Unit 12 Assignment – Managing Side Effects Across the Lifespan

Unit 12 Assignment – Managing Side Effects Across the Lifespan: Write a generalized paper concerning common side effects and how to manage these for the psychiatric mental health patient…

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Unit 12 Assignment – Managing Side Effects Across the Lifespan

Instructions

• Write a generalized paper concerning common side effects and how to manage these for the psychiatric mental health patient.
• Why is it important to include side effects in informed consent?
• The paper should be 3-4 pages double spaced then an additional 1-2 pages addressing the following mini-cases.

For the following 5 mini-cases, answer the following questions:

1. What is the potential side effect of the medication that will be started?
2. Is this medication appropriate (right med, right dose, right time, right route) for this patient?
3. What would be another medication(s) you could possibly start and the side effects of that medication(s)?

Patient 1: 67-year-old female who presents with MDD and GAD. She has been treated with Cymbalta in the past however finds it not working very well and having sadness, insomnia, ruminations, and a sense of impending doom again. She is to be started on Pristiq 50mg.

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Patient 2: a 9-year-old male who presents with ADHD and panic disorder. He is to be started on Adderall XR 20mg at noon.

Patient 3: 40-year-old male who presents with Bipolar 1 Disorder and in a manic state after stopping his Abilify for the 3rd time in 8 months. It had been discussed previously to start Abilify Maintena 400mg IM q 4 weeks and will be started today. He has not had PO Abilify for 1 week.

Patient 4: 93-year-old female who presents with the recent loss (6 months ago) of her husband of 58 years. She notes trouble sleeping, not being hungry, and sad. She has no previous psychiatric history and is to be started on paroxetine 30mg daily and quetiapine 200mg hs for her recent insomnia.

Patient 5: 52-year-old female who presents with MDD. She reports recently going through menopause and having a lot of trouble with irritability and hot flashes. Her current medication is not working like it was before and she will be started on clonazepam 0.5mg bid.

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Solution

Managing Side Effects across the Lifespan

Antipsychotics are effective in the treatment of schizophrenia, among other psychotic disorders. However, the side effects of these medications often obscure their benefits. There is a need to weigh the benefits against their adverse effects while treating and managing these mental health problems.

Side effects of the psychotic medication range from mild issues that are tolerable such as a dry mouth, to very unpleasant such as sexual dysfunction and weight gain, to life-threatening effects such as agranulocytosis (Kaar et al., 2020).

Nonetheless, these effects may have short-term clinical implications, while some may involve long-term complications. Castle et al. (2018) add that first-generation antipsychotics are often associated with movement disorders while second-generation antipsychotics, especially olanzapine and clozapine, are associated with metabolic syndrome problems such as type 2 diabetes and obesity. In this regard, all antipsychotics pose a risk of sexual dysfunction, dystonias, akathisia, sedation, orthostatic hypotension, and sudden cardiac death.

Sedation is one of the main side effects of antipsychotic medication. Additionally, it is determined with the dose prescribed by the health provider. Specifically, it may be attributed to poor medication compliance, and if left unattended, it can disrupt the patient’s social and vocational functioning.

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Clozapine is considered the most sedating, while quetiapine and olanzapine significantly affect sedation. According to Castle et al. (2018), most patients become tolerant of this effect. However, this side effect may be addressed by lowering the dosage, switching to a medication with low sedation effects, or changing the dose to once a day before sleep. Additionally, methylphenidate may help treat patients with severe sedation associated with clozapine.

Second, antipsychotics cause sexual dysfunction among patients with mental health issues. Kaar et al. (2020) highlight that approximately 43% of patients under antipsychotics experience sexual dysfunction, which can cause poor adherence to the medication. Specifically, antipsychotics may affect different sexual functions, including orgasm, arousal, and libido, which cause distress to the patients. Both first-generation and second-generation antipsychotics harm the sexual functioning of both men and women.

In most cases, first-generation antipsychotics cause ejaculatory and erectile dysfunction in men. Nonetheless, it is mainly associated with painful ejaculation, affecting their relationships (Kaar et al., 2020). However, this symptom may be addressed by switching to olanzapine which improves the sexual functioning of men and women. Sildenafil may also be essential in treating antipsychotic-induced sexual dysfunction in men (Castle et al., 2018).

Third, antipsychotics may lead to neurological side effects, including dystonias and akathisia. Dystonias refers to the antagonistic muscle groups’ involuntary contractions that cause twisting, abnormal postures, and repetitive movements, especially in the neck, face, or head (Kaar et al., 2020). These effects often occur within days of antipsychotic administration or dose increase.

