week 9 response

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Response 1

Thank you for your thorough post this week on Neurological disorders and medications used to treat seizure disorders. I agree with you on the first question, that Shaynah should be informed of the risks associated with taking AED’s during pregnancy for the safety of the mother and unborn child. According to literature studies, he safety of antiepileptic drug use in pregnancy involves the mother, fetus, and subsequent extra-uterine existence as a neonate and infant. I also agree with you that the first drug of choice for Shayna should be Keppra 500mg daily. Although phenytoin is less sedating and considered the first line drug of choice according to (Woo &Robinson, 2020), I recommended the patient be started on Keppra 500mg daily due to its pregnancy category C and few drug-drug interactions. Given the information shared about Shayna’s plans to conceive,  my thought process aligns with yours about starting her on a safe broad spectrum AED. As Shayna’s NP, I would suggest close monitoring of her symptoms while starting on Keppra 500mg daily for effectiveness up until the time she conceives. I also agree with you that the second line of treatment should be lamotrigine with gradual titration for therapeutic levels. In addition to your rationale for Shyana’s sub therapeutic levels of carbamazepine, the use of contraceptives is likely to be the cause of the drop in levels. According to literature studies,combining oral contraceptives with carbamazepine may not produce any toxicity or increased carbamazepine serum levels but can lead to lower limits of carbamazepine serum levels. Lazorwitz et al. (2017), Lastly, I agree with you that weaning her off the Valporic acid due to its side effects and pregnancy category would be a viable option and continuing her on Lacosamide would be a safer option for her and her unborn baby.

 

References

Tomson, T., Battino, D., & Perucca, E. (2019). Teratogenicity of antiepileptic drugs. Current Opinion in Neurology, 32(2), 246-252. https://journals.lww.com/co-neurology/Fulltext/2019/04000/Teratogenicity_of_antiepileptic_drugs.11.aspx

Woo, T, M., & Robinson, M. V. (2020). Pharmacotherapeutics for advanced practice nurse prescribers (5th ed.) Philadelphia, PA: F.A. Davis Company.

Lazorwitz, A., Davis, A., Swartz, M., & Guiahi, M. (2017). The effect of carbamazepine on etonogestrel concentrations in contraceptive implant users. Contraception, 95(6), 571-577.

 

 

Response 2

I enjoyed reading your post for this week’s discussion question because we chose many different answers. I liked reading your rationale for why you chose your answers especially since we came to different conclusions. I found similar information about levetiracetam that you included in your post when I was reading the course materials and UpToDate. I think it is hard to say who is absolutely right/wrong when answering this question because research is yet to identify a single antiseizure medication that is superior simply in terms of efficacy or tolerability (Karceski, 2021). Some of the factors used to determine which antiseizure medication to use include: drug effectiveness, potential adverse effects, interactions with other medication, comorbid medical conditions, age/gender and childbearing plans, lifestyle and cost (Schachter, 2021). Levetiracetam would not have been initiated as first line treatment because it is approved as adjunctive therapy for primary generalized tonic-clonic seizures. The dose on question two is also incorrect. When initiating levetiracetam treatment the initial dose is 500 mg BID not daily. This medication has a rapid onset and may be increased up to 4000mg a day (Schachter, 2022). Combination therapies are not preferred to monotherapy for seizures. Combination therapy reduce the likelihood of compliance, is more costly to the patient, and doubles the risk for drug interactions and adverse effects. I was also able to find some general principles to consider when starting an antiseizure medication: start with a single drug, gradually titrate, and monitor treatment regularly (Schachter, 2022). I am thankful that as a future nurse practitioner in women’s health, that I will be able to collaborate with other providers and specialists to determine the best medication regimens for my patients. I can definitely understand how this would be something that often gets referred to neurology as there are so many choices to make when it comes to antiseizure treatment.

 

References

Karceski, S. (2021, July 19). Initial treatment of epilepsy in adults. UpToDate. Retrieved March 4, from https://www.uptodate.com/contents/initial-treatment-of-epilepsy-in-adults?search=seizure+disorder+treatment&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H1

Schachter, S. (2021, November 15). Overview of the management of epilepsy in adults. UpToDate. Retrieved March 4, 2022, from https://www.uptodate.com/contents/overview-of-the-management-of-epilepsy-in-adults?search=seizure%20management&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H4

Schachter, S. (2022, February 8). Antiseizure medications: Mechanism of action, pharmacology, and adverse effects. UpToDate. Retrieved March 4, 2022, from https://www.uptodate.com/contents/antiseizure-medications-mechanism-of-action-pharmacology-and-adverse-effects?search=generalized+tonic+clonic+seizures&source=search_result&selectedTitle=6~135&usage_type=default&display_rank=6#H844055138

 

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WEEk 9 response

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Response 1 : Levels of prevention response

 

The purpose of this reply post is to briefly summarize a scholarly article related to primary prevention that provides additional information to the discussion.

