NU 641 Week 9 Discussion: Neurology

Regis University NU 641 Week 9 Discussion: Neurology-Step-By-Step Guide

This guide will demonstrate how to complete the Regis University NU 641 Week 9 Discussion: Neurology    assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NU 641 Week 9 Discussion: Neurology                                                                     

Whether one passes or fails an academic assignment such as the Regis University NU 641 Week 9 Discussion: Neurology    depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NU 641 Week 9 Discussion: Neurology                                                                   

The introduction for the Regis University NU 641 Week 9 Discussion: Neurology   is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NU 641 Week 9 Discussion: Neurology                                                                   

After the introduction, move into the main part of the NU 641 Week 9 Discussion: Neurology    assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NU 641 Week 9 Discussion: Neurology                                                                   

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NU 641 Week 9 Discussion: Neurology                                                                     

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NU 641 Week 9 Discussion: Neurology

1. Which of the following should be true regarding your initial Adverse Effect Drugs (AED) regimen?

1. The risks of pregnancy must be discussed prior to starting any AED.

The clinician should discuss the risks of pregnancy with the patient being initiated on antiepileptic drugs that induce hepatic enzymes, such as phenytoin, carbamazepine, phenobarbital, felbamate, primidone, topiramate, lamotrigine, and oxcarbazepine (Abou-Khalil, 2019). The AEDs reduce the efficacy of oral contraceptive pills through drug interaction, which increases the risk of pregnancy. Therefore, the clinician should counsel the patient on using a high-dose estrogen-progesterone contraceptive to counter the drug effect or use a second contraception method (Kim et al., 2021).

1. Which of the following is the most appropriate initial antiepileptic regimen for this patient?

1. Phenytoin 100 mg PO three times daily.

Newly diagnosed epileptic patients can be initiated on treatment with standard Phenytoin. Indications for Phenytoin include controlling generalized tonic-clonic and complex partial seizures (Kim et al., 2021). Thus, Phenytoin is the ideal drug for the patient’s initial treatment. Patients with no history of Phenytoin treatment can start with one 100-mg extended phenytoin capsule three times per day.

1. The patient fails to respond and has significant side effects to her initial therapy. Her initial therapy is to be discontinued. Which of the following would be the most appropriate replacement?

1. Lamotrigine 100 mg twice daily

Lamotrigine is indicated as monotherapy or adjunctive therapy for partial-onset seizures. It is indicated for adults above 16 years with partial seizures who are switching to monotherapy and were previously on phenytoin, carbamazepine, phenobarbital, primidone, or valproic acid (Abou-Khalil, 2019). Therefore, Lamotrigine would be ideal for replacing the first-line drug.

1. After several different AEDs, the patient ends up on carbamazepine and phenytoin. The carbamazepine serum concentration on week 2 of therapy was 6 mcg/mL. The patient presents after 8 weeks of therapy with increased seizures and she is found to have a serum concentration of 2 mcg/mL. Which of the following is a likely cause?

1. Autoinduction of CYP3A4

When the dosage of carbamazepine increases, the CYP3A4 activity increases. Consequently, the drug clearance speeds up, and the half-life shortens, termed autoinduction. Autoinduction of CYP3A4 reduces the drug’s serum concentration (Fuhr et al., 2021). It continues with subsequent dose increment but reaches a plateau within 5-7 days. Therefore, increment in dose at a rate of 200 mg 1-2 weekly may be needed to attain a stable seizure threshold.

1. Despite the use of oral contraception, the patient becomes pregnant. Her AED regimen consists of valproic acid and lacosamide. What is the most appropriate treatment intervention?

A: Discontinue valproic acid and continue lacosamide monotherapy.

Arfman et al. (2020) explain that the pharmacokinetics of antiepileptic drugs can change during pregnancy resulting in a change of effect. Valproic acid should be avoided during pregnancy due to the risk of teratogenic effects. This informs the above response of discontinuing valproic acid and continuing lacosamide monotherapy. Besides, it is recommended that during pregnancy, monotherapy be used if AED therapy is necessary polytherapy has been connected to teratogenesis.