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Therefore, there is a need to implement the most effective management strategies to reduce the discomfort and pain associated with dystonias. In this regard, it is recommended that one should administer Benztropine prophylaxis to reduce these symptoms, especially if a patient is receiving a first dose of high potency antipsychotics by injection (Stroup & Gray, 2018). If the patient is on a high potency antipsychotic, it would be best to switch to lower potency medication to reduce the risk of dystonias.

On the other hand, akathisia refers to the feeling of tension and restlessness that may induce suicidality (Stroup & Gray, 2018). This side effect often develops gradually over weeks of treatment and varies based on the current antipsychotic dose and the increased dose. Patients prescribed aripiprazole are at the highest risk of having akathisia as it is one of the high potency agents.

Therefore, switching the medication to olanzapine, clozapine, or quetiapine lowers the risk of the side effect and counters these symptoms upon their onset. Additionally, antagonists such as propranolol have been used to help in akathisia therapy, showing moderate efficacy (Kaar et al., 2020). Nonetheless, a PMHCP can recommend benzodiazepines to treat this side effect as it provides a rapid resolution of symptoms.

Forth, all antipsychotics cause orthostatic hypotension where blood pressure drops below normal. This side effect can lead to dizziness, falls, syncope, and worsened angina (Stroup & Gray, 2018). Specifically, sertindole, clozapine, quetiapine, iloperidone, and chlorpromazine have the highest effect on hypotension.

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While treatment is necessary, prevention is the most effective management approach. In this regard, prevention of this side effect relies on the antipsychotic dosing distribution, gradual titration, and medication choice. Additionally, increased consumption of salt and water intake, approximately 1-2 grams per day, can help to reduce hypotension among mental health patients (Stroup & Gray, 2018). Also, if the patient has been on clozapine, fludrocortisone can help to treat orthostatic hypotension.

Fifth, antipsychotics are associated with an increased risk of sudden cardiac death. This side effect is mainly due to rapid administration, high dose, pre-existing ischemic heart disease or hypertension, and butyrophenone or thioridazine antipsychotics (Kaar et al., 2020). One of the measures to address this effect is administering second-generation antipsychotics with a lower risk of sudden cardiac death than first-generation antipsychotics.

Kaar et al. (2020) add that health providers should conduct an electrocardiogram (ECG) before administering any antipsychotics to patients. The American Psychiatric Association recommends that providers carry out a physical examination and an ECG when prescribing ziprasidone, mesoridazine, thioridazine, pimozide, or a family history of sudden cardiac death (Stroup & Gray, 2018). This measure may help to provide the proper treatment with the lowest risks. Additionally, frequent monitoring of high-risk antipsychotics may also help prevent sudden cardiac death.

According to Wu et al. (2019), it is vital to include side effects in informed consent to ensure that the patient is aware of the risk associated with the medication prescribed. The documentation of the informed consent should include the nature of the problem, the risks, and benefits of the procedure, reasonable alternatives, the risks and benefits of the alternatives, and the assessment of patient understanding of the above (Wu et al., 2019).

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Therefore, health providers are obligated to inform the patients about the medication to help decision-making and ensure that the patient is not forced to agree with the provider. Also, it increases the patient’s awareness of the effects associated with the medication, which makes it easier to seek professional help in case the side effects worsen.

References

• Castle, D. J., Buckley, P. F., & Gaughran, F. P. (2018). Effects of antipsychotic medications on physical health. Oxford Medicine Online. https://doi.org/10.1093/med/9780198811688.003.0006
• Kaar, S. J., Natesan, S., McCutcheon, R., & Howes, O. D. (2020). Antipsychotics: Mechanisms underlying clinical response and side-effects and novel treatment approaches based on pathophysiology. Neuropharmacology, 172, 107704. https://doi.org/10.1016/j.neuropharm.2019.107704
• Stroup, T. S., & Gray, N. (2018). Management of common adverse effects of antipsychotic medications. World Psychiatry, 17(3), 341-356. https://doi.org/10.1002/wps.20567
• Wu, Y., Howarth, M., Zhou, C., Hu, M., & Cong, W. (2019). Reporting ethical approval and informed consent in clinical research published in leading nursing journals: A retrospective observational study. BMC Medical Ethics, 20(1). https://doi.org/10.1186/s12910-019-0431-5

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