As discussed in your post, there are five levels of prevention primordial, primary, secondary, tertiary, and quaternary prevention (Kisling & Das, 2020). Whilst all of them are important, primary prevention is the principle level concerned with adult learning. Primary prevention measures target individuals or at-risk populations with an aim to halt disease development.

Article summary

Moreno-peral et al. (2015) conducted a meta-ethnographic synthesis on primary care patients’ perspectives of barriers and enablers of primary prevention and health promotion. Some of the barriers noted were the lack of culturally competent care. Patients described being instructed to perform actions that were contrary to their beliefs and or values. Other patients reported that their providers spent very little time with them during visits and that this time was spent discussing the issues that brought them in and treatment options and rarely on prevention. Some patients discussed the fact that some primary prevention actions such as eating healthy and physical activity were not feasible for various reasons. For example, some stated they had financial insecurities and their priority was bills and not healthier food options which were pricier. Additionally, some lived in areas that were not walkable or in very tight living quarters that they felt exercise was not conducive thus hampering their ability to increase physical activity.

Some enablers of primary prevention were facilitation of available community resources such as financial, transportation, and food bank connections that made it possible to adopt some primary prevention teachings such as healthier food choices. Other enablers mentioned were consistent primary care that allowed for seamless care and trust-building between patients and their providers. Some patients noted that individualized care that factored in their values, beliefs and limitations encouraged their autonomy and empowered them to change. Ali & Katz (2015) also found that culturally competent care and perceived physician interest and concern was more successful in encouraging behavior change and knowledge retention.

Summary

Researchers theorize that behavioral and lifestyle choices account for most of the premature mortality in the United States as they are linked to the development of chronic conditions such as heart, kidney, and lung diseases (Ali & Katz, 2015). As such, primary prevention is important because these efforts are directed towards disease prevention and encourages healthier lifestyles and behaviors. However, the success of primary prevention strategies hinges on effective communication, proper knowledge dissemination, cultural congruent care and the willingness and ability of the patient to make the appropriate changes.

References

Ali, A., & Katz, D. L. (2015). Disease Prevention and Health Promotion: How Integrative Medicine Fits. American Journal of Preventive Medicine, 49(5), S230–S240. https://doi.org/10.1016/j.amepre.2015.07.019

Kisling, L., & Das, J. (2020). Prevention Strategies. https://www.ncbi.nlm.nih.gov/books/NBK537222/

Moreno-Peral, P., Conejo-Cerón, S., Fernández, A., Berenguera, A., Martínez-Andrés, M., Pons-Vigués, M., Motrico, E., Rodríguez-Martín, B., Bellón, J. A., & Rubio-Valera, M. (2015). Primary care patients’ perspectives of barriers and enablers of primary prevention and health promotion-a meta-ethnographic synthesis. PloS One, 10(5), e0125004. https://doi.org/10.1371/journal.pone.

 

 

 

 

Response 2: Keeping patients healthy and preventative care response

 

Great post on immunizations and the issues that occur in the United States. I agree that there are quite a few barriers to patients receiving the immunizations they need to stay healthy. The issue begins in childhood and continues into adulthood. According to Ventola (2016) vaccination noncompliance begins when parents delay immunization schedules or decline them because of medical, religious or socioeconomic reasons. The article by C. L. Ventola titled “Immunization in the United States: Recommendations, Barriers and Measures to Improve Compliance” discusses the importance of vaccinations and the barriers in compliance for vaccinations.The author states that health care providers must be able to educate the patients on the importance of vaccinations. One of the issues that occur is the lack of access to the vaccinations. Anderson (2014) states that often times, children miss vaccinations because of the situation that their parents are in. Children who are raised in poverty-stricken homes, are less likely to receive their vaccines when needed. According to Ventola, when parents are going through hard times such as job loss, divorce or financial troubles, they do not always keep up with their child’s well visits. The parents may also have lack of transportations or the clinic hours are inconvenient with their word schedule (2016).When parents delay vaccines or use alternate vaccine schedules, they are creating a resurgence of disease that can be prevented (2016). This puts many different people at risk. Many parents believe that their children are protected because of the herd immunity, but this is not the case in all situations. Parents are reading about side effects and problems that other children have had with vaccines, and that makes them apprehensive to vaccine their own children (Anderson, 2014). I think that it is so important as an APRN to educate parents on the misconceptions of vaccines. Vaccine compliance begins with parents and is needed so that it can continue into the child’s adulthood. I feel that many people have relied on other people vaccinating their children to keep their own child safe, and that is a problem.ReferencesAnderson, E. L. (2014). Recommended solutions to the barriers to immunization in children and adults. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179470/pdf/ms111_p0344.pdfVentola, C. L. (2016). Immunization in the united states: recommendations, barriers, and measures to improve compliance. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4927017/pdf/ptj4107426.pdf

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