Bipolardisorder is an illness of the brain, which causes unusual changes inmood, the ability to carry out day-to-day tasks, and energy. Thereare four types of this condition, namely bipolar I disorder, bipolarII disorder, cyclothymia disorder, and specified/unspecified bipolardisorder. The treatment of a bipolar disorder involves the use ofthree classes of medication, namely mood stabilizers, antipsychotics,and antidepressants. The purpose of this paper is to make threedecisions regarding the medication to prescribe to a patient that wasdiagnosed with bipolar I disorder and hospitalized for twenty-onedays. The three decisions include beginning Lithium 300 mg orallyBID, beginning Risperdal 1 mg orally BID, and beginning Seroquel XR100 mg orally at HS.
Decision1: Beginning Lithium 300 mg Orally BID
Thefirst decision selected is to start administering Lithium 300 mgorally for two times per day. One of the reasons that this decisionwas made is the fact that Lithium exerts its antipsychotic effects bycompeting with other cations at the sodium-potassium ion pump forexchange. Therefore, this competition alters the exchange of cationsat the tissue level. On an additional note, lithium is thought toinhibit adenyl cyclase, which, in turn, reduces cAMP levels(Cipriani,Hawton, Stockton, & Geddes, 2013).Also, distribution of the active ingredient in this particular drugis usually wide throughout the body, including in breast milk. Infact, the levels of lithium in brain tissue, bone, and thyroid glandexceed that of serum.
Anotherreason as to why I chose lithium is that it is an approved medicationfor bipolar disorder. As McInnis(2014) asserts, “Lithium is FDA-approved for acute and maintenancetreatment of mania in bipolar disorder.” This author also statesthat “Lithium could help manage mood dysregulation in the contextof temperament and personal­ity and that there is evidence thatlithium has an antidepressant effect and has shown efficacy as anadjunctive treatment for depression” (McInnis, 2014). Furthermore,according to this author, "Some data sug­gest that lithium,with its neuroprotective mechanisms, may prevent progression of mildcognitive impairment” (McInnis, 2014).
WhenI chose to make this decision, I hoped that I would prevent or lessendepressive episodes. Although the patient currently denies suicidalor homicidal ideation, continued depressive episodes are likely toresult in such thoughts. Therefore, I decided to begin administeringLithium 300 mg orally for two times per day to prevent such fromoccurring in future. One of the reasons for hoping to prevent orlessen depressive episodes is that lithium acts presynaptically onreceptors of serotonin-sending cells (Malhi,Tanious, Das, Coulston, & Berk, 2013).This is important in the management of depression because itincreases the amount of serotonin passed from one cell of the brainto the other. Also, lithium acts postsynaptically on receptors ofserotonin-receiving cells. This is critical in lessening depressionbecause it enables these brain cells to take up the lithium that isreleased. According to Malhiet al. (2013),it is believed that lithium blocks the serotonin ‘transporter`protein, which is crucial for the management of depressive episodesbecause the protein ordinarily clears away serotonin at the synapsebetween the sending and receiving brain cell.
However,there were differences between what I expected to achieve in thischoice and the results of the decision. In this regard, I expectedthat lithium would be an effective therapy for the bipolar disorderand did not expect side effects. Some of the side effects of lithiumevident in this decision include gastrointestinal (GI) distress likevomiting, abdominal discomfort, nausea, and diarrhea. Also, thepatient exhibited prominent thirst that was accompanied by polyuria.Another unexpected side effect of this medication, which wasupsetting not only to the patient but also to her family members, wasdrowsiness and clouded thinking.
Decision2: BeginningRisperdal 1 mg Orally BID
Thesecond decision made in the management of the bipolar disorder was tobegin administering Risperdal 1 mg orally for two times per day. Thereason as to why I made this decision is that the current practiceguidelines advocate for the use of atypical antipsychotic medicationsfor the treatment of the dipolar disorder. As such, since Risperdalis one of these atypical antipsychotic medications, which is believedto be related to positive effects on mood, I made this decisionbecause it would manage the condition successfully.
