Haloperidol Prescription PPT

Haloperidol Prescription PPT Haloperidol Prescription PPT Question Description I’m studying for my Nursing class and don’t understand how to answer this. Can you help me study? we can pick Haloperidol as well NUR 1104 University Of Texas Rio Grande Valley Haloperidol Prescription PPT For this DB, you will choose one (1) psychotropic drug that is metabolized by CYP450 enzymes and complete the following steps: Create a brief three-slide PowerPoint presentation hypothesizing the outcome of prescribing this drug in the presence of its CYP450 inhibitor and inducer. Answer the following questions: For which CYP450 enzyme/s is it a substrate? Are there any other pharmacokinetic considerations when prescribing this medication (absorption, distribution, elimination)? To Complete Your Discussion: Post your PowerPoint to the discussion board. Haloperidol Prescription PPT Reply Posts Compare your response to two of your peers. Do you agree with their findings? What variability do you observe between psychotropic medications? Your response should include evidence of review of the course material through proper citations using APA format. 2) two responses to the two attached short powerpoint. NUR 1104 University Of Texas Rio Grande Valley Haloperidol Prescription PPT see attache ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS risperidone_ppt_db_2_utrgv_berilla.pptx discussion_2_haloperidol_victoria RISPERIDONE: METABOLIZED BY CYTOCHROMES P450 (CYP) 2D6 ENZYMES BERYLLA SARFO FNP-BC UNIVERSITY OF TEXAS RIO GRANDE VALLEY DIAGNOSIS AND MANAGEMENT ACROSS THE LIFESPAN NURS 6475-96L FALL 2020 DR. R. DIAZ SEPTEMBER 8, 2020 En.wikipedia.org RISPERIDONE (BRAND NAME: RISPERDAL) Risperidone is a second-generation atypical antipsychotic used to manage symptoms of schizophrenia, episodes of mania, mixed episodes such as mania and depression, and behavioral problems such as aggression. It comes as an oral solution, tablets, orally disintegrating tablets, and as an injectable, Risperdal Consta, which is a long-acting (Medline Plus, 2017). • Mode of action: • Risperidone decreases positive symptoms of psychosis by blocking dopamine receptors, thereby alleviating affective symptoms. It improves cognitive and affective symptoms by blocking the serotonin 2A receptors, thereby promoting the release of dopamine in some areas of the brain. The efficacy of the drug can be determined 4 to 6 weeks, but it can take up to 16 weeks to improve cognitive functions (Stahl, 2017). FOR WHICH CYP450 ENZYME/S IS IT A SUBSTRATE? • Cytochromes P450 are enzymes found in the liver, small intestines, lungs, and kidneys and metabolize about 25 % of drugs such as beta-blockers, antidepressants, antipsychotics, and mood stabilizers (Ayano, 2016). One of the members of CYP450 enzymes is CYP2D6. CYP2D6 is important as it plays a role in the metabolism of over 70 substrate medications. Individuals may metabolize drugs either quickly or slowly, depending on the genetic variability of the CYP2D6 Enzyme. Efficacy of a drug may be reduced if the drug is metabolized quickly, and toxicity if the drug is metabolized slowly. Therefore, drug dose may need to be adjusted (Ayano, 2016). CYP2D6 mostly metabolizes Risperidone, and the metabolism can be affected by drugs that are inhibitors of CYP2D6. Examples of these inhibitors are Paroxetine, fluoxetine, and quinidine. Fluoxetine and Paroxetine are very potent inhibitors of CYP2D6, which can raise the plasma levels of Risperidone by 2.5 to 3.9 times resulting in overdose or toxicity. It is essential to understand inducers and inhibitors of CYP2D6 before selecting the appropriate medicines to avoid drug to drug interaction and to have the best outcome for treatment (Ayano, 2016). PHARMACOKINETICS The way the body acts on drugs by absorption, distribution, and elimination is known a pharmacokinetic and this is facilitated through the hepatic and gut metabolizing system known as cytochrome P450 (CYP) system (Stahl, 2013). Absorption: Risperidone is rapidly absorbed after oral administration reaching a peak plasma level one hour after administration. Bioavailability is about 70%. Risperidone can be given with or without food (Guzman, 2019). Distribution: volume of distribution is 1-2 L/kg, and 90% binds with the plasma protein. Risperidone binds to albumin and alpha 1-acid glycoprotein (Guzman, 2019). NUR 1104 University Of Texas Rio Grande Valley Haloperidol Prescription PPT 9-hydroxrisperidone (paliperidone) is the primary active metabolite of Risperidone, which are the substrates of the drug P-glycoprotein (P-gp) which affects the absorption and brain concentration of the drug (Puangpetch et al., 2016). Excretion: The kidneys excrete Risperidone. Patients with renal disease, drug clearance and its metabolite are reduced which poses patients at risk for overdose or toxicity. It takes 3 hours in extensive metabolizers and 20 hours in poor metabolizers (Guzman, 2019) It is essential to monitor the weight of patients and levels of prolactin