Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example

Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example

Schizophrenia spectrum and other psychosis disorders cause disturbance in thought processes, perception, and affect (American Psychiatric Association [APA], 2019). Besides, individuals diagnosed with such disorders experience severe deterioration of important areas of functioning. The disorders are caused by biochemical dysfunction, psychosocial stressors, genetic predisposition, and physiological factors. The disorders are characterized by lengthy hospital stays, high treatment costs, high suicide risk, and dysfunctional families. No treatment cures these disorders, but several medication agents have been recommended to treat and manage symptoms. This assignment provides a study guide outline of Cariprazine for treating Schizophrenia.(Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example)

Description of the Psychopharmacological medication agent, including brand and generic names and appropriate FDA indication and uses

The chosen psychopharmacological medication agent is Cariprazine. Cariprazine is FDA-approved (2015) to treat Schizophrenia and manic or mixed episodes associated with bipolar I disorder (Campbell et al., 2017). Cariprazine is sold under the names Vraylar and Reagila. Cariprazine’s active ingredient is Cariprazine HCL. The chemical name of Cariprazine is trans-N-{4-[2-[4-(2, 3-dichlorophenyl) piperazine-1-yl] ethyl] cyclohexyl}-N’, N’ dimethylurea hydrochloride.(Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example)

Any supporting, valid and reliable research for non-FDA uses

Cariprazine is used off-label for resistant depression and schizoaffective disorder. Oral long-acting Cariprazine has been proven effective in treating depressive episodes (Dyrmishi et al., 2022). Cariprazine is well-tolerated and decreases depression symptoms (Fava et al., 2018).

Drug Classification

Cariprazine is a second-generation oral atypical antipsychotic manufactured by Forest Laboratories, New York.

Mechanism of Action

Cariprazine acts through partial agonist activity at the serotonin 5-HT1A and dopamine D2 and D3 receptors and antagonist activity at the 5-HT2A receptors (Calabrese et al., 2020). Furthermore, Cariprazine has a moderate affinity to histaminergic, cholinergic, and adrenergic receptors that mediates the side effects of typical APDs. In the process, Cariprazine forms didesmethyl Cariprazine (DDCAR) and desmethyl Cariprazine (DCAR) metabolites. Inactive ingredients include shellac, gelatin, pregelatinized starch, titanium dioxide, and magnesium stearate.(Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example)

The Medication Pharmacokinetics

Cariprazine is unique from other oral antipsychotics. Its actions are mediated by three equipotent contributors, i.e., two active metabolites (DCAR and DDCAR) and Cariprazine (Campbell et al., 2017; FDA, 2015a). DCAR metabolite and the parent drug (Cariprazine) are associated with Cariprazine’s early tolerability and efficacy. The mean concentration of DCAR metabolite and the parent drug (Cariprazine) is steady by weeks 1 and 2. DDCAR metabolite is associated with later tolerability and efficacy. The concentration of DDCAR is steady from weeks 4-8.(Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example)

The Medication Pharmacodynamics

Cariprazine has a unique pharmacodynamics profile compared to other typical and atypical antipsychotics. However, Cariprazine has similar antagonistic activity at serotonin 5-HT2B and 5-HT2A receptors as other antipsychotics. Cariprazine exhibits partial agonistic activity at Dopamine D2 and D3 receptors and serotonin type 1 A receptor. Unlike other typical and atypical antipsychotics, Cariprazine demonstrates a high affinity for the Dopamine D2 and D3 receptors (Campbell et al., 2017). Cariprazine has moderate antagonistic activity at histamine, low serotonin 5­ HT2C and α-1a antagonism, and no significant affinity for muscarinic receptors (Citrome, 2015).(Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example)

Appropriate dosing, administration route, and any considerations for dosing alterations

Considerations of use and dosing in specific specialty populations to consider children, adolescents, elderly, pregnancy, suicidal behaviors, etc.

It is recommended to administer Cariprazine once daily with or without food, see Table 1 (FDA, 2015b). The recommended dosage for Schizophrenia ranges from 1.5mg to 6mg daily (FDA, 2015b). The recommended starting dosage is 1.5mg daily (FDA, 2015b). There are no significant benefits for doses above 6mg. Doses above 6mg increase the risks of dose-related adverse reactions. The available form of Cariprazine dosage is hard capsules that contain of-white/a white powder of Cariprazine HCl. The capsule strength ranges from1.5 mg, 3 mg, 4.5 mg, and 6 mg. Cariprazine is intended for oral administration only (Route). The medication can be discontinued for adverse reactions such as neuroleptic malignant syndrome, tardive dyskinesia, and leukopenia or neutropenia.(Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example)

	Starting/Beginning Dose	Range of recommended Dose
Schizophrenia	1.5 mg daily	1.5 – 6 mg daily
Bipolar Mania	1.5 mg daily	3 – 6 mg daily

Table 1: Dosage

Definition of Half-life, why half-life is important, and the half-life for your assigned medication.

