An Asian American Woman with Bipolar Disorder
Decision 1
Of the probable options –Lithium 300 mg, Risperdal and Seroquel XR 100 mg, – I chose Risperdal (Risperidone) 1mg orally BID.
Justification
First and foremost, beginning Lithium 300 mg would be a bad idea because of its high toxicity levels which often lead to undesirable side effects such as diarrhea and vomiting. Seroquel XR too is not preferable as it can cause irreversible side effects such as movement disorder (Torrent et al., 2013).
Risperdal is usually biotransformed to its active metabolite state known as 9- hydroxyrisperidone. That happens when Risperidone come into contact with the polymorphic CYP2D6 in Caucasians. According to Fortino, (2015), there is a relationship between plasma levels of risperidone and CYP2D6*10 allele. Therapeutic indications show that Risperdal is most suitable for the treatment of bipolar disorder. Genetic testing showed that the woman had CYP2D6*10 allele and that no other type of medication seemed to work.
Expectations
By administering Risperidone, I hoped to address the bipolar symptoms depicted by the patient. Risperdal is an antipsychotic medication that works by altering the effects of chemical substances in the human brain. It is used to treat symptoms of manic depression (bipolar disorder) in grown-ups and children who are 10 years old and above.According toGeddes & Miklowitz (2013), CYP2D6 catalyzes the metabolism of Risperidone, which is among the antipsychotics that are highly recommended clinically. Risperdal is known to have potent antipsychotic activity and is easily transformed biologically to active metabolite without any serious side effects.
Deviations
I expected the Risperdal to work correctly as long as the patient adhered to all the instructions provided. However, the outcome was totally different. The patient came back inactive and unable to move on her own. She also appeared sedated and lethargic. Two possible explanations for this turn of events could be one; the patients experienced unforeseen side effects of the medication or two, she used other drugs such as clozapine simultaneously. Risperdal has side effects such as uncoordinated muscle movements and dizziness (Torrent et al., 2013). Taking other types of medications concurrently may also lead to similar side effects.
Decision 2
At this stage, I had three options at my disposal. These entailed discontinuing Risperdal and starting Lithium sustained release 300 mg orally BID, reducing Risperdal to 1mg at HS or changing Risperdal to 2 mg at HS. With full understanding of the patient’s past and current state, I found it preferable to lower Risperdal to 1mg at HS.
Justification
First, discontinuing Risperdal abruptly would have resulted to more dangers since it remains in the system for a while. Also, increasing Risperdal to 2 mg could lead to further complications. With a lower dose of Risperdal, however, the bipolar symptoms are likely to clear without any serious side effects. According to Geddes &Miklowitz (2013), a lower dose of Risperidone is more effective especially when dealing with patients who have been diagnosed with bipolar symptoms for the first time.
Expectations By decreasing the Risperdal to 1mg at HS, I was hoping that my patient would start showing minimal side effects and that her bipolar symptoms would begin to improve. According to Craddock, & Sklar (2013) Risperidone is metabolized by CYP2D6, in which together with its active metabolite 9-hydroxyrisperidone are substrates.
Lowering the dosage of Risperdal would most likely stabilize Risper……………………….
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