Medication Adherence in Bipolar I Disorder

2593 words (10 pages) Essay in Psychology

18/05/20 Psychology Reference this

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Medication Adherence in Bipolar I Disorder

Medication Regimen

Medication

Reason for taking

Interactions

Special instructions

Time(s) that medication will be taken

Lithium Carbonate 1500 mg

Stabilize mood/ treat acute mania and hypomania

Limit Alcohol/ Caffeine/ Medication interactions: NSAIDs/ SSRIs/ Calcium channel blockers: increase risk of toxicity. Diuretics cause hypotension.

Take with food if upsets stomach. Maintain steady salt, fluid intake. Take as directed. Do not stop. If missed dose, do not double dose. Lithium levels must be monitored. Report vomiting, diarrhea, drowsiness, confusion, muscle twitching, and tremors.

Take two pills by mouth in the morning 7am and two in the evening 7pm

Seroquel (quetiapine) 100 mg

Treatment of acute mania and hypomania. Taken in combination with Lithium.

Interacts with Alcohol/ CNS depressants/ grapefruit juice/ST. john’s wort, kava kava.

Increase fluid intake when active. Take as directed. Take with food if upsets stomach. Slowly go from lying to standing.

Take one pill by mouth in the morning 9 am and two in the evening 9 pm

Ativan (lorazepam) 1 mg

Relief Agitation/ symptoms of anxiety

Alcohol/ caffeine/ grapefruit juice/valproic acid/ CNS depressants/ ST. john’s wort, kava kava.

Take with food. Avoid tasks that require alertness (driving).

Take one pill twice a day as needed

Trileptal (oxcarbazepine) 500 g

Stabilize mood/ Prevent seizures

Alcohol/ Oral contraceptives/ CNS depressants. Herbal: kava kava, St. John’s wort, valerian..

Take as directed. Do not stop. Avoid tasks that require alertness (driving) until affects of drug are known.

Take one pill by mouth in the morning 7am and two in evening 7pm

Ambien (zolpidem tartrate) 10 mg

Sleep/ treat insomnia

Avoid Alcohol/ CNS depressants/herbs: Kava kava, valerian, and St. John’s wort.

To fall asleep faster, do not take with food or right after a meal. Do not stop abruptly. Avoid tasks that require alertness (driving). Plan to sleep at least 8 hours. Avoid taking with Seroquel (increase CNS depression)

Take one pill at bedtime (10pm)

* Kizior, R. J., & Hodgson, B. B. (2017). Saunders Nursing Drug Handbook 2018 – E-Book. Retrieved from https://www.clinicalkey.com/nursing/#!/topic

Medication Adherence in Bipolar I Disorder

To get some understanding of non-adherence to complex medication regimens in Bipolar I patients, a short-term experiment was conducted. This experiment involves following an assigned medication regimen for ten days and applying all dietary guidelines on each medication.  Above is the medication schedule, which includes medication interactions, special instruction and administration times.

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Rational for the Medication Schedule

The medication scheduled was set up to allow time for absorption to take place and impairing effects such as: drowsiness, blurred vision and CNS depression, to decrease. Lithium carbonate, Seroquel (quetiapine) and oxcarbazepine (Trileptal) were taken in the morning at 7am with breakfast to allow medication effects to pass, before driving at 8am. There wasn’t a specific time set up for lorazepam (Ativan), but it shouldn’t be taken with Seroquel and Ambien due to increased CNS depression. Ambien was taken at bedtime and at least one to two hours after a meal to help fall asleep quicker. Since zolpidem (Ambien) should be administered when at least eight hours of sleep is planned, it was scheduled for 10pm.

 

Barriers to Treatment

 Due to abnormal changes in mood, impaired judgment, impulsivity and inability to carry out daily activities, it’s difficult to follow daily routine. A symptom of mental illness is lack of insight, called anosognosia (Halter, 2018, pg. 589). Anosognosia increases the problem with adherence and causes others to believe the patient is in denial (Halter, 2018, pg. 589). Mental illness stigma causes lack of understanding and fear of mentally ill people who are experiencing psychosis; this leads to isolation and discrimination towards them (Halter, M. J. 2018, Pg. 587). Many with Bipolar I disorder are unable to hold a job, which effects access to health care and means to pay for medication. Substance use is a barrier to medication adherence because of the additional risk of relapse and cognitive impairments (Halter, 2018, pg. 587). Medication side effects such as: excessive drowsiness, dizziness, cognitive impairment, blurred vision, sedation, hypotension and dry mouth, cause patients to stop taking their medication.

