Although she reports that her anxiety is gone, she still reports suicidal ideation, but states “with that valium stuff, who cares?”;;;

Diagnosis: Gambling disorder, alcohol use disorder

Decision Point One

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Antabuse (Disulfiram) 250 mg orally every morning ON 

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Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks

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Antabuse (Disulfiram) 250 mg orally daily

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Campral (Acamprosate) 666 mg orally three times/day

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E

·  Client returns to clinic in four weeks

·  Mrs. Perez states that she has noticed that she has been having suicidal ideation over the past week, and it seems to be getting worse

·  Clientis She is also reporting that she is having “out of control” anxiety.. 

Decision Point Two

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Educate Mrs. Perez on the side effects of Campral and add Valium (diazepam) 5 mg orally TID to address anxiety symptoms

RESULTS OF DECISION POINT TWO Decision Point Two

Select what the PMHNP should do next:

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Add on Valium (diazepam) 5 mg orally TID/PRN/anxiety

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/08/mm/co-morbid_addiction_etoh_and_gambling/img/pill-blue.png

Refer to a counselor to address gambling issues

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Add on Chantix (varenicline) 1 mg orally BID

  • Client returns to clinic      in four weeks
  • Mrs. Perez reports that      when she first received the valium, it helped her tremendously. She states      “I was like a new person- this is a miracle drug!” However, she reports      that she has trouble “waiting” between drug administration times and      sometimes takes her valium early. She is asking today for you to increase      the valium dose or frequency
  • Although she reports that      her anxiety is gone, she still reports suicidal ideation, but states “with      that valium stuff, who cares?”;;;;;;;; 
  • Decision Point Three
  • Add on Wellbutrin (bupropion) XL 150 mg orally daily
  • Guidance to Student

     
  • Given her weight (less than 60      kg), Campral should have been started at 666 mg orally BID. It is possible      that the higher dose may be responsible for the severity of the symptoms      that Mrs. Perez is experiencing.
  • Technically, the drug should      have been stopped (not simply decreased) once Mrs. Perez reported suicidal      ideation. Even with the decrease in dose, she is still having suicidal      ideation, which indicates the need to discontinue the drug. Although      controversy exists regarding how long to use pharmacologic approaches to      treatment of alcohol dependence, 8 weeks is probably insufficient,      therefore, the drug should not simply be discontinued without using a      different agent in its place.
  • Mrs. Perez should be started on      Antabuse at 250 mg orally daily and referred to psychotherapy to address      her gambling issue.
  • In all cases, the PMHNP needs      to discuss smoking cessation options with Mrs. Perez in order to address      the totality of addictions and to enhance her overall health. The decision      to begin Wellbutrin XL 150 mg orally daily may help achieve this goal, but      this choice does not address her abstinence from alcohol.
  • Additionally, it should be      noted that although Mrs. Perez reports that she has been avoiding the      casino secondary to her fear that she will drink, this “fear” has not      actually treated her gambling addiction. This particular addiction has      resulted in considerable personal financial cost to Ms. Perez. Mrs. Perez      needs to be referred to a counselor who specializes in the treatment of      gambling disorder, and she should also be encouraged to establish herself      with a local chapter of Gamblers Anonymous.
  • Examine Case Study: A      Puerto Rican Woman With Comorbid Addiction. You will be asked to make      three decisions concerning the medication to prescribe to this client. Be      sure to consider factors that might impact the client’s pharmacokinetic      and pharmacodynamic processes.
  • At each decision point stop to      complete the following:
  • Decision #1
  • Which decision did you select?
  • Why did you select this      decision? Support your response with evidence and references to the      Learning Resources.
  • What were you hoping to achieve      by making this decision? Support your response with evidence and      references to the Learning Resources.
  • Explain any difference between      what you expected to achieve with Decision #1 and the results of the      decision. Why were they different?
  • Decision #2
  • Why did you select this      decision? Support your response with evidence and references to the      Learning Resources.
  • What were you hoping to achieve      by making this decision? Support your response with evidence and      references to the Learning Resources.
  • Explain any difference between      what you expected to achieve with Decision #2 and the results of the      decision. Why were they different?
  • Decision #3
  • Why did you select this      decision? Support your response with evidence and references to the      Learning Resources.
  • What were you hoping to achieve      by making this decision? Support your response with evidence and      references to the Learning Resources.
  • Explain any difference between      what you expected to achieve with Decision #3 and the results of the      decision. Why were they different?

 

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