References

Abou-Khalil, B. W. (2019). Update on Antiepileptic Drugs 2019. Continuum (Minneapolis, Minn.), 25(2), 508–536. https://doi.org/10.1212/CON.0000000000000715

Arfman, I. J., Wammes-van der Heijden, E. A., Ter Horst, P., Lambrechts, D. A., Wegner, I., & Touw, D. J. (2020). Therapeutic Drug Monitoring of Antiepileptic Drugs in Women with Epilepsy Before, During, and After Pregnancy. Clinical pharmacokinetics, 59(4), 427–445. https://doi.org/10.1007/s40262-019-00845-2

Fuhr, L. M., Marok, F. Z., Hanke, N., Selzer, D., & Lehr, T. (2021). Pharmacokinetics of the CYP3A4 and CYP2B6 Inducer Carbamazepine and Its Drug-Drug Interaction Potential: A Physiologically Based Pharmacokinetic Modeling Approach. Pharmaceutics, 13(2), 270. https://doi.org/10.3390/pharmaceutics13020270

Kim, D., Kim, J. M., Cho, Y. W., Yang, K. I., Kim, D. W., Lee, S. T., No, Y. J., Seo, J. G., Byun, J. I., Kang, K. W., Kim, K. T., & Drug Committee of Korean Epilepsy Society (2021). Antiepileptic Drug Therapy for Status Epilepticus. Journal of clinical neurology (Seoul, Korea), 17(1), 11–19. https://doi.org/10.3988/jcn.2021.17.1.11

Sample Answer 2 for NU 641 Week 9 Discussion: Neurology

Shaynah has mentioned that she would like to become pregnant in the next 12- 24 months. The risks of pregnancy must be discussed prior to strating any AED. For example, dilantin is a Pregnancy category D and the overall risk of malformation for children exposed to Dilantin is 10 % (Woo & Robinson 2020 p197). This is the case for most AED. There are previous recommendations that women who are taking Dilantin can have reduce the risks to the fetus by taking 400mcg of folic acid daily (Woo & Robinson 2020 p197). Newborns who have been exposed to phenytoin in utero may experience decreased levels of vitamin K and will need to receive it at birth (Woo & Robinson 2020 p197). In addition to the effect these drugs may have on the fetus they can also lower the efficacy of oral contraceptives (Waseem 2021).

The most appropriate initial antiepileptic regimen for this patient would be phenytoin 100mg PO three times a day. Hydantoins are the first line treatment choice for tonic- conic and partial complex seizures; additionally they are the least sedating drugs to treat seizure disorders (Woo & Robinson 2020 p197). After the initial start of the drug and receiving the loading dose she may receive 300mg of extended release dilantin or continue with the 100 mg TID (Woo & Robinson 2020 p 201).
Lamotrigine is an adjunct therapy that would be most effective while taking another drug (Woo & Robinson 2020 p209). Rufinamide is not a treatment medication for the type of seizures and is also used in combination with another drug (Woo & Robinson 2020 p210). Valproic acid is not commonly used for this type of seizure. This drug is usually well tolerated and most side effects are mild and transient (Woo & Robinson 2020 p254). This will be effective in treating Shaynah’s seizures with the smallest amount of side effects.
The therapeutic range for a carbamazepine serum concentration is between 4 to 12 mcg/ml (Woo & Robinson 2020 p206). The cause of the serum concentration of 2mcg weeks later is most likely caused by the autoinduction of CYP3A4. The auto- induction process takes about four weeks (Waseem 2021). This is why the level is lower weeks later as the autoinduction process was still happening. The sub-therapeautic level is often caused by auto- induction and small therapeutic range (Guo & Shaikh 2017). Often a low level means under treatment or non- compliance, which is less likely (Guo & Shaikh 2-17).
The carbamazepine that the patient is taking interacts with oral contraceptives, leading to break through bleeding, ovulations and pregnancy in women who are taking both medications (Waseem, 2021).
The most appropriate treatment intervention is to discontinue the valproic acid and continue lacosamide. If Valproic acid is used during the first trimester of pregnancy there is a listed side effect of neural tube defect- including spina bifida (Woo & Robinson 2020 p254). It is a pregnancy category D drug and it’s use should be restricted unless the woman’s life would be endangered without it (Woo & Robinson 2020 p254). Lacosamide is an FDA pregnancy category C drug. Studies have shown those taking it during pregnancy have had no teratogenicity and no major or minor congenital abnormalities (Khuda & Aljaafari 2018). Shaynah will need to get her seizures under control and compared to the other available options Lacosamide is the medication with the highest benefit and lowest risk.

References

Guo, R. & Shaikh, A.S (2017) Measurement and Comparison of Carbamazepine Plasma Levels for Assessment of Compliance, Safety and Toxicity. Institute of Clinical Pharmacology, Qilu Hospital of Shandong University, Junan China.
Khuda, I., & Aljaafari, D. (2018). Epilepsy in pregnancy: A comprehensive literature review and suggestions for saudi practitioners. Neurosciences Journal, 23(3), 185-193.
Waseem M. (2021). Carbamazepine toxicity. Medscape. Retrieved from https://emedicine.medscape.com/article/813654-overview
Woo, T, M., & Robinson, M. V. (2020). Pharmacotherapeutics for advanced practice nurse prescribers (5th ed.) Philadelphia, PA: F.A. Davis Company.