Week 6: Decision Tree for Neurological and Musculoskeletal Disorders Essay

Week 6: Decision Tree for Neurological and Musculoskeletal Disorders Essay

Week 6: Decision Tree for Neurological and Musculoskeletal Disorders Essay

Multiple sclerosis (MS) is a nervous system disorder affecting the spinal cord and the brain. The myelin sheath is normally destroyed in people diagnosed with MS, slowing down or blocking messages between the body and the brain leading to the associated symptoms. Most people normally start displaying symptoms between the ages of 20 and 40 years (Ferraro et al., 2018). Such symptoms include muscle weakness, visual disturbances, coordination, and balance problems, numbness, and memory problems among others. However, with appropriate treatment patients’ quality of life and well-being can be improved. The purpose of this paper is to demonstrate appropriate decision-making in selecting the most effective medication for the treatment of a 26-year-old with multiple sclerosis.

Summarize the Patient Case Study

The patient in the provided case study is a 26-year-old female with a diagnosis of multiple sclerosis. She was scheduled for a follow-up appointment with her physician but is still concerned about more knowledge about her MS diagnosis. She also needs to be informed concerning the impact of the disorder on her neurologic and musculoskeletal system in addition to the specific drug therapy plans on which she can decide.

Treatment Decisions

From the available option, the best medication to consider for initial therapy for the patient is 25mg Amitriptyline orally at bedtime. Based on the patient outcome, the drug can be titrated upwards at intervals of 25mg per week, not exceeding 200mg per day. Amitriptyline is a tricyclic antidepressant that has proven to be effective in the management of painful parenthesis in the legs and arms among MS patients (Rae-Grant et al., 2018). The second intervention was to continue with the same medication and increase the dose to 125mg at bedtime given that the patient displayed a minimal reduction of symptoms but great tolerance to the medication. The last intervention was to continue the same drug and dose, 125mg amitryptiline at bedtime, and advise the patient to see a life coach for counseling on good dietary habits and exercise (Mésidor et al., 2021). This decision was based on the great effectiveness displayed by the drug in the management of the patient’s symptoms, with weight gain as the only side effect.

Expected Outcome

            With the use of Amitriptyline 25mg once daily, the patient was expected to display at least 50% remission of symptoms, with common side effects such as nausea, vomiting, headache, and dry mouth (Stankiewicz & Weiner, 2020). These side effects were however expected to diminish with time as the patient continues taking the drug. The dose was expected to be titrated upwards at the rate of 25 mg per week to an optimal dose with complete remission of the patient’s symptoms within 8 to 12 weeks.

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Difference Between Expected and Actual Outcome

The patient displayed great effectiveness with the medication just as expected. Her pain level reduced gradually with an increased dose with the optimum dose attained at 125mg orally at bedtime (Stamoula et al., 2021). However, she displayed significant weight gain which was not expected. As such, it was necessary to introduce a life coach to help with lifestyle modification that will help the patient maintain healthy body weight.

Conclusion

            Multiple sclerosis is a disabling neurological and musculoskeletal disorder that can be managed by the use of several medications. For the 26-year-old patient in the provided case study, the use of 125mg amitriptyline once daily displayed great effectiveness in the management of the MS symptoms.

References

Ferraro, D., Plantone, D., Morselli, F., Dallari, G., Simone, A. M., Vitetta, F., … & Vollono, C. (2018). Systematic assessment and characterization of chronic pain in multiple sclerosis patients. Neurological Sciences, 39(3), 445-453. https://doi.org/10.1007/s10072-017-3217-x

Mésidor, M., Rousseau, M. C., Duquette, P., & Sylvestre, M. P. (2021). Classification and visualization of longitudinal patterns of medication dose: An application to interferon‐beta‐1a and amitriptyline in patients with multiple sclerosis. Pharmacoepidemiology and drug safety, 30(9), 1214-1223. https://doi.org/10.1002/pds.5297

