Olanzapine --- Nursing Care

In this essay, I would be reflecting a case in which better health outcome was achieved using an antipsychotic drug called Olanzapine. While identifying the issues of the service user, I ensure that confidentiality will be maintained and so pseudonyms will be used instead of the full name corresponding to the Nursing and Midwifery Council (NMC 2008).  All the decisions will be justified and the choice of medicine proportionate to the health promotion will also be discussed. The essay will also talk about all the possible mechanism, pharmacokinetics and pharmacodynamics of the chosen medicine along with the possible adverse effects. The health outcome of the use of the drug and any recommendations for future will also be considered.  The conclusion will revolve around the evaluation of the outcome of the drug of choices administered.

Case Study

Kate, a 56 year old female with previous psychiatric history of schizophrenia presented with the marked deterioration in her health.  She was at present using haloperidol and sodium valproate twice daily.  Kate was examined thoroughly. She was though conscious but now having more auditory and visual hallucinations. She also felt difficulties in working and concentration. She answered all the questions well but also showed auditory hallucination and told that someone is talking with her, let her answer her too. She was admitted the psychiatry ward. Her current medications were asked to stop and instead Olanzapine was started. She was asked to be currently monitored. Once her condition became stable, she was discharged but asked her to use this medication regularly. She showed concordance that she will follow all the instructions and take the medication regularly.  She was also explained about her condition and shown full sympathy and ensured her that she would feel fine. She was also called for follow up after few days.

After few days, she came for follow-up and was found to be feeling much better and there were also improvements in her auditory and visual hallucinations. She also reported herself that she is feeling well now.  Olanzapine was found to be suiting more and thus, she was asked to continue this medicine.

General Background About Schizophrenia

Schizophrenia is basically a mental disorder characterised by the disturbances in thinking, behaviour and feelings. People often report visual and auditory hallucinations. Some may report delusions and disorganized speech. This serious mental illness disturbs the individual’s aptitude to think evidently, deal with sentiments, and decisions making. It is the result of changes in the brain structure and brain chemicals. It is a chronic condition of complex nature and affects different persons differently. The treatment of schizophrenia may involve all-encompassing strategies including medication, psychotherapy and even psychosocial rehabilitation.

It is believed that clinical expertise is very important in selecting and managing drug therapy for a patient. It usually entails an understanding and knowledge of the research evidence involving the effectiveness, efficiency and efficacy of the choices poised with concern of the clinical situations of the patient (Morris, 2002).

What is Olanzapine?

Olanzapine is from the group of drugs known as antipsychotics. It is basically an atypical antipsychotic and is one of the members of thienobenzodiazepine category. The U.S. Food and Drug Administration (FDA) has approved it for the treatment of conditions like bipolar disease and schizophrenia. It treats the symptoms of schizophrenia and linked psychoses with this disease (Duggan, Fenton, Dardennes, et al 2003).

Mechanism of Action of Olanzapine

Though, the correct mechanism via which olanzapine provides it antipsychotic effect is not known, yet, this effect is believed to be caused by its antagonism for both the serotonin 5-HT ₂ and dopamine. Olanzapine offers selective monoaminergic antagonist and it has a strong affinity for four dopamine receptors as well as for serotonin 5-HT _2C and 5-HT _2A receptors. However, its affinity for benzodiazepine (BZD), gamma-aminobutyric acid type A (GABA _A), and beta-adrenergic receptor is very low (Citrome , and Volavka 2003).

Olanzapine also show high affinity towards all the muscarinic receptors such as M ₁, M ₂, M ₃, M ₄, and M ₅. However, it behaves as an antagonistic to these receptors. Due to the antagonism, the anticholinergic effects are observed with the use of Olanzapine. Moreover, Olanzapine has also shown to bind with an elevated affinity to alpha ₁-adrenergic and histamine H ₁ receptors.  Due to antagonism to these receptors i.e. alpha ₁-adrenergic and histamine H₁ receptors, orthostatic hypotension and somnolence may occur respectively, with the use of olanzapine (McEvoy, Lieberman, et al 2006).

Pharmacokinetics

Though, olanzapine is well absorbed yet about forty percent of drug is metabolised well before it reaches the systemic circulation. Food does not affect the rate of absorption of this drug. Also, it has been found that antacids (magnesium and aluminum- -containing) also do not affects its oral bioavailability.  This drug is broadly distributed all the way through the body.