Dietary Guidelines

 Most of the prescribed medications interact with alcohol causing severe CNS depression and other serious side effects. For individuals who drink caffeine on the daily basis it could be difficult to decrease or eliminate caffeine consumption from their diet. Consumption of grapefruit juice should be avoided due to interaction with Ativan and Seroquel. During treatment with Lithium and Seroquel, fluids should be increased to two to three liters per day. To prevent GI upset, most of the prescribed medication can be taken with food. Ambien should not be taken with food or right after dinner because sleep could be delayed. Herbs such as kava kava, valerian, St. Johns wort, should be avoided when taking Seroquel, Ativan, Trileptal, and Ambien due to medication interaction.

Barriers Encountered

 Ensuring all medications were administered on time was a challenge due to several barriers. In the beginning of the treatment all the pills weren’t organized in pillbox to keep track of medications and times. It was hard to remember to take the medication routinely especially when not used to taking medication daily. Due to the complex medication schedule, there was a struggle in taking the pills on time. Since excessive caffeine consumption affects absorption of Lithium and Ativan, it was difficult to limit usual coffee intake due low energy levels. Avoiding changes in amount of salt consumptions was also challenging due to irregular diet.

Patient Safety and Compliance Tools

Examining the causes of non-compliance to treatment helps identify the interventions and tools needed to improve adherence. In the beginning of the experiment, the participant gained knowledge of the medication side effects, interactions and dietary guidelines. Medication schedule was organized in a travel pillbox indicating daytime, evening and nighttime. To also help with timely administration, an application called Pill Reminder & Medication Tracker was utilized. 

To help identify tools that may support a bipolar patient with adherence, nurses should first build rapport, assess health literacy, life-style and provide education. Safety measures and compliance tools can be established depending on the unique needs of the patient (Lewis et al, 2017, p.5). A tool that can be utilized by patients to help with adherence is the pill reminder and tracker application that sends alerts repeatedly until medication is marked as administered. Patient with multiple medications can organize pills by times of day and carry the pillbox in backpacks or bags. Patients with Bipolar I Disorder can benefit from family and friends support with adherence to treatment. They can help remind and organize medications weekly. If the medication schedule is too complicated to follow, health care providers may consider switching the patient to once a day dose or decreasing the number of medications that are indicated for the same illness. Health care providers could help patients adhere to medication by addressing and teaching ways to manage and reduce side effects.

Factors that impact patient centered care

It’s important to establish nurse-patient relationship built on trust and respect while incorporating their culture, values, and preferences in the care (Lewis et al, 2017, p.5). Factors that influence a patient’s response to care could be limitations in cognition or functional abilities, access to care, language, religious guidelines, social support and comfort. When the nursing process is utilized and patients are involved in planning their care, these factors are addressed and patient centered care is achieved (Lewis et al, 2017, p.5).

Other lessons learned

Initially the euphoric mood, elevated energy and self-esteem give the bipolar individuals a sense of happiness and wellbeing (Bulteau et al., 2018). By allowing a Bipolar I patient share details of a previous manic episode, healthcare providers and patients improve their understanding of the experience and psycho-education (Bulteau et al., 2018). A recent study (Mert, D. G., Turgut, N. H., Kelleci, M., & Semiz, M. 2015) found that adherence to medication regimen is enhanced when scheduled follow-up appointments are attended, care plan is modified according to disorder and factors that cause patient resistance to medications are addressed. Having social support and being in a relationship was found to enhance medication adherence (Onur Karaytug et al, 2017). Bipolar patients who lack social support should be continuously assessed for treatment adherence (Onur Karaytug et al, 2017).