Rae-Grant, A., Day, G. S., Marrie, R. A., Rabinstein, A., Cree, B. A., Gronseth, G. S., … & Pringsheim, T. (2018). Practice guideline recommendations summary: disease-modifying therapies for adults with multiple sclerosis: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology, 90(17), 777-788. https://doi.org/10.1212/WNL.0000000000005347

Stamoula, E., Siafis, S., Dardalas, I., Ainatzoglou, A., Matsas, A., Athanasiadis, T., … & Papazisis, G. (2021). Antidepressants on multiple sclerosis: a review of in vitro and in vivo models. Frontiers in Immunology, 12. DOI: 10.3389/fimmu.2021.677879

Stankiewicz, J. M., & Weiner, H. L. (2020). An argument for broad use of high efficacy treatments in early multiple sclerosis. Neurology-Neuroimmunology Neuroinflammation, 7(1). https://doi.org/10.1212/NXI.0000000000000636

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Decision Tree for Neurological and Musculoskeletal Disorders

For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.

Photo Credit: KATERYNA KON/SCIENCE PHOTO LIBRARY / Science Photo Library / Getty Images
To Prepare
• Review the interactive media piece assigned by your Instructor.
• Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
• Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
• You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.
By Day 7 of Week 8
Write a 1- to 2-page summary paper that addresses the following:
• Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
• Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
• What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
• Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

Week 6: Neurologic and Musculoskeletal Disorders
Class,
This week we will cover the pharmacology of neurological and musculoskeletal disorders. These are extensive topics and we will cover many different conditions this week. The pharmacology of drugs used to treat these conditions can have complex mechanisms of action, significant drug-drug interactions, and serious side effects to consider.
There are many different neurotransmitters involved in the neurological conditions we will discuss this week. When learning different drug classes, try to keep in mind the neurotransmitter involved and what effect the drug has on it. Some of the topics you will learn about this week are some of the hardest conditions to treat pharmacologically, such as seizures, Parkinson’s, and Alzheimer’s.
For musculoskeletal disorders, again we are faced with some unique pharmacological agents. This week you will read about disease-modifying antirheumatic drugs (DMARDs). Also, there are drugs referred to as biologics entering the market for conditions such as arthritis. These drugs represent exciting new technologies in the pharmaceutical world, and I hope some of you choose to research them further. Again, reach out to me if you have any questions on these topics.
Instead of a discussion this week, you are assigned a 1-2 page paper that is due on Day 7 of Week 8 (the night of April 24) on the Interactive Media file titled “Alzheimer’s Disease” located under Week 6 in the Resources tab on the Course Home page (left hand column). Please be sure to review the rubric for the assignment so that you cover all of the required topics. This is what I will be grading you on.
Also, at this point you should be studying for the mid-term that will be due by the end of week 7 (the night of April 17). Note that there is a study guide available on the Resources tab for Week 6. I am looking forward to another great week of learning! You are at the halfway point already! Keep it up!

Learning Resources

Required Readings (click to expand/reduce)

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
• Chapter 26, “Antipsychotic Agents and Their Use in Schizophrenia” (pp. 203–213)
• Chapter 27, “Antidepressants” (pp. 214–226)
• Chapter 28, “Drugs for Bipolar Disorder” (pp. 228–233)
• Chapter 29, “Sedative-Hypnotic Drugs” (pp. 234–242)
• Chapter 30, “Management of Anxiety Disorders” (pp. 243–247)
• Chapter 31, “Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder” (pp. 248–254)

Required Media (click to expand/reduce)

Walden University, LLC. (Producer). (2019a). Adult geriatric depression [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat adult geriatric depression.

Walden University, LLC. (Producer). (2019c). Attention deficit hyperactivity disorder [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat attention deficit hyperactivity disorder.

Walden University, LLC. (Producer). (2019d). Bipolar therapy [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics for bipolar therapy.

Walden University, LLC. (Producer). (2019g). Generalized anxiety disorder [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat generalized anxiety disorder.

Speed Pharmacology. (2016). Pharmacology – Antidepressants – SSRIs, SNRIs, TCAs, MAOIs, Lithium (Made Easy) [Video]. https://www.youtube.com/watch?v=T25jvLC6X0w&t=3s
Note: This media program is approximately 19 minutes.

