thomas & Saadabadi, 2023). There is a need to monitor neonates for these adverse effects of the medication.

Breastfeeding: Olanzapine is the preferred agent during breastfeeding due to its low concentrations in human milk and breastfed infants. The primary adverse effect of concern is sedation in the infant (Thomas & Saadabadi, 2023).

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Side Effects/Adverse Reactions Potential:

1. Weight gain – Olanzapine increases appetite, leading to hyperphagia and weight gain (Thomas & Saadabadi, 2023).
2. Metabolic syndrome—The medication causes reduced insulin sensitivity, which could lead to impaired glucose tolerance, especially in younger patients (Thomas & Saadabadi, 2023). The mechanism of action of these adverse effects is postulated to involve an increased expression of TCF7L2, which is crucial in glucose homeostasis caused by weight gain and olanzapine-induced decreased insulin sensitivity.
3. Hematological effects – Neutropenia and thrombocytopenia (Thomas & Saadabadi, 2023). Therefore, there is a need to monitor the patient’s complete blood count on olanzapine.

Clinical concerns with EPS and Tardive Dyskinesia:

Olanzapine’s D2 receptor blockage directly leads to an increased risk of akathisia, tardive dyskinesia, extrapyramidal symptoms, and neuroleptic malignant syndrome (Thomas & Saadabadi, 2023). However, the drug’s lower affinity and ease of dissociation from D2 receptors produce a lower risk for EPS compared to first-generation antipsychotics (Thomas & Saadabadi, 2023)Patient Medication Guide Essay Assignment Paper.

Contraindications:

• The drug is contraindicated in patients known to be hypersensitive to this medication.
• In the elderly with dementia-related psychosis, for a risk of increased mortality from increased risk of heart failure, sudden death due to cardiac disease, and pneumonia (Thomas & Saadabadi, 2023).
• Simultaneous use of benzodiazepines due to sedation and risk of severe cardiorespiratory depression (Thomas & Saadabadi, 2023).
• Caution in obese and diabetes mellitus patients due to olanzapine-induced metabolic dysfunction (Thomas & Saadabadi, 2023).

Overdose considerations:

The therapeutic window of olanzapine is 20 ng/mL to 40 ng/mL (Thomas & Saadabadi, 2023). At 80 ng/mL, adverse effects occur, and the drug is lethal only when used with other medications, such as benzodiazepines (Thomas & Saadabadi, 2023). The drug becomes toxic at serum concentrations above 0.1 mg/L and is fatal at serum concentrations of more than 1 mg/L (Thomas & Saadabadi, 2023).

Diagnostics and Labs Monitoring:

• Monitor blood glucose levels frequently due to the occurrence of olanzapine-induced glucose intolerance.
• Monitor complete blood count for hematological adverse effects such as neutropenia and thrombocytopenia.

Other Considerations:

1. Tap the dose gradually to avoid the risk of physical withdrawal and rebound symptoms associated with discontinuing the drug (Thomas & Saadabadi, 2023)Patient Medication Guide Essay Assignment Paper.
2. Administer the drug in a registered health care facility with ready access to emergency services given the potential of post-injection delirium (). Therefore, the patient should be monitored for at least three hours after injection (Thomas & Saadabadi, 2023).

Pertinent Patient Education Considerations:

1. Encourage an active lifestyle with a healthy diet to combat the metabolic dysfunction associated with the medication.
2. Advise the patient to take medication as prescribed to avoid overdoses that could lead to toxicity, which is characterized by:

• Agitation
• Dysarthria
• Tachycardia and hypotension
• Ventricular arrhythmia
• Respiratory depression
• Extrapyramidal symptoms
• Sedation
• Delirium
• Convulsions, and
• Coma (Thomas & Saadabadi, 2023).

The patient should report immediately to the healthcare setting if these symptoms develop after taking olanzapine.

References

Hallare, J., & Gerriets, V. (2023). Half-life. Treasure Island (FL): Patient Medication Guide Essay Assignment Paper StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554498/

Keepers, A. G., Fochtmann, J. L., Anzia, M. J., Benjamin, S., Lyness, M. J., Mojtabai, R., Servis, M., Walaszek, A., Buckley, P., Lenzenweger, F. M., Young, S. A., Degenhardt, A., & Hong, S. (2020). The American Psychiatric Association practice guidelines for the treatment of patients with schizophrenia. American Journal of Psychiatry, 177(9), 868-872. https://doi.org/10.1176/appi.ajp.2020.177901

Medscape (n.d.). Olanzapine (Rx). Medscape. https://reference.medscape.com/drug/zyprexa-relprevv-olanzapine-342979

Thomas, K., & Saadabadi, A. (2023). Olanzapine. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532903/ Patient Medication Guide Essay Assignment Paper

NURS 6630N WEEK 7 ASSIGNMENT INSTRUCTIONS

TOPIC: DISCUSSION/ASSIGNMENT: PATIENT MEDICATION GUIDE

This week, you will create a Medication Study Guide to share with your peers. This guide is intended to be a useful learning tool for you to use as you prepare for your clinical courses.