Additionally,my second decision of administering Risperdal 1 mg orally for twotimes per day was guided by the absorption of the active ingredientof this drug. Apparently, food does not affect Risperdal’sabsorption rate. On this note, a solution of Risperdal has anabsolute oral bioavailability of seventy percent a tablet of the samedrug has a bioavailability of sixty-six percent. On an additionalnote, the peak plasma concentration of 9-hydroxyrisperidone, which isRisperdal’s main active ingredient, occurs about one hour inextensive metabolizers. The same peak plasma concentration of9-hydroxyrisperidone occurs in three hours in cases whereby themetabolizers are poor (Khanna et al., 2005).
WhenI made this second decision, I was hoping to achieve the positiveeffects that this particular drug has on the mood of an individual.According to Khanna, Vieta, Lyons, Grossman, Eerdekens, & Kramer,(2005), Risperdal is an effective medication for bipolar disorderbecause it has a high affinity for 5-HT2,D2,alpha1,and alpha2H1 histaminergic and adrenergic receptors. Also, Khanna andcolleagues assert that Risperdal has a low to moderate affinity forserotonin receptors. What is more, Risperdal has a weak affinity forthe dopamine D1, leave alone having no affinity for B1,B2,and cholinergic muscarinic (Khanna et al., 2005).
Therewas no difference between the obtained and expected results. Iexpected that the drug would rebalance dopamine and serotonin, which,in turn, would improve the patient`s moods, thinking, and behavior,and this was evident during treatment. However, I must mention someof the common side effects of Risperdal that were apparent during thetreatment. First, the client exhibited increased heart rate,specifically when she stood up. Also, the patient would feel dizzyand would also indicate low blood pressure. Other side effects ofRisperdal that the patient experienced during the treatment includefatigue, headache, increased appetite, sleepiness, and constipation.
Decision3: BeginningSeroquel XR 100 mg Orally at HS
Thethird decision that I made during the treatment of the bipolardisorder was to begin the administration of Seroquel XR. One of thereasons that I chose to administer Seroquel XR is the fact that thedrug has been approved for the treatment of depressive episodes ofbipolar disorder. Additionally, according to Thase et al. (2006),"FDA has approved Seroquel XR for the treatment of depressivelows and manic highs of bipolar disorder." This author alsoasserts that "FDA has approved Seroquel XR to work alone totreat three types of episodes that may occur in bipolar disorder forthe short term" (Thase et al., 2006). The three episodes thatmay occur in a bipolar disorder that this author argues can betreated with Seroquel XR include depressive lows, manic highs, andmixed episodes of lows and highs.
WhenI made this medication decision, I expected the patient to exhibitimprovements as early as the first week of medication. The reasonattributed to this expectation is that Seroquel XR is anextended-release tablet. This implies that the drug is deliveredaround the clock. Indeed, this explains why Seroquel XR is only takenonce in a day, specifically, three or four hours before one goes tobed. There was no difference between the expected and obtainedresults because the patient had shown improvements within the firstweek of medication.
Insummary, this paper has successfully presented threedecisions regarding the medication to prescribe to a patient that wasdiagnosed with bipolar I disorder and hospitalized for twenty-onedays, namely beginning Lithium 300 mg orally BID, beginning Risperdal1 mg orally BID, and beginning Seroquel XR 100 mg orally at HS.Although the results obtained upon the administration of Lithium 300mg orally for two times per day were different from the expectedones, the decision was as effective as the others.
Cipriani,A., Hawton, K., Stockton, S., & Geddes, J. R. (2013). Lithium inthe prevention of suicide in mood disorders: updated systematicreview and meta-analysis.
Khanna,S., Vieta, E., Lyons, B., Grossman, F., Eerdekens, M., & Kramer,M. (2005). Risperidone in the treatment of acute mania. TheBritish Journal of Psychiatry, 187(3),229-234.
Malhi,G. S., Tanious, M., Das, P., Coulston, C. M., & Berk, M. (2013).Potential mechanisms of action of lithium in bipolar disorder. CNSDrugs,27(2),135-153.
McInnis,M. G. (2014). Lithium for : A Re-Emerging Treatmentfor Mood Instability: Low Dosage, Slow Titration Might Mitigate SideEffects. CurrentPsychiatry, 13(6),38.
Thase,M. E., Macfadden, W., Weisler, R. H., Chang, W., Paulsson, B., Khan,A., … & Bolder II Study Group. (2006). Efficacy of quetiapinemonotherapy in bipolar I and II depression: a double-blind,placebo-controlled study (the BOLDER II study). Journalof clinical psychopharmacology, 26(6),600-609.