Puerto Rican Woman With Comorbid Addiction.

The Assignment: 5 pagesExamine Case Study: A Puerto Rican Woman With Comorbid Addiction. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.Introduction to the case (1 page)Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision-making when prescribing medication for this patient.Decision #1 (1 page)Which decision did you select?Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.Decision #2 (1 page)Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.Decision #3 (1 page)Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.Conclusion (1 page)Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.BACKGROUNDMrs. Maria Perez is a 53-year-old Puerto Rican female who presents today due to a rather “embarrassing problem.” SUBJECTIVEMrs. Perez admits that she has had “problems” with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20’s and has been involved with Alcoholics Anonymous “on and off” for the past 25 years. She states that for the past 2 years, she has been having more and more difficulty maintaining her sobriety since the opening of the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during its grand opening at which point she was “hooked.” She states that she gets “such a high” when she is gambling. While gambling, she “enjoys a drink or two” to help calm her during high-stakes games. She states that this often gives way to more drinking and more reckless gambling. She also reports that her cigarette smoking has increased over the past 2 years and she is concerned about the negative effects of cigarette smoking on her health.She states that she attempts to abstain from drinking but she gets such a “high” from the act of gambling that she needs a few drinks to “even out.” She also notices that when she drinks, she doesn’t smoke “as much,” but she enjoys smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much. She currently weighs 122 lbs., which represents a 7 lb. weight gain from her usual 115 lb. weight.Mrs. Perez is quite concerned today because she borrowed over $50,000 from her retirement account to pay off her gambling debts, and her husband does not know. MENTAL STATUS EXAMThe client is a 53-year-old Puerto Rican female who is alert and oriented to person, place, time, and event. She has dressed appropriately for the weather and time of year. Her speech is clear, coherent, and goal-directed. Her eye contact is somewhat avoidant during the clinical interview. When you make eye contact with her, she looks away or looks down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported mood is “sad.” Affect is appropriate to the content of the conversation and self-reported mood. She denies visual or auditory hallucinations, and no delusional or paranoid thought processes are readily appreciated. Insight and judgment are grossly intact; however, impulse control is impaired. She is currently denying suicidal or homicidal ideation.Diagnosis: Gambling disorder, alcohol use disorder  Decision Point One Antabuse (disulfiram) 250 mg orally every morningRESULTS OF DECISION POINT ONE·    Client returns to the clinic in four weeks·    Mrs. Perez reports to the office complaining of sedation, fatigue, and a “metallic taste” in her mouth, which “seems to be going away.” She also reports that she had just one drink about 5 days after starting the drug and thought that she would “die.” She reports that her face was red, and she felt that her heart would “pound right out of my chest.”·    Mrs. Perez also reports that she continues to visit the casino but has not been spending as much money there. She has noticed that her cigarette smoking is increasingDecision Point Two Continue current dose of Antabuse and begin Wellbutrin (bupropion) XL 150 mg orally daily RESULTS OF DECISION POINT TWO·    Client returns to the clinic in four weeks·    Mrs. Perez reports that the side effects of the Antabuse are “gone” and that she is feeling much better·    She reports that she is still smoking but that “it has dropped to only a couple of cigarettes a day.”·    She still reports that she is visiting the casino but is not spending “as much money” as she had been in the pastDecision Point Three Maintain current doses of each medication and refer to counseling for her gambling Guidance to Student Sedation/fatigue is a common complaint of people who take Antabuse, the best approach would be to change the administration time to the evening. The “metallic” taste in Mrs. Perez’s mouth is also another side effect that lessens and may fully go away with the passage of time. When a person taking disulfiram ingests alcohol, they will probably experience “flushing,” tachycardia, nausea, and vomiting.At this point, you should maintain the current dose of each medication and refer the client to a counselor. Recall that there are no FDA-approved medications for the treatment of gambling addiction, and counseling is the mainstay of treatment for this particular disorder.Nothing indicates an increase the Wellbutrin. Recall that it could take as long as 12 weeks for this medication to exert its full therapeutic effect. Cognitive-behavioral principles can also be employed to help Mrs. Perez stop smoking, in addition to the Wellbutrin.Although controversy exists in the literature regarding how long to maintain a client on Antabuse, 8 weeks is probably too soon to consider discontinuation.