Wk10 decision tree

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Please see attachment for instructions.

Please see the decision tree case study attached

APA format with intext citation

4-5 scholarly references with in the last 5 years

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It is important that you describe the pharmacology of the medications that you choose, as well as those that you did not choose. It is vital that a practitioner
understand the pharmacology, indications, side effects and monitoring considerations for all medications in order to make an informed decision on the most appropriate therapy.

please be detailed in your description of the medications, including uses, potential adverse effects, monitoring and potential drug interactions. 

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.


Mrs. Maria Perez is a 53-year-old Puerto Rican female who presents today due to a rather “embarrassing problem.”


Mrs. 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 the 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 weights 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.


The client is a 53 year old Puerto Rican female who is alert and oriented to person, place, time, and event. She is 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 content of 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

Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks


Client returns to clinic in four weeks

 Mrs. Perez says she feels “wonderful” as she has not “touched a drop” of alcohol since receiving the injection

 Client reports that she has not been going to the casino, as frequently, but when she does go she “drops a bundle” (meaning, spends a lot of money gambling)

 Client She is also still smoking, which has her concerned. She is also reporting some problems with anxiety, which also has her concerned

Decision Point Two

Add on Chantix (varenicline) 1 mg orally BID


Client returns to clinic in four weeks

 Client reports that she had to stop taking Chantix secondary to abnormal dreams and agitation

 She also reports that she felt nauseous and vomited several times after she began taking the drug

Decision Point Three

Restart Chantix at 0.5 mg orally daily

Guidance to Student
Mrs. Perez was experiencing normal side effects associated with Chantix. She should be counseled regarding the potential side effects associated with Chantix and reassured that they will most likely abate. It should be noted that the problem Mrs. Perez is experiencing from the Chantix is most likely related to the starting dose. Recall that this drug should be initiated at 0.5 mg/day; after 3 days, increase to 1 mg/day in two divided doses; after 4 days, the dose can be increased to 2 mg/day in two divided doses. Side effects would most likely have been minimized or completely avoided had she been started at the appropriate starting dose. Therefore, it may be prudent to restart this drug at 0.5 mg orally daily and up titrate consistent with the manufacturer’s suggested titration schedule. It would not be appropriate to restart Mrs. Perez at 1 mg orally BID, as it would most likely result in a return of the unpleasant symptoms she experienced.

If Mrs. Perez is adverse to the idea of restarting Chantix, you could begin Wellbutrin XL, 150 mg orally daily.

Additionally, it should be noted that Mrs. Perez continues to engage in problematic gambling, at considerable personal financial cost. Mrs. Perez needs to be referred to a counselor who specializes in the treatment of gambling disorder and should also be encouraged to establish herself with a local chapter of Gamblers Anonymous.

Please indicated why you decided not to select Decision #2 (1 page) and Decision #3 (1 page) see below

Decision # 2

Antabuse (disulfiram) 250 mg orally every morning


 Client returns to 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 increasing

Decision # 3 this is the reason why we did not select this choice.

Campral (acamprosate) 666 mg orally TID


·  Client returns to clinic in four weeks indicated reason for not choosing this one is due to suicidal ideation.

·  Upon return Mrs. Perez states that she has noticed that she has been having suicidal ideation over the past week, and it seems to be getting worse

·  She is also reporting that she is having “out of control” anxiety


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