Choose a medical condition
Topic 7 DQ 1
Choose a medical condition from the neurological, musculoskeletal, or integumentary system and explain the pathophysiology changes that may occur. What patient education would need to be included related to this disorder? Make sure that you select a different medical condition than your peers. Include the name of the medical condition in the subject line so that the medical condition can be followed. Include your references in APA style.
Sample student response 1
Huntington’s Disease
Huntington’s disease is a genetic neurodegenerative disorder associated with the progressive breakdown of nerve cells in the brain. An estimated 30,000 Americans have the disease as per the statistics by the National Institute of Neurological Disorders and Stroke (U.S. Department of Health and Human Services., n.d). The disease usually begins between 30 and 50. However, early-onset occurs in some patients in what is known as juvenile Huntington’s disease. Most patients with the disorder usually die 10 to 30 years after the onset of the disease (Gonzalez-Usigli, 2022).
The pathophysiology of In Huntington’s disease is associated with gross atrophy of the caudate nucleus, the degeneration of the inhibitory medium spiny neurons in the corpus striatum, and a decrease in both substance P and neurotransmitters gamma-aminobutyric acid (GABA).
Similarly, marked atrophy and neuronal loss are also seen in deep layers of the cerebral cortex. the globus pallidus, subthalamic nucleus, thalamus, and cerebellum, depending on the pathologic grade of the disease (Gonzalez-Usigli, 2022). The disease usually occurs as a result of mutation of the huntingtin gene leading to abnormal repetition of the DNA sequence CAG that is responsible for the coding of the amino acid glutamine.
Some of the patient education in persons with the disease include providing information and encouragement to engage in genetic testing, encouraging the patient to take part in support groups, and providing caregiver education due to the emotionally exhaustive nature of the disease. The goal of patient education in Huntington’s disease is to improve the quality of life of affected patients and caregivers, by enhancing coping strategies that help to deal with psychological stress (A’Campo et al., 2012).
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References
A’Campo, L. E., Spliethoff-Kamminga, N. G., & Roos, R. A. (2012). The Patient Education Program for Huntington’s Disease (PEP-HD). Journal of Huntington’s disease, 1(1), 47–56. https://doi.org/10.3233/JHD-2012-120002
Gonzalez-Usigli, H. A. (2022). Huntington disease – neurologic disorders. MSD Manual Professional Edition. https://www.msdmanuals.com/professional/neurologic-disorders/movement-and-cerebellar-disorders/huntington-disease
U.S. Department of Health and Human Services. (n.d.). Huntington’s Disease Information Page. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/All-Disorders/Huntingtons-Disease-Information-Page
Sample student response 2
RA is a chronic, systemic inflammatory autoimmune disease that may involve many tissues and organs but it typically affects the joints (McCance & Huether, 2018). RA involves joint swelling, synovial inflammation, ankylosis, and destruction of articular cartilage and the first joint tissue to be affected is the synovial membrane, which lines the joint cavity (McCance & Huether, 2018).
Furthermore, McCance and Huether (2018) state that the pathologic events of RA are mediated by antibodies against self antigens and inflammatory cytokines, especially CD4+ T cells that promote inflammation. Acting together, T cells produce cytokines that stimulate other inflammatory cells and promote tissue injury.
The onset of RA is usually insidious although according to McCance and Huether (2018), 15 % of cases are considered to be acute onset. A person may have widespread, symmetrical joint swelling or they may have one particular joint affected. Diagnosing RA is through following a series of criteria evaluating joint swelling, degree of involvement, and serology studies. Early treatment begins with disease-modifying anti-rheumatic drugs (DMARD’s).
One familiar to many of us is Methotrexate and is considered the first line of treatment (McCance & Huether, 2018). It is important that patients report their symptoms early to aid in decreasing inflammation, controlling pain, and to allow the physician to keep a close eye on more debilitating symptoms if RA should progress to the heart and lungs.
McCance, K., & Huether, S. (2018). Pathophysiology: The biological basis for disease in adults and children (8th ed.). Mosby. ISBN-13: 9780323402811
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Topic 7 DQ 2
Select a medication used in evidence-based treatment guidelines for the condition chosen in the first discussion question. Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions of which one should be aware. Make sure that you select a different medication than your peers. Include the name of the medication in the subject line so that the medications can be followed. Include your references in APA style.
Sample student response 1
Huntington’s disease does not have any cure. However, studies are still being conducted to reduce the rate at which the disease progresses. Similarly, various medications can be used to deal with the various symptomatic features of the disease. One such medication is Tetrabenazine. Tetrabenazine belongs to the class of medication known as monoamine depilators. It helps to decrease the uncontrollable movements present in people with Hannington disease.
The primary mechanism of action of Tetrabenazine involves reversible high-affinity inhibitor of mono-amine uptake into granular vesicles of presynaptic neurons by binding selectively to VMAT-2. This results in an increase in monoamine degradation in the neuron resulting in the depletion of monoamines, specifically dopamine causing a decrease in chorea among affected patients (Paleacu, 2007).
One of the aspects to monitor is the development of neuroleptic malignant syndrome (NMS) since the medication reduces dopamine transmission in the brain. Caregivers should also monitor for severe depression and suicidal tendencies among patients under tetrabenazine. Some of the potential side effects associated with the drug other than NMS and suicidal tendencies include akathisia, parkinsonism, and tardive dyskinesia (Yero & Rey, 2008).
Other slightly less severe side effects include nausea and vomiting, diarrhea, loss of appetite, burning sensation while urinating, headache, to list a few. Tetrabenazine should not be taken with alcohol since it increases sedation and affects liver function (Yero & Rey, 2008). The drug may also interact with reserpine, paroxetine, and fluoxetine.
References
Paleacu D. (2007). Tetrabenazine in the treatment of Huntington’s disease. Neuropsychiatric disease and treatment, 3(5), 545–551.
Yero, T., & Rey, J. A. (2008). Tetrabenazine (Xenazine), An FDA-Approved Treatment Option For Huntington’s Disease-Related Chorea. P & T: a peer-reviewed journal for formulary management, 33(12), 690–694.
Sample student response 2
Methotrexate
Methotrexate is the preferred drug of choice in the treatment of Rheumatoid Arthritis (RA) and has been shown to slow the course of the disease, induce remission, and prevent further destruction of the joints and involved tissues. Methotrexate inhibits cytokine production and purine nucleotide biosynthesis, leading to immunosuppressive and anti-inflammatory effects (Whalen, 2019).
Patients respond to methotrexate within 3-6 weeks after starting treatment and this treatment should be started as soon as possible after receiving a diagnosis to delay progression of the disease. Doses of methotrexate are much lower to treat RA than those needed in cancer chemotherapy and are typically only administered once weekly, minimizing adverse effects.
Also, according to Whalen (2019), patients should be educated on the adverse side effects such as mucosal ulceration and nausea. Additionally, cytopenia, cirrhosis of the liver, and an acute pneumonia-like syndrome may occur with chronic administration. Because Methotrexate is a folic acid antagonist, supplementation with folic acid may improve tolerability and GI and hepatic adverse events. Periodic liver function tests, CBC, and monitoring for signs of infection are also recommended.
Whalen, K. (2019). Lippincott illustrated reviews: Pharmacology (7th ed.). Lippincott Williams & Wilkins.
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