Module 06 Discussion – Common Medication-Nutrient (Food) Interactions

Directions:

For this discussion forum, find three interactions between medications and nutrients (food). List the interaction, foods to avoid while taking the medication, and describe key points that should be included in client education regarding the interactions.

You can use Epocrates to find your information https://online.epocrates.com/, or Medline Plus http://www.nlm.nih.gov/medlineplus/druginformation.html, or any other evidence based resource.

I have to write a reply to each of the texts in the document attached below, they must be 200 words each and include references.

Unit 9 ADHD Medications. 800w. 4 references. Due 10-26-23

Thomas Deliver, a 36-year-old male patient, enters your office for his initial appointment.  According to the intake paperwork, Mr. Deliver is a computer programmer who is complaining of problems with concentration, completing tasks, and being terrible at listening during company meetings and even at home.  He explains that he has difficulty starting and completing work projects and trouble being on time or keeping appointments and commitments.  He has divorced 3 months ago and has joint custody of two daughters ages 6 and 10 years old.  On most days, he sleeps late and he has trouble keeping a regular schedule and getting his children to their lessons and extracurricular appointments on time. 

Mr. Deliver believes the lack of concentration and poor communication with his wife led to the divorce, and Mr. Deliver worries that his trouble with organization and attention may affect his custody agreement and prevent him from keeping his job. 

Mr. Deliver’s employer and his family and friends have suggested to him that he should get evaluated for ADHD, but he has resisted because of concerns about the stigma of a psychiatric diagnosis and the risks of taking a psychotropic medication.

Mr. Deliver is 5'11″ and his weight is 165 lb.  He takes a men’s multivitamin daily, HCTZ at 25 mg for hypertension, fish oil 1,000 mg at bedtime for hyperlipidemia, and a rescue inhaler that he keeps with him although he hasn’t had to use it for many years.

1. What screening tools can be used to affirm your initial diagnosis that Mr. Deliver meets the criteria for ADHD?

2. Further assessment determines that Mr. Deliver does meet the criteria for ADHD, inattentive type. What is the current recommendation for pharmacological treatment for Mr. Deliver?

Assume that instead of Mr. Deliver being 36-years-old, Thomas is a 13-year-old male that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on any medications at this age).  How will your pharmacological treatment change?

Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.

Please review the rubric to ensure that your response meets the criteria.

1. What screening tools can be used to affirm your initial diagnosis that Mr. Deliver

meets the criteria for ADHD?

 The first tool I would use to affirm that this patient meets the criteria for ADHD would be

the DSM-5. The DSM-5 lists the diagnostic criteria for ADHD as needing six or more of

the symptoms in either category 1 (inattention) or category 2 (hyperactivity and

impulsivity) that last for at least 6 months and to a degree that negatively impacts social,

academic or occupations activities. These symptoms also need to be present in two or

more settings, be present prior to age of 12 years and do not occur exclusively during

the course of schizophrenia or another psychotic disorder and are not better explained

by another mental disorder (American Psychiatric Association, 2013). There are also

many screening tools to use in addition to the DSM-5. Rating scales are used in

conjunction with the DSM-5 to help with diagnosis of ADHD. Rating scales specifically

designed for use in adults include: Brown Attention-Deficit Disorder Symptom

Assessment Scale for Adults (BADDS); Adult ADHD Clinical Diagnostic Scale (ACDS);

ADHD Rating Scale-IV With Adult Prompts (ADHD-RS-IV); and the Adult ADHD SelfReport Scale (ASRS) (Gualtieri & Johnson, 2005).

This study source was downloaded by 100000769192234 from CourseHero.com on 10-21-2023 15:58:26 GMT -05:00

https://www.coursehero.com/file/123197904/discussion-9docx/

2. Further assessment determines that Mr. Deliver does meet the criteria for ADHD,

inattentive type. What is the current recommendation for pharmacological

treatment for Mr. Deliver?