Speed Pharmacology. (2018). Pharmacology – Benzodiazepines, Barbiturates, Hypnotics (Made Easy) [Video]. https://www.youtube.com/watch?v=4ZHudeMho8g&t=24s
Note: This media program is approximately 8 minutes.

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RUBRIC:

Excellent Good Fair Poor
Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented. Be specific. 18 (18%) – 20 (20%)
The response accurately and thoroughly summarizes in detail the patient case study assigned, including specific and complete details on each of the three decisions made for the patient presented. 16 (16%) – 17 (17%)
The response accurately summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented. 14 (14%) – 15 (15%)
The response inaccurately or vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented. 0 (0%) – 13 (13%)
The response inaccurately and vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented, or is missing.
Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources. 23 (23%) – 25 (25%)
The response accurately and thoroughly explains in detail how the decisions recommended for the patient case study are supported by the evidence-based literature.

The response includes specific and relevant outside reference examples that fully support the explanation provided. 20 (20%) – 22 (22%)
The response accurately explains how the decisions recommended for the patient case study are supported by the evidence-based literature.

The response includes relevant outside reference examples that lend support for the explanation provided that are accurate. 18 (18%) – 19 (19%)
The response inaccurately or vaguely explains how the decisions recommended for the patient case study are supported by the evidence-based literature.

The response includes inaccurate or vague outside reference examples that may or may not lend support for the explanation provided or are misaligned to the explanation provided. 0 (0%) – 17 (17%)
The response inaccurately and vaguely explains how the decisions recommended for the patient case study are supported by the evidence-based literature, or is missing.

The response includes inaccurate and vague outside reference examples that do not lend support for the explanation provided, or is missing.
What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources. 18 (18%) – 20 (20%)
The response accurately and thorough explains in detail what they were hoping to achieve with the decisions recommend for the patient case study assigned.

The response includes specific and relevant outside reference examples that fully support the explanation provided. 16 (16%) – 17 (17%)
The response accurately explains what they were hoping to achieve with the decisions recommended for the patient case study assigned.

The response includes relevant outside reference examples that lend support for the explanation provided that are accurate. 14 (14%) – 15 (15%)
The response inaccurately or vaguely explains what they were hoping to achieve with the decisions recommended for the patient case study assigned.

The response includes inaccurate or vague outside reference examples that may or may not lend support for the explanation provided or are misaligned to the explanation provided. 0 (0%) – 13 (13%)
The response inaccurately and vaguely explains what they were hoping to achieve with the decisions recommended for the patient case study assigned, or is missing.

The response includes inaccurate and vague outside reference examples that do not lend support for the explanation provided, or is missing.
Explain any difference between what you expected to achieve with each of the decisions and the results of the decisions in the exercise. Describe whether they were different. Be specific and provide examples. 18 (18%) – 20 (20%)
The response accurately and clearly explains in detail any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise.

The response provides specific, accurate, and relevant examples that fully support whether there were differences between the decisions made and the decisions available in the exercise. 16 (16%) – 17 (17%)
The response accurately explains any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise.

The response provides accurate examples that support whether there were differences between the decisions made and the decisions available in the exercise. 14 (14%) – 15 (15%)
The response inaccurately or vaguely explains any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise.

The response provides inaccurate or vague examples that may or may not support whether there were differences between the decisions made and the decisions available in the exercise. 0 (0%) – 13 (13%)
vaguely explains in detail any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise, or is missing.

The response provides inaccurate and vague examples that do not support whether there were differences between the decisions made and the decisions available in the exercise, or is missing.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. 3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. 0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors 4 (4%) – 4 (4%)
Contains a few (1–2) grammar, spelling, and punctuation errors 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) grammar, spelling, and punctuation errors 0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%)
Uses correct APA format with no errors 4 (4%) – 4 (4%)
Contains a few (1–2) APA format errors 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) APA format errors 0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors