NR 546 WEEK 3 CASE STUDY AND NR 546 WEEK 3 DISCUSSION UPDATED 2023

D. Provide an evidence-based rationale for the selected medication using at least one scholarly reference. Textbooks may be used for additional references but are not the primary reference. Aripiprazole was chosen for LM for several reasons, it has low incidence of motor side effects, is not sedating, can reduce prolactin levels rather than increase them so does not cause weight gain, has a favorable tolerability profile, a long half-life, and food does not affect absorption so it can be taken with or without food, which may increase compliance (Smith et al., 2018; Stahl. 2020; Stahl, 2021). She does have risk factors for diabetes including being overweight with a BMI of 27.4, not exercising, and drinking several cups of coke or sweet tea during the day; aripiprazole is one of the only antipsychotics that is not associated with increased risk of diabetes or increased triglyceride levels, whereas quetiapine and olanzapine have higher risk of diabetes and have been shown to increase both glucose and triglycerides (Smith et al., 2018). The American psychiatric association updated its practice guidelines for the treatment of patients with schizophrenia in 2020 (Keepers et al., 2020). APA recommendations include patients with schizophrenia be treated with antipsychotic medication and monitored for effectiveness and side effects, patients whose symptoms have improved with an antipsychotic medication continue to be treated with an antipsychotic medication, and they suggest that patients whose symptoms have improved continue to be treated with the same medication (Keepers et al., 2020). Aripiprazole also comes in a long-acting injectable form which may be an option for LM at some point in the future if the treatment is effective, depot antipsychotics have an advantage over oral medication in preventing hospitalization (Smith et al., 2018). E. List any side effects or adverse effects associated with the medication. While aripiprazole’s side effect profile is smaller than many other antipsychotics, there are risks for dizziness, insomnia, akathisia, activation, nausea, vomiting, orthostatic hypotension, constipation, headache, asthenia, sedation, tardive dyskinesia, and risk of potentially irreversible involuntary dyskinetic movements at higher doses (Stahl. 2020). There are some rare yet serious potential side effects such as, seizure, impulse control problems, and neuroleptic malignant syndrome (muscle rigidity, high fever, delirium, renal failure) (Stahl. 2020). F. Include any required diagnostic testing. State the time frame for this testing (testing is before medication initiation or q 3 months, etc.). Includes normal results range for any listed laboratory tests. • Weight and BMI (normal: 18.5-24.9) should be monitored prior to and during treatment, monthly for the first three months then quarterly thereafter (Stahl. 2020). • Baseline blood pressure, fasting plasma glucose (normal: 70-110 mg/dL), and fasting lipids should be obtained within first three months and then annually thereafter but may need to be more frequent in patients who have diabetes or have gained greater than 5% of their initial weight (Stahl. 2020). • Patients that are at higher risk for metabolic complications should have triglycerides checked monthly for several months (normal: <150 mg/dL) and should also be monitored for signs of onset of diabetes (polyuria, polydipsia, polyphagia, weight loss, N/V, dehydration, confusion) although aripiprazole has not been associated with increased risk (Stahl. 2020). • Baseline CBC should be done with frequent monitoring for the first few months of treatment to assess for decline in WBCs (normal: 5,000-10,000/mm3) (Stahl. 2020). • Abnormal involuntary movement scale (AIMS) should be done at baseline and every three to six months to assess for development of tardive dyskinesia (Stahl. 2020; Stahl. 2021).