I would recommend either an amphetamine or methylphenidate. I am slightly

concerned about this patient’s history of hypertension and hyperlipidemia, as both

of these psychostimulant classes have been shown to raise blood pressure. Long

term studies have shown that stimulant use is not associated with increased risk of

heart attacks, cardiac death or stroke. Those with well-controlled hypertension have

been shown to manage ADHD symptoms effectively with amphetamines and

methylphenidates. This still does not negate the fact however, that the product

labels of stimulants state that “caution is indicated” when treating patients with preexisting hypertension (Fairman et al., 2018). I would also be sure to encourage this

patient to partake in behavioral therapy as well as using prescription medication.

3. Assume that instead of Mr. Deliver being 36-years-old, Thomas is a 13-year-old male

that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on

any medications at this age). How will your pharmacological treatment change?

For an adolescent patient the treatment plan is not a lot different than for adults

with ADHD. Stimulants are more effective than non-stimulants, but there can be a

risk for growth restriction. There are other non-stimulant medications that could be

tried first (atomoxetine, guanfacine, clonidine, bupropion, and modafinil). As with

adults with ADHD, I would also recommend concurrent behavioral therapy (Heldt,

2017).

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Arlington, VA: American Psychiatric Publishing

Fairman, K. A., Davis, L. E., Peckham, A. M., & Sclar, D. A. (2018). Diagnoses of

Cardiovascular Disease or Substance Addiction/Abuse in US Adults Treated for ADHD

with Stimulants or Atomoxetine: Is Use Consistent with Product Labeling? Drugs – Real

World Outcomes, 5(1), 69–79. https://doi.org/10.1007/s40801-017-0129-2

This study source was downloaded by 100000769192234 from CourseHero.com on 10-21-2023 15:58:26 GMT -05:00

https://www.coursehero.com/file/123197904/discussion-9docx/

Gualtieri, C. T., & Johnson, L. G. (2005). ADHD: Is Objective Diagnosis Possible? Psychiatry

(Edgmont (Pa. : Township)), 2(11), 44–53.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993524/

Heldt, J. P. (2017). Memorable psychopharmacology. Createspace Independent Publishing

Platform

1.What screening tools can be used to affirm your initial diagnosis that Mr. Deliver meets the criteria for ADHD?

The DSM-5 would be the first resource I would consult to confirm if this patient satisfies the requirements for ADHD. According to the DSM-5, six or more symptoms from either group—category 1 (inattention) or category 2 (hyperactivity and impulsivity)—must be present for at least six months and have a detrimental influence on a person's ability to engage in social, academic, or occupational activities. Additionally, these symptoms must appear in two or more contexts, appear before the age of twelve, not only occasionally during the course of schizophrenia or another psychotic condition, and not be better explained by another mental illness (American Psychiatric Association, 2013).The DSM-5 is just one of several screening instruments available. The DSM-5 and rating scales are combined to assist in the diagnosis of ADHD. The Brown Attention-Deficit Disorder Symptom Assessment Scale for Adults (BADDS), the Adult ADHD Clinical Diagnostic Scale (ACDS), the ADHD Rating Scale-IV With Adult Prompts (ADHD-RS-IV), and the Adult ADHD SelfReport Scale (ASRS) are among the rating scales created expressly for use in adults (Gualtieri & Johnson, 2005).

 

 

2.Further assessment determines that Mr. Deliver does meet the criteria for ADHD, inattentive type. What is the current recommendation for pharmacological treatment for Mr. Deliver?

 

Either an amphetamine or methylphenidate is what I would advise. The patient's history of hypertension and hyperlipidemia causes me a little anxiety because it has been demonstrated that both of these kinds of psychostimulants can increase blood pressure. Studies conducted over an extended period of time have revealed no link between stimulant usage and an increased risk of heart attacks, cardiac death, or stroke. Amphetamines and methylphenidate have been demonstrated to help people with well-controlled hypertension manage their ADHD symptoms. However, this does not change the fact that while treating patients with preexisting hypertension, caution is advised on the product labels of stimulants (Fairman et al., 2018). In addition to prescription medication, I would make sure to encourage this patient to engage in behavioral treatment.

 

3.Assume that instead of Mr. Deliver being 36-years-old, Thomas is a 13-year-old male that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on any medications at this age). How will your pharmacological treatment change?

