NURS 6630 Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders

NURS 6630 Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders

Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders

Aripiprazole

• Abilify, Aristada, and Abilify Maintena are the brand names.
• The generic name is aripiprazole.
• The pharmacological category being discussed is second-generation antipsychotic medicines.
• Aripiprazole has shown efficacy in enhancing psychosocial and cognitive performance in persons diagnosed with schizophrenia via the modulation of serotonin and dopamine neurotransmitter levels.
• According to Coustals et al. (2021), the antipsychotic medicine aripiprazole, which the FDA has approved, is used to treat schizophrenia in persons who are 13 years old and above.
• According to Kumar et al. (2020), the medicine is given to people with autism spectrum conditions to help with symptoms including impatience, aggressiveness, mood swings, and self-harm. It is also used to treat Tourette’s syndrome in six and older children.
• According to Preda and Shapiro (2020), aripiprazole is approved for the treatment of bipolar I disorder in children, adults, and adolescents aged ten and older. It may be used as a standalone treatment or a medication that helps regulate mood.
• In order to treat severe depression, a mix of medicine and antidepressant therapy may be used.

Mechanism of action

The exact mechanism through which aripiprazole achieves its therapeutic effects remains unknown, similar to other pharmaceutical interventions utilized to treat schizophrenia and bipolar disorder.

The effectiveness of the medicine is attributed to its partial agonistic effects on the D2 and 5-HT1A receptors and its antagonistic effects on the 5HT2A receptors (Coustals et al., 2021).

Pharmacodynamics

• According to Preda and Shapiro (2020), aripiprazole has a significant affinity for certain receptor types, including alpha1 and alpha2 adrenergic, H1 histaminergic, serotonin type 2, and dopamine type 2 (APAA).
• Furthermore, it is worth mentioning that other receptors are affected, albeit with reduced affinities.
• The exact mechanism through which aripiprazole impacts these receptors and leads to a clinically significant result is still not fully understood.

Pharmacokinetics

• The medicine is absorbed from the gastrointestinal system quickly after being taken orally, reaching its maximum plasma concentration within three to five hours. According to Preda and Shapiro (2020), aripiprazole tablets have a bioavailability of 75%. Consumption of the drug may take place either with or without the presence of meals. After administering the same amount of the oral solution, the blood concentration of the oral solution was greater than that of the tablet formulation.
• Following oral administration, the medication was shown to have a distribution of 404 Liters, equivalent to 4.9 Liters per kilogram (Kim et al., 2021). The outcomes of the research established this. Both aripiprazole and dehydro-aripiprazole show a notable affinity for serum proteins, with albumin being the primary target. Both of these situations have a connection that is more than 99 percent.
• Aripiprazole is metabolized chiefly via dehydrogenation, hydroxylation, and N-dealkylation. The predominant drug component found in the bloodstream is dehydro-aripiprazole, which is the active metabolite of the chemical at the time of detection. It accounts for around forty percent of the total concentration of the medication in the plasma and persists at this level for the whole duration of the study.
• Aripiprazole exhibits a half-life of around 75 hours in those with metabolic efficiency, whereas in those with impaired metabolism, this time span can be prolonged to 146 hours.
• Regarding the CYP2D6 pathway, the drug has no effect whatsoever. Following the oral administration of aripiprazole, a quarter of the delivered radioactivity is lost via urine, while the remaining fifty-five percent is excreted through faces (Kim et al., 2021). Only one percent of the oral dosage is removed by urine excretion, whereas around eighteen percent is excreted unaltered through fecal excretion.

Dosage And Administration

Patients who have been diagnosed with schizophrenia are advised to take a daily dosage of Abilify, which may range anywhere from 10 to 20 milligrams, regardless of whether or not they consume meals, both during the first administration of the medicine and in future administrations.

• According to Kumar et al.’s research from 2020, it is suggested that medical professionals refrain from raising the treatment dose until the drug has achieved its steady state, which usually takes around two weeks.
• Pharmacological dosage concerns for a particular section of the population: No dosage modifications are required depending on gender, race, age, liver disease, and kidney disease (Kim et al., 2021).
• Maintenance therapy is ceasing the administration of Abilify at a daily dose of 15 mg in persons diagnosed with schizophrenia who have achieved symptom stabilization after a three-month course of treatment with various other antipsychotic medicines. Subsequently, these people are subjected to rigorous surveillance to detect any potential recurrence for up to 26 weeks (Johnsen et al., 2020). Frequently assessing the patient’s state is crucial for deciding ongoing therapy needs.

Considerations of use in special populations:

• According to Kumar et al.’s research from 2020, it is not essential to make modifications to the dosage of aripiprazole by taking into account factors such as gender, race, age, cigarette use, kidney function, or hepatic function.

Half-life

• The term “half-life” is used in the field of pharmaceutical substances to refer to the amount of time that must pass before the concentration of the active component of a medication drops by fifty percent within the human body. This is done while considering the various metabolic and excretory processes involved in drug metabolism (Coustals et al., 2021).
• According to Johnsen et al.’s 2020 research, the pharmaceutical agent aripiprazole has a half-life of 75 hours, whereas its active metabolite has a half-life of 94 hours. In situations where people have a lower CYP2D6 metabolic activity, it is advised that a dose that is similar to half of the regular quantity be used. This is because aripiprazole has an average half-life of 146 hours.

Side Effects/Adverse Reaction Potentials

• Aripiprazole side effects frequently reported include fatigue, gastrointestinal disturbances like constipation or diarrhea, stomach pain, appetite changes, increased salivation, restlessness and agitation, seizures, dizziness, and poor balance (Johnsen et al., 2020).