Half-life is the time a drug’s active substance takes to reduce by half. The half-life of Cariprazine depends on the time taken to reach a steady state (FDA, 2015a). The half-life of Cariprazine is 2-4 days and 1-3 weeks for DDCAR. However, the half-life of DDCAR metabolite varies among patients. Some patients can achieve a steady state sooner than others patients.(Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example)

Side Effects/Adverse Reaction Potentials

The common side effects of Cariprazine medication include extrapyramidal symptoms, insomnia, Akathisia, headache, tremor, dizziness, and gastrointestinal disturbances (Campbell et al., 2017). Akathisia (psychiatric restlessness/inability to remain still) and other extrapyramidal symptoms are considered the most common treatment-emergent adverse reactions and are associated with higher rates of treatment discontinuation/nonadherence and worsening psychiatric symptoms. Akathisia and extrapyramidal symptoms are sometimes associated with aggression, violence, and suicide risks. The impact of Cariprazine on prolactin levels and metabolic parameters is minimal. However, metabolic syndrome can occur, given the characteristic impact of second-generation antipsychotics on metabolic parameters. Metabolic syndrome can lead to complications such as hyperlipidemia, hypertension, prediabetes, cardiovascular disease, and type II diabetes mellitus that can increase mortality. Cariprazine can cause a significant increase in weight, although different studies have heterogeneous findings on weight gain. Lastly, Cariprazine is associated with vital signs abnormalities, the elevation of liver enzymes, and QTc prolongation.(Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example)

Several adverse reactions are associated with Cariprazine. Cariprazine is associated with cerebrovascular adverse reactions such as transient ischemic attack and stroke among older patients with psychosis attributed to dementia. Cariprazine is also associated with a potentially fatal neuroleptic malignant syndrome characterized by delirium, hyperpyrexia, autonomic instability, and muscle rigidity. Other signs, such as rhabdomyolysis, high creatine phosphokinase levels, and acute renal failure, are also common with NMS.(Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example)

Cariprazine medication can also lead to Tardive dyskinesia. Tardive dyskinesia is a syndrome characterized by involuntary and dyskinetic movements and is potentially irreversible (FDA, 2015a). Risks of Tardive dyskinesia are higher in older women. Late-occurring adverse reactions are also common with Cariprazine since its plasma levels and major metabolites accumulate over time. Cariprazine medication can also cause Dysphagia and body temperature dysregulation. Dysphagia is esophageal dysmotility and aspiration.(Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example)

Conversely, body temperature dysregulation is characterized by the impaired ability of the body to reduce and regulate body temperature. Lastly, Cariprazine is associated with seizure and cognitive and motor impairment. Seizures are common in patients with conditions that lower brains resistant to seizures, such as the elderly. Moreover, cognitive and motor impairment affects thinking, judgment, and motor skills. Somnolence has been reported in Schizophrenia patients taking Cariprazine (FDA, 2015b).(Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example)

Contraindications for use include significant drug-to-drug interactions

Cariprazine is contraindicated for patients with known hypersensitivity. Such individuals risk developing skin rashes, angioedema, pruritus, and urticaria (Campbell, 2017). There are drugs with significant interactions with Cariprazine, including Strong CYP3A4 inhibitors and CYP3A4 inducers, while others do not, see Table 2.(Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example)

	CYP3A4 Inducers	CYP3A4 Inhibitors
Clinical Impact	CYP3A4 forms and eliminates DCAR and DDCAR. The clinical impact is not clear.	Concomitant use increases exposure to Cariprazine, DCAR, and DDCAR.
Intervention	Concomitant use of CYP3A4 and Cariprazine is not recommended.	Reduce Cariprazine dosage if used together
Examples	Carbamazepine and rifampin.	Ketoconazole and itraconazole.