The treatment strategy is mostly the same for adolescents and adults with ADHD. Although stimulants are more effective than non-stimulants, there is a chance that they may limit growth. There are more non-stimulant drugs that might be tried initially (atomoxetine, guanfacine, clonidine, bupropion, and modafinil). In the same way that I would advise concurrent behavioral therapy for people with ADHD (Heldt, 2017)

Step-by-step explanation

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing

 

 Fairman, K. A., Davis, L. E., Peckham, A. M., & Sclar, D. A. (2018). Diagnoses of Cardiovascular Disease or Substance Addiction/Abuse in US Adults Treated for ADHD with Stimulants or Atomoxetine: Is Use Consistent with Product Labeling? Drugs – Real World Outcomes, 5(1), 69-79. https://doi.org/10.1007/s40801-017-0129-2

 

Gualtieri, C. T., & Johnson, L. G. (2005). ADHD: Is Objective Diagnosis Possible? Psychiatry (Edgmont (Pa. : Township)), 2(11), 44-53. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993524/ 

 

Heldt, J. P. (2017). Memorable psychopharmacology. Createspace Independent Publishing Platform. 

   

Week 4 Discussion Forum

      

Complete your week 4 required discussion prompt.

• The  NLN vision series is considered a roadmap for where nurse education is  headed. Review the different statements listed at the following linkhttp://www.nln.org/newsroom/nln-position-documents/nln-living-documents 

 Links to an external site.  Consider where your research proposal most closely fits within or  aligns to the listed statements. Choose one or two and explain in detail  why you feel it aligns with the NLN’s vision.

Case Study: Prescribed Drugs with CAMs

Mr. X, a 42-year-old male presents to your primary care practice today complaining of low back pain.

History – Mr. X states that he has had chronic low back pain since he had a skiing accident about 10 years ago. Three days ago, he felt a pulling sensation in his lower back after moving some boxes. The pain intensity increased over the subsequent 24 hours and is now steady, aching in nature, at 3-4 out of 10. Mr. X also has Type2 diabetes, which is well controlled on metformin with a HGA1c of 5.6. He has a history of DVT 4 months ago for which he takes Coumadin, INR is WNL. He is followed by a specialist for this problem. He recently started taking two OTC products; kava kava for what he describes as “anxiety” and CoEnzyme Q10 on the advice of a friend.

Social – Mr. X is a smoker, 1 pack per week for 15 years. No alcohol or drug use. He is employed as an accountant and has medical insurance. He is divorced.
PE/ROS – Complains of low back stiffness and pain on movement with occasional spasms related to moving in certain directions. You note he has mild difficulty getting onto the exam table but gait is normal. He denies weakness/numbness/tingling of legs, no radiation, no change in bowel or bladder habits. BMI 27. All range of motion of the back is decreased by 25%. Straight leg lift is negative bilaterally, DTR intact. All other systems WNL.

Medications:

Metformin 1000mg ER one tab daily – Type II Diabetes controlled

Coumadin 5 mg. daily – Hx of DVT – Controlled

Kava Kava 50 mg. tid – Self-medication for anxiety

CoQ10 – 200 mg. daily. – Self-medication for unknown reason

1. Provide a diagnosis for the patient and your rationale for the diagnosis

2. Provide a treatment plan specifically for this patient, pharmacologic and non-pharmacologic.

3. Comment on the use of OTC products in relation to Mr. X’s current chronic and acute disease diagnoses and medications. Include drug-drug interactions and side effect profiles.

4. Provide an education plan for Mr. X

5. Present this Assignment as a PowerPoint presentation with between 12 and 16 slides (not including opening slide and resource slide).

6. You will use the Narrative notes section of the presentation to include the majority of your evidentiary support of your treatment choices and education of family complete with in-text citations using APA formatting,

Due by the last day of Unit 9 at 11:59 p.m.

Assignment Requirements:

Before finalizing your work, you should:

· be sure to read the Assignment description carefully (as displayed above);

· consult the Grading Rubric (under Course Resources) to make sure you have included everything necessary; and

· utilize spelling and grammar check to minimize errors.