 Use Zyprexa (Olanzapine) or one below

TO PREPARE FOR THIS ASSIGNMENT:

• Identify your assigned psychotropic medication agent.
• Review this week’s Learning Resources, including the medication resources indicated for this week.
• Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of vulnerable patient populations requiring antidepressant therapy. Patient Medication Guide Essay Assignment Paper

THE ASSIGNMENT

Create a 3- to 4-page (excluding visual elements) Medication Study Guide for your assigned psychotropic medication agents that may be utilized by you and colleagues for study. Your medication guide should be in the form of an outline and should include a title page, citations, and references. You should incorporate visual elements, such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. Be creative!

Note: Your Medication Study Guide should not be in the format of an APA paper.

Also Note: Your guide should be informed by the FDA-Approved and Evidenced-Based, Clinical Practice Guidelines Research.

Areas of importance that you should address—but are not limited to—include: Patient Medication Guide Essay Assignment Paper

• Title page
• Description of the psychopharmacological medication agent, including brand and generic names, as well as 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
• Appropriate dosing, administration route, and any considerations for dosing alterations
• Considerations of use and dosing in specific specialty populations, such as children, adolescents, elderly, pregnant people, those exhibiting suicidal behaviors, etc.
• Definition of half-life, why half-life is important, and the half-life for your assigned medication
• Side effects/adverse reactions potential
• Discuss clinical concerns with EPS and Tardive Dyskinesia
  Note:Be sure to include screening tools that would be utilized.
• Contraindications for use including significant drug to drug interactions
• Overdose considerations
• Diagnostics and labs monitoring comorbidities considerations
• Legal, ethical, and social considerations
• Pertinent patient education considerations
• References page

Support your rationale with a minimum of three (3) academic resources.

Note: While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing primary and secondary literature. Patient Medication Guide Essay Assignment Paper

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• Review this week’s Learning Resources, including the medication resources indicated for this week.

LEARNING RESOURCES:

• Goldin, D. S. (2023). Fast facts for psychopharmacology for nurse practitioners. Springer Publishing.
  • Chapter 7, “Antipsychotic Medications” (pp. 110–149)
• American Psychiatric Association (2020). The American Psychiatric Association 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 (2023). What is the clozapine REMS?Links to an external site.https://www.newclozapinerems.com/home#Links to an external site.
• Utah State University. (n.d.). Creating study guidesLinks to an external site.. https://www.usu.edu/academic-support/test/creating_study_guides
• comLinks to an external site.. (2023). https://www.drugs.com/
  Note:Please use the following resource to check the most up-to-date box warnings, FDA approvals and indications, recommendations for follow-up evaluations, changes, etc.
• Antipsychotic Medications
  Note:Utilize the following medication table to familiarize yourself with the medications aligned with the topics presented this week. Patient Medication Guide Essay Assignment Paper

You will need to submit your Assignment to two places:

1. Week 7 Medication Guide Discussion forum (linked at the button below) as an attachment
2. Week 7 Medication Guide Assignment submission link 

NOTE BELOW:

Students who use subheadings/paragraphs in their posts get better grades.

PLEASE USE SUBHEADINGS/PARAGRAGHS

 NURS_6630_Week7_Assignment_Rubric

Create a 3- to 4-page (excluding visual elements) Medication Study Guide for your assigned psychotropic medication agents that may be utilized by you and colleagues for study. Your medication guide should be in the form of an outline and should include a title page, citations, and references. You should incorporate visual elements, such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. Be creative!
Note: Your Medication Study Guide should not be in the format of an APA paper.
Also Note: Your guide should be informed by the FDA-Approved and Evidenced-Based, Clinical Practice Guidelines Research.
Areas of importance that you should address—but are not limited to—include:
• Title page
• Description of the psychopharmacological medication agent, including brand and generic names, as well as 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
• Appropriate dosing, administration route, and any considerations for dosing alterations
• Considerations of use and dosing in specific specialty populations, such as children, adolescents, elderly, pregnant people, those exhibiting suicidal behaviors, etc.
• Definition of half-life, why half-life is important, and the half-life for your assigned medication
• Side effects/adverse reactions potential
• Discuss clinical concerns with EPS and Tardive Dyskinesia
Note: Be sure to include screening tools that would be utilized.
• Contraindications for use including significant drug to drug interactions
• Overdose considerations
• Diagnostics and labs monitoring comorbidities considerations
• Legal, ethical, and social considerations
• Pertinent patient education considerations
• References page
Support your rationale with a minimum of three (3) academic resources.
Note: While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing primary and secondary literature.