Problem:
As a PMHNP working in a community mental health setting, you are conducting an initial psychiatric evaluation for a 62-year-old Filipino American man with a confirmed diagnosis of bipolar illness. He has been off his medications for two months and reports lithium has been efficacious for him previously in treating both mania and depression. He would like to restart this medication at this time and realizes that a history of alcohol abuse has interfered with treatment adherence. The patient has been sober for five years. His wife assists with medication adherence and is supportive of treatment.
Applying the principles of pharmacokinetics and pharmacodynamics, identify three patient-specific characteristics of this individual (age, metabolic changes, CYP450 profile, etc.) that could directly impact prescribing a high-potency drug with a narrow therapeutic range. Discuss how each characteristic could increase risk for toxicity. Then discuss whether the precipitating interaction is pharmacokinetic or pharmacodynamic and why. Respond to one other classmate, providing alternative considerations for one of your classmate's prioritized patient-specific characteristics. Need Assignment Help?