Read the answer to a case study below:
1. Select one drug to treat the diagnosis(es) or symptoms.
A medication that would be prescribed for the patient’s alcohol use disorder is naltrexone, and the medication for major depressive disorder is sertraline (Dyna Med, 2024).
2. List the medication class and mechanism of action for the chosen medication.
The medication class for naltrexone is it is a pure opioid antagonist, and a cyclopropyl derivative of oxymorphone similar in structure to naloxone and nalorphine (a morphine derivative) (McGraw Hill Access, 2024), and the mechanism of action is that it blocks opioid receptors inhibiting reward response and reducing cravings (Dyna Med, 2024). The medication class and the mechanism of action of sertraline is that it is a serotonin reuptake inhibitor (SRI), and an SSRI, a selective serotonin reuptake inhibitor, is often classified as an antidepressant, but it is not just an antidepressant (Stahl, 2020).
Write the prescription in prescription format.
Patient information (name, age, and date of birth):
Max Morrison, 35, 10/22/1987.
Medication (RX), name of medication, dose, and form (tablets, liquid, etc.):
Naltrexone 50mg tablet
Instructions:
One tablet PO daily
Dispensing:
30
Refills,
0 refills
Max Morrison, 35, 10/22/1987.
Medication (RX), name of medication, dose, and form (tablets, liquid, etc.):
Sertraline 50 mg tablet
Instructions:
One tablet PO daily
Dispensing:
30
Refills,
0 refills
3. Provide an evidence-based rationale for the selected medication using at least one scholarly reference. Textbooks may be used for additional references but are not the primary reference.
In patients who require treatment for dual diagnoses such as alcohol use disorder and major depressive disorder, a study demonstrated that a combination of sertraline, an SSRI, with naltrexone as a treatment for alcohol dependence would result in higher alcohol discontinuation rates and a significant reduction in depression symptoms with the acceptable incidence of side effects (Alsheikh et al., 2020). Oral naltrexone may reduce the return to any drinking and heavy drinking in patients with alcohol use disorder, and naltrexone alone or in combination with medical management, oral naltrexone may reduce the risk of relapse (Dyna Med, 2024).
4. List any side effects or adverse effects associated with the medication.
Adverse side effects of naltrexone may include nausea, vomiting, headache, dizziness, anorexia, fatigue, somnolence, anxiety, and hepatotoxic effects at high doses (Dyna Med, 2024). Side effects of sertraline include insomnia, diarrhea, sexual dysfunction, decreased appetite, agitation, tremors, headache and tremors, bruising, rare bleeding, rare hypotension, rare seizures, and rare induction of mania (Stahl, 2020).
5. Include any required diagnostic testing. State the time frame for this testing (testing is before medication initiation or q 3 months, etc.). Includes normal results range for any listed laboratory tests.
Required testing for naltrexone is none for treating alcohol dependence, although baseline liver function testing, usually obtained for managing alcohol dependence, may be useful (Stahl, 2020). Common liver function tests, including the normal ranges:
ALT (Alanine transaminase), 7-55 U/L
ASR (Aspartate transaminase), 8-48U/L
ALP (Alkaline phosphatase), 40-129 U/L
Albumin-3.5-5.0 g/dL.
Total protein, 6.3-7,9 g/dL
Bilirubin-(direct) maximum 0.3mg/dL; (indirect)0.1-1.0 mg/dL,
Gamma-glutamyltransferase (GGT)-8-61 U/L,
L-lactase dehydrogenase (LD)122-222 U/L,
Prothrombin time (PT)-9.4-12.5 seconds (Mayo Clinic, 2024).
There is no required testing for sertraline for healthy individuals (Stahl, 2020).
6. Provide a minimum of three appropriate medication-related teaching points for the client and/or family.
Three appropriate medication-related teaching points for the client and family for side effects of naltrexone are nausea, vomiting and decreased appetite, dizziness, dysphoria, and anxiety. Three appropriate medication-related teaching points for the client and family regarding the side effects of sertraline would be to observe for agitation, insomnia, and seizures, which are rare.
Instructions:
Read the above case study reply and reply above agreeing with the medication that was chosen
a. Engage peers and faculty by asking questions, and offering new insights, applications, perspectives, information, or implications for practice. Communicate using respectful, collegial language and terminology appropriate to advanced nursing practice.
b. Communicate with minimal errors in English grammar, spelling, syntax, and punctuation.
c. Reference Citation:Use current 7th edition APA that’s within 5 years using format to format citations and references and is free of errors. 1 paragraph
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