 

References

  • Kizior, R. J., & Hodgson, B. B. (2017). Saunders Nursing Drug Handbook 2018 – E-Book. Retrieved from https://www.clinicalkey.com/nursing/#!/topic/lithium?topic=lithium
  • Kizior, R. J., & Hodgson, B. B. (2017). Saunders Nursing Drug Handbook 2018 – E-Book. Retrieved from https://www.clinicalkey.com/nursing/#!/topic/Seroquel?topic=Seroquel
  • Kizior, R. J., & Hodgson, B. B. (2017). Saunders Nursing Drug Handbook 2018 – E-Book. Retrieved from https://www.clinicalkey.com/nursing/#!/topic/Ativan?topic=Ativan
  • Kizior, R. J., & Hodgson, B. B. (2017). Saunders Nursing Drug Handbook 2018 – E-Book. Retrieved from https://www.clinicalkey.com/nursing/#!/topic/Trileptal?topic=Trileptal
  • Kizior, R. J., & Hodgson, B. B. (2017). Saunders Nursing Drug Handbook 2018 – E-Book. Retrieved from https://www.clinicalkey.com/nursing/#!/topic/Ambien?topic=Ambien
  • Halter, M. J. (2018). Serious Mental Illness. Varcarolis foundations of psychiatric-mental health nursing: a clinical approach. (pp. 587-589). St. Louis, Missouri: Elsevier
  • Halter, M. J. (2018). Bipolar and Related Disorders. Varcarolis foundations of psychiatric-mental health nursing: a clinical approach (8th ed.). (p. 223). St. Louis, Missouri: Elsevier
  • Lewis, S. M., Bucher, L., Heitkemper, M. M. L., & Harding, M. M. (2017). Professional Nursing Practice. Medical-surgical nursing: assessment and management of clinical problems. (p.5). St. Louis, Missouri: Elsevier
  • Onur Karaytug, M., Keskin, N., Tamam, L., Ozpoyraz, N., Emin Demirkol, M., & Gurbuz, M. (2017). Assessment of Treatment Adherence in Patients with Bipolar Disorder. Journal of Mood Disorders7(4), 185–190
  • Bulteau, S., Grall-Bronnec, M., Bars, P.-Y., Laforgue, E.-J., Etcheverrigaray, F., Loirat, J.-C., … Sauvaget, A. (2018). Bipolar disorder and adherence: implications of manic subjective experience on treatment disruption. Patient Preference & Adherence12, 1355–1361.
  • Mert, D. G., Turgut, N. H., Kelleci, M., & Semiz, M. (2015). Perspectives on reasons of medication no adherence in psychiatric patients. Patient Preference & Adherence9, 87–93.

 

NSG 211

Medication Adherence Assignment Survey

Directions: Complete this survey in our learning management system as part of the medication adherence assignment.

  1.  How many different medications were you prescribed for this assignment?

 Five medications

  1.  How many different medications, vitamins, or herbs do you regularly take each day? 

 Two

  1.  How many times did you miss a dose of medication during the 10-day period?

 12 times

  1. Did this assignment have any effect on your empathy towards patients who have to manage multiple medications?

Answer choices: Increased, Decreased, No affect

  1. Using the following scale, respond to the following statement:

The medication regimen was difficult to follow.

Strongly agree      Agree      Neither agree or disagree     Disagree     Strongly disagree

  1. Using the following scale, respond to the following statement:

I felt this was a valuable learning exercise.

Strongly agree   Agree      Neither agree or disagree     Disagree     Strongly disagree

  1. Using the following scale, respond to the following statement :

I was successful in adhering to the medication regimen.

Strongly agree       Agree      Neither agree or disagree     Disagree     Strongly disagree

 

Grading Rubric

 

Discussion

Points possible

Points earned

Develop medication regimen as stated in #2

Reason for taking

5

Interactions

5

Special instructions

5

15

Identify barriers & discuss

10

Discuss dietary guidelines

10

Barriers

Barriers to taking medication as scheduled

5

Barriers to following dietary guidelines

5

10

Discuss tools identified and give rationale

10

Discuss factors that impact patient centered care

10

Other lessons learned

5

Completed survey

10

APA/grammar

10

Total

100

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