Overdose Considerations

There is no known antidote for Cariprazine overdose. However, incidences of Cariprazine overdose are rare. A reported overdose of 48mg/day led to sedation and orthostasis (FDA, 2015a). The patient recovered in a day. Considerations for Cariprazine overdose include supportive care, monitoring, and close medical supervision by healthcare personnel. Clinicians should consider polysubstance use and consult a certified poison control institution for advice and guidance.(Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example)

Diagnostics and Labs Monitoring

Close monitoring is recommended for risks of a neuroleptic malignant syndrome, late-occurring adverse reactions, and metabolic changes, such as monitor for weight gain, dyslipidemia, and hyperglycemia/diabetes mellitus. Furthermore, patients at risk of syncope/dehydration or with a known cerebrovascular disease should be assessed for risks of hypotension by monitoring blood pressure and heart rate. Furthermore, patients should be monitored for adverse reactions such as Akathisia or extrapyramidal symptoms for weeks after beginning treatment and with every dose increase. Patients with neutropenia for fever should be monitored for infections by measuring absolute neutrophil count. Treatment should be discontinued if the absolute neutrophil count is less than < 1000/mm3.(Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example)

Comorbidities Considerations

For an elderly patient with dementia-related psychosis, Cariprazine increases mortality. Cariprazine causes cerebrovascular adverse reactions, including transient ischemic attack and stroke. Therefore, comorbidities are not recommended for this population.(Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example)

Legal and Ethical Considerations

Every physician should uphold the principle of non-maleficence. Physicians should prescribe Cariprazine and monitor patients to reduce risks of adverse reactions/side effects and contraindications associated with Cariprazine. In this regard, a Cariprazine prescription should be made for patients with conditions that respond to the medication or when other potential treatments are not available or appropriate. A physician should prescribe the lowest dosage and shortest treatment duration with optimal clinical response. It is recommended that physicians periodically reassess patients for continued treatment.(Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example)

Pertinent patient education considerations

Physicians should discuss with the patients of crucial safety information. Discuss the dosage administration, including the need for dose escalation adherence. Explain the benefits and risks associated with the medication, including potentially fatal adverse reactions such as neuroleptic malignant syndrome. Explain the signs and symptoms of crucial side effects of medications, such as dyskinesia, metabolic changes, and orthostatic hypotension. Caution the patient on carrying out activities that require concentration due to the potential impact of medication on cognitive and motor performance. Advise the patients on ways to reduce dehydration and overheating. Lastly, advise the patient to report their current medications or medications they plan to take to avoid potential interactions.(Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example)

Reference Page

American Psychiatric Association. (2019). Diagnostic and statistical manual of mental disorders (7^th ed.). American Psychiatric Publishing, Inc.   (Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example)

Calabrese, F., Tarazi, F. I., Racagni, G., & Riva, M. A. (2020). The role of dopamine D3 receptors in the mechanism of action of cariprazine. CNS Spectrums, 25(3), 343-351(Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example). https://doi.org/10.1017/s109285291900083x

Campbell, R. H., Diduch, M., Gardner, K. N., & Thomas, C. (2017). Review of cariprazine in management of psychiatric illness. Mental Health Clinician, 7(5), 221-229(Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example). https://doi.org/10.9740%2Fmhc.2017.09.221 

Campbell, R. H., Diduch, M., Gardner, K. N., & Thomas, C. (2017). Review of cariprazine in management of psychiatric illness. Mental Health Clinician, 7(5), 221-229. https://doi.org/10.9740/mhc.2017.09.221

Citrome, L. (2015). The ABCs of dopamine receptor partial agonists–aripiprazole, brexpiprazole, and cariprazine: the 15‐min challenge to sort these agents out. International Journal of Clinical Practice, 69(11), 1211-1220.

Dyrmishi, E., De Pieri, M., Ferrari, M., Traber, R., Preve, M., De Peri, L., & Bolla, E. (2022). Case Report: Long-Acting Oral Cariprazine. Frontiers in Psychiatry, 13. (Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example)https://doi.org/10.3389%2Ffpsyt.2022.876003

Fava, M., Durgam, S., Earley, W., Lu, K., Hayes, R., Laszlovszky, I., & Németh, G. (2018). Efficacy of adjunctive low-dose cariprazine in major depressive disorder: a randomized, double-blind, placebo-controlled trial. International Clinical Psychopharmacology, 33(6), 312(Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example). https://doi.org/10.1097/yic.0000000000000235

Food and Drug Administration. (2015a). Center for Drug Evaluation and Research [Internet]. Silver Spring (MD): Available at: http://www.accessdata.fda.gov/drugsatfda_docs/nda/2015/204370Orig1Orig2s000SumR.pdf (Accessed 14 October 2022)(Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example)

Food and Drug Administration. (2015b). Highlights of prescribing information. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/204370lbl.pdf (Accessed 14 October 2022)(Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders Comprehensive Solved Nursing Essay Example)