· Submit to and review results of Turnitin. Purdue University Global Student Conduct policy as it relates to plagiarism will be adhered to in this course.

Your writing Assignment should:

· follow the conventions of Standard English (correct grammar, punctuation, etc.);

· be well ordered, logical, and unified, as well as original and insightful;

· display superior content, organization, style, and mechanics; and

· utilize APA 7th edition formatting.

Rubric Title: MN553 Unit 9 Assignment Rubric

Assignment Criteria	Level III	Level II	Level I	Not Present
Criteria 1	Level III Max Points Points: 8	Level II Max Points Points: 6.4	Level I Max Points Points: 4.8	Not Present 0 Points
Correctly diagnosing the patient	· A correct diagnosis is provided with supportive rationale from literature	· A correct diagnosis is provided without rationale	· Does not meet the Criteria	· Does not meet the criteria
Criteria 2	Level III Max Points Points: 12	Level II Max Points Points: 9.6	Level I Max Points Points: 7.2	Not Present 0 Points
Prescribing a treatment plan	· An appropriate and specific treatment plan for the case study patient is provided with rationale from literature for treatment choices.	· A specific treatment plan is provided for the case study patient but is missing less than 50% of pharmacologic and non-pharmacologic treatment with rationale from literature for treatment choices	· A specific treatment plan is provided for the case study patient but is missing more than 50% of pharmacologic and non-pharmacologic treatment with rationale from literature for treatment choices; Or · Rationale for treatment choices from literature are not provided	· Does not meet the criteria
Criteria 3	Level III Max Points Points: 11	Level II Max Points Points: 8.8	Level I Max Points Points: 6.6	Not Present 0 Points
Over-the-counter medication use discussion	A thorough discussion of the kinetics and dynamics of OTC products is provided and a rationale for including or excluding them from the treatment plan is provided.	· Kinetics and dynamics of OTC products are discussed and are related to the patient's current meds/conditions but specific direction regarding continued use is not included	· Kinetics and dynamics of OTC products are discussed but not related to the patient's current meds/conditions.	· Does not meet the criteria
Criteria 4	Level III Max Points Points: 8	Level II Max Points Points: 6.4	Level I Max Points Points: 4.8	Not Present 0 Points
Education plan	· A thorough education plan for the treatment plan is provided which includes principles of therapeutic communication.	· An education plan is provided which provides more than 50% of necessary information for the treatment plan and includes principles of therapeutic communication	· An education plan is provided but contains less than 50% of necessary information and includes principles or therapeutic communication OR · Principles of therapeutic communication are not included	· Does not meet the criteria
Criteria 5	Level III Max Points Points: 8	Level II Max Points Points: 6.4	Level I Max Points Points: 4.8	Not Present 0 Points
College-level academic writing	· Professional, peer-reviewed, advanced practice references are used · Grammar and mechanics of writing demonstrate graduate level work · Adheres to page number requirements	· The majority of references used are professional, peer-reviewed and advanced practice · Errors in grammar or mechanics of writing are present but do not interfere with readability · Adheres to page number requirements	· The minority of references used are professional, peer-reviewed and advanced practice · Errors in grammar or mechanics of writing are present Which interferes with readability · Does not adhere to page number	· Does not meet the criteria
Criteria 6	Level III Max Points Points: 8	Level II Max Points Points: 6.4	Level I Max Points Points: 4.8	Not Present 0 Points
Citations and Formatting	· There is a strong attempt to cite all sources using APA style. · Minor paper formatting errors may occur. · Minor in-text citation errors may occur. · All authorship is clear and retrievable.	· There is an overall attempt at APA formatting and citation style. · Errors in formatting of citation or sources are present. · All sources have some form of citation and all citations have a matching source. · Citations generally make authorship clear.	· Major errors in citations or source formatting are present. · Citation or source information may be missing or incorrect. · Authorship may be unclear.	· Does not meet the criteria
Maximum Total Points	55	44	33	0
Minimum Total Points	45 points minimum	34 points minimum	1 point minimum	0