Contraindications

• Aripiprazole should not be used by anybody who has a history of medication hypersensitivity that has been medically established. As its main metabolic route, aripiprazole has less glucuronidation, which suggests a lower chance of interacting with CYP1A1, CYP2A6, CYP1A2, CYP2B6, or CYP2E1 enzyme inducers or inhibitors (Kishi et al., 2020).
• Some medications, including carbamazepine, can increase the amount of medications that cause the human body’s CYP3A4 enzymes to become active, accelerating the medicines’ excretion from the bloodstream. When paroxetine, Prozac, and ketoconazole are taken at the same time, aripiprazole’s metabolism may be hindered, leading to higher levels of the drug in the body.

Overdose Considerations

• The study that has been done so far indicates that it is not possible to control the dose of aripiprazole effectively. According to Giordano et al.’s research from 2020, it is advised that patients who are experiencing an overdose should consider the possibility of using an electrocardiogram. For optimal results, it is recommended to start cardiac monitoring during extended QTc intervals.
• Overdose treatment aims to achieve many important goals, such as ensuring adequate breathing, oxygenation, airway preservation, supportive care, and appropriately managing symptoms (Kishi et al., 2022). It is of the utmost importance to continue monitoring the patient with utmost thoroughness and attention until he reaches a state of healing.
• In the initial phases of a drug overdose, the application of charcoal may be deemed a viable strategy to mitigate drug absorption to some extent. One hour after a single oral dosage of 15 milligrams of aripiprazole, 50 grams of activated charcoal reduces AUC and Cmax by 50% (Kishi et al., 2020).

Diagnostics and lab monitoring

• Numerous physiological markers, such as blood glucose levels, lipid profiles, and heart function, are impacted by aripiprazole. Numerous factors are included in the initial evaluations that are advised, including lipid profiles, glomerular filtration rate, height, body weight, blood sugar levels, complete blood counts, and tests for liver function (Giordano et al., 2020). An ECG approach is used to get the measurements.

Comorbidities consideration

• Abilify is also used as an adjuvant therapy for people with mental illnesses and substance use disorders. According to Kishi et al. (2022), pharmacological intervention shows promise in the treatment of a variety of illnesses, such as paranoia, schizophrenia, and agitation linked to dementia. As an additional benefit, it has shown the potential to be effective in treating blepharospasm and apraxia of eyelid motions, often seen in people with Parkinson’s disease.

Legal and ethical considerations

• The implementation of contemporary medical technologies, including nano treatments and trackable devices, holds considerable importance in light of the obligation of practitioners to assess patients’ decision-making capacity (Kishi et al., 2022).

Pertinent patient education considerations

• Aripiprazole should be consistently administered daily at approximately the same time each day. It is of the utmost importance to adhere strictly to the instructions on the prescription label. It is recommended to seek clarification from the prescribing physician or the pharmacy in cases of uncertainty (Giordano et al., 2020).
  

References

Coustals, N., Ménard, M., & Cohen, D. (2021). Aripiprazole in children and adolescents. Journal of Child and Adolescent Psychopharmacology, 31(1), 4–32. https://doi.org/10.1089/cap.2020.0014

Giordano, G., Tomassini, L., Cuomo, I., Amici, E., Perrini, F., Callovini, G., Carannante, A., Kotzalidis, G. D., & De Filippis, S. (2020). Aripiprazole Long-Acting Injection during First episode Schizophrenia—An Exploratory analysis. Frontiers in Psychiatry, 10. https://doi.org/10.3389/fpsyt.2019.00935

Johnsen, E., Kroken, R. A., Løberg, E., Rettenbacher, M. A., Joa, I., Larsen, T. K., Reitan, S. K., Walla, B., Alisauskiene, R., Anda, L. G., Bartz‐Johannessen, C., Berle, J. Ø., Bjarke, J., Fathian, F., Hugdahl, K., Kjelby, E., Sinkeviciute, I., Skrede, S., Stabell, L. A., . . . Fleischhacker, W. W. (2020). Amisulpride, aripiprazole, and olanzapine in patients with schizophrenia-spectrum disorders (BeSt InTro): a pragmatic, rater-blind, semi-randomised trial. The Lancet Psychiatry, 7(11), 945–954. https://doi.org/10.1016/s2215-0366(20)30341-2

Kim, D. D., Barr, A. M., Lian, L., Yuen, J. W. Y., Fredrikson, D., Honer, W. G., Thornton, A. E., & Procyshyn, R. M. (2021). Efficacy and tolerability of aripiprazole versus D2 antagonists in the early course of schizophrenia: a systematic review and meta-analysis. Npj Schizophrenia, 7(1). https://doi.org/10.1038/s41537-021-00158-z

Kishi, T., Ikuta, T., Matsuda, Y., Sakuma, K., & Iwata, N. (2020). Aripiprazole vs. brexpiprazole for acute schizophrenia: a systematic review and network meta-analysis. Psychopharmacology, 237(5), 1459–1470. https://doi.org/10.1007/s00213-020-05472-5

Kishi, T., Sakuma, K., & Iwata, N. (2022). Aripiprazole Once-Monthly versus Oral Aripiprazole for Schizophrenia in the Maintenance Phase: A Systematic Review and Network Meta-Analysis. Pharmacopsychiatry, 55(06), 291–296. https://doi.org/10.1055/a-1860-2793

Kumar, A., Singh, H., Mishra, A., & Mishra, A. K. (2020). Aripiprazole: an FDA approved bioactive compound to treat schizophrenia- A mini-review. Current Drug Discovery Technologies, 17(1), 23–29. https://doi.org/10.2174/1570163815666181008151718

Preda, A., & Shapiro, B. (2020). A safety evaluation of aripiprazole in the treatment of schizophrenia. Expert Opinion on Drug Safety, 19(12), 1529–1538. https://doi.org/10.1080/14740338.2020.1832990

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