as Risperidone causes weight gain as well as an increase in prolactin levels. A therapeutic drug monitoring tool can be used to monitor dosage assessment, the efficacy of the drug, and medicinal optimization in treatment (Puangpetch et al., 2016). REFERENCES • Ayano, G. (2016). Psychotropic Medications Metabolized by Cytochromes P450 (CYP) 2D6 Enzyme and Relevant Drug Interactions. Clin Pharmacol Biopharma 5: 162. doi: 10.4172/2167-065X.1000162 • Guzman, F. (2019). Risperidone: Clinical Summary. Retrieved from https://psychopharmacologyinstitute.com/publication/pharmacokinetics-of-risperidone-clinical-summary-2125 • Medline Plus, 2017). Risperidone. Retrieved from https://medlineplus.gov/druginfo/meds/a694015.html#:~:text=Risperidone%20is%20in%20a%20class,natural%20s ubstances%20in%20the%20brain. • Puangpetch, A., Vanwong, N., Nuntamool, N., Hongkaew, Y., Chamnanphon, M., & Sukasem, C. (2016). CYP2D6 polymorphisms and their influence on risperidone treatment. Pharmacogenomics and personalized medicine, 9, 131–147. https://doi.org/10.2147/PGPM.S107772 • Stahl, S. M. (2013). Stahl’s Essential psychopharmacology: Neuroscientific Basis and Practical Applications (4th ed.). Cambridge: Cambridge University Press. • Stahl, S. M. (2017). Stahl’s Essential Psychopharmacology: Prescribers Guide (6th ed.). Cambridge: Cambridge University Press. HALOPERIDOL VICTORIA DOMINICS, APRN, FNP-C UNIVERSITY OF TEXAS RIO GRANDE VALLEY NURS-6475: DIAGNOSIS AND MANAGEMENT ACROSS THE LIFESPAN DISCUSSION-2 DR DIAZ RICHARD 09/08/2020 HALOPERIDOL ? Haloperidol is a first generation (typical) antipsychotic medication that is widely used around the world. Food and Drug Administration (FDA) approved the use of haloperidol for schizophrenia (Rahman and Marwaha, 2020). ? Haloperidol (HP) underwent cytochrome P450 (P450)-mediated metabolism to potentially neurotoxic pyridinium metabolites; although, the chemical pathways and specific enzymes involved in these reactions are yet to be identified. ? The CYP2D6 gene is highly polymorphic, causing absent (poor metabolizers), decreased, normal or increased enzyme activity (extensive and ultra-rapid metabolizers). The genetic polymorphism of the CYP2D6 influences plasma concentration of a wide variety of drugs metabolized in the liver by the cytochrome P450 (CYP) 2D6 enzyme, including antipsychotic drugs used for schizophrenia treatment. ? Additionally, CYP2D6 is involved in the metabolism of endogenous substrates in the brain, its also located in regions such as the cortex, hippocampus and cerebellum, which are reduced in schizophrenia. Also, lately we have found that CYP2D6 poor metabolizers are not represented adequately in a case–control association study of schizophrenia(Dorado, Peas-LLed, & Llerena, 2017) For which CYP450 enzyme/s is it a substrate? ? Cytochrome P450 CYP2D6 Inhibitor ? Haloperidol is a substrate of CYP3A4, an inhibitor, and a stimulator, of CYP2D6. ? Decreased haloperidol is also a substrate of CYP3A4 and inhibitor of CYP2D6 ? Pharmacokinetic interactions occur between haloperidol and several drugs given concurrently, for example, phenytoin, carbamazepine,, phenobarbital, fluvoxamine, fluoxetine,, nefazodone, venlafaxine, buspirone, alprazolam, rifampicin (rifampin), quinidine and carteolol. NUR 1104 University Of Texas Rio Grande Valley Haloperidol Prescription PPT ? Generally, drug interaction finding recommended to involve CYP3A4 in the biotransformation of haloperidol in humans Pharmacokinetic considerations when prescribing Haldol ? The doctor should consider recommended dosing guidelines and issues related to safety before prescribing (Eidelman and Abdel-Rahman, 2016). ? Drug to Drug Interactions are avoided(Wiese, Ellingrod, Gardner,& Nasrallah, 2015). ? Prescribers should also consider QT prolongation and TdP when deciding on administration route for patients. Patient with multiple risk factors for QT prolongation should be monitored carefully (including ECGs and potassium levels), particularly during the initial phase of treatment (Vesely et al., 2019). References ? ? Dorado, P., Peas-LLed, E. M., & LLerena, A. (2017). CYP2D6 polymorphism: implications for antipsychotic drug response, schizophrenia and personality traits. Progress in NeuroPsychopharmacology and Biological Psychiatry, 33(7). ? Eidelman, C., & Abdel-Rahman, S. M. (2016). Pharmacokinetic considerations when prescribing in children. International journal of Pharmacokinetics, 1(1), 69-80. ? Rahman, S., & Marwaha, R. (2020). Haloperidol. In StatPearls [Internet]. StatPearls Publishing ? Wiese, K., Ellingrod, V. L., Gardner, K. N., & Nasrallah, H. A. (2015). Avoiding common drug-drug interactions. Current Psychiatry, 14(7), 21-26. ? References cont. ? Vesely, P., Stracina, T., Hlavacova, M., Halamek, J., Kolarova, J., Olejnickova, V., … & Novakova, M. (2019). Haloperidol affects coupling between QT and RR intervals in guinea pig isolated heart. Journal of pharmacological sciences, 139(1), 23-28. … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10