NUR 600 Module 5 Assignment Drug PowerPoint Presentation

Sample Answer

Introduction

Greetings everyone. My name is ___, and I welcome you to this presentation on Gabapentin. There are generic and brand versions of gabapentin available. Gabapentin is the generic name for it. Gabapentin is marketed under the brand names Neurontin, Horizant, and Gralise (Pauly et al., 2020). Gabapentin, a structural analog of GABA, received its initial approval in the United States in 1993 for the treatment of seizures and neuropathic pain (Russo et al., 2022).

It offers several advantages compared to other anti-epileptic medications. These include a favorable adverse effect profile, a broad therapeutic index, and minimal metabolism, which reduces the likelihood of interactions with pharmacokinetic drugs. Gabapentin and pregabalin are closely related in structure and function, as they belong to the GABA derivative family.

Drug Pharmacology

Gabapentin is a medication that helps control abnormal neurotransmissions, such as neuropathic pain and seizure disorders. It works by inhibiting excitatory neurotransmitters in the brain. The therapeutic index of this substance is quite broad, as doses of over 8000 mg/kg did not result in a fatal reaction in rats (Horne et al., 2020).

It has been found that Gabapentin does not provide effective treatment for absence seizures and should be used with caution in patients who have mixed seizure disorders. It has been linked to a potentially life-threatening condition known as drug reaction with eosinophilia and systemic symptoms (DRESS).

The therapeutic effects of Gabapentin primarily occur through its action on the auxiliary α2δ-1 subunit of voltage-gated calcium channels. This action facilitates the movement of pore-forming calcium channels from the endoplasmic reticulum to pre-synaptic neurons. Chronic pain states can lead to an increase in the expression of α2δ subunits, resulting in hyperalgesia.

Gabapentin hinders the function of these subunits, reducing the number of pre-synaptic voltage-gated calcium channels and the release of excitatory neurotransmitters (Pauly et al., 2020). This inhibition is probably the underlying mechanism behind gabapentin’s anti-epileptic effects. Evidence suggests that gabapentin may have additional effects on adenosine receptors and voltage-gated potassium channels. However, the significance of these actions in a clinical context remains uncertain.

Pharmacokinetics

Absorption

The absorption of gabapentin happens through transport facilitated by the LAT1 transporter in the intestines. The oral bioavailability of the drug is inversely related to the dose. When taking a daily dose of 900mg, about 60% of the medication is absorbed orally. However, with a higher daily dose of 4800mg, only 27% of the medication is absorbed. The Tmax for gabapentin is typically 2-3 hours, and the absorption of the drug is not significantly affected by food (Martin & Gainer, 2022).

Volume of distribution

The distribution of gabapentin after intravenous administration is approximately 58 liters, with concentrations in the cerebrospinal fluid ranging from 9% to 20% of plasma concentrations. Similarly, gabapentin is also found in breast milk at similar concentrations (Martin & Gainer, 2022).

Gabapentin is a medication that is predominantly excreted through renal elimination. When humans consume a dose orally, only a small fraction of less than 3% is found to be bound to plasma proteins. A small fraction of the administered dose is metabolized into metabolites, while the majority is eliminated as the original drug in urine. Gabapentin is primarily excreted in the urine without undergoing any changes.

Its clearance can be reduced by 12% when co-administered with Cimetidine, a substance that inhibits the secretion of the drug in the renal tubules (Costales & Goodin, 2021). Gabapentin’s elimination half-life is typically 5-7 hours in patients with normal renal function, but it may be extended in patients with impaired renal function. The clearance of gabapentin in both plasma and the kidneys is directly related to the patient’s creatinine clearance.

Dosing

Gabapentin is a medication commonly prescribed for the treatment of migraines. The recommended starting dose is typically 300 mg per day. The dosage can be raised to 4800 mg and subsequently taken thrice daily. Taking the initial dose three times daily is recommended for optimal results. Typically, the effects manifest within the initial week, although notable improvement may require up to a month.

The medication can be gradually discontinued within seven days. This medication is prescribed to treat partial seizures, post-herpetic neuralgia, neuropathic pain, and fibromyalgia. Renal dosing requires the careful adjustment of both the dose amount and frequency.

The adjustment of creatinine clearance can be achieved through various dosage regimens, including twice daily administration of 200 to 700 mg, once daily administration of 200 to 700 mg, once daily administration of 100 to 300 mg, or as a supplement of 125 to 350 mg (Costales & Goodin, 2021).

Indications For Use

Gabapentin, an anticonvulsive medication, has been approved by the FDA since 1993 (Russo et al., 2022). This medication has been prescribed for the treatment of postherpetic neuralgia, partial seizures, and moderate to severe restless leg syndrome. Additionally, it has been utilized in the treatment of neuropathic pain, fibromyalgia, bipolar disorder, and various other medical conditions.

A study conducted using a placebo control group revealed that gabapentin showed positive effects on the general well-being of patients who have refractory partial seizure disorder. This outcome led to a subsequent investigation of the drug’s potential in treating primary psychiatric conditions. Gabapentin does not interact with valproate, lithium, and carbamazepine, and it has minimal side effects. The effectiveness of this approach has prompted a thorough investigation into primary psychiatric conditions.

Side Effects

Gabapentin is a medication that may result in a range of side effects, such as allergic reactions, significant drug interactions, alterations in mood, and respiratory problems. Gabapentin has the potential to cause respiratory depression, particularly when used in conjunction with opioids or alcohol (Costales & Goodin, 2021). Children who are prescribed gabapentin may exhibit alterations in behavior, encounter challenges with memory, and struggle with maintaining focus.

Adverse effects may include drowsiness, dizziness, weakness, impaired balance or muscle coordination, or heightened seizure activity. Typical adverse reactions may encompass fever, chills, sore throat, body aches, headaches, swelling, speech difficulties, vision impairments, tremors, balance or muscle movement impairments, nausea, and vomiting.

Contraindications

Certain individuals with a medical history of allergic reactions, misuse, pregnancy, a sodium/potassium diet, kidney problems, or other health conditions may not be suitable candidates for gabapentin. According to recent clinical research by Hong et al. (2021), caution is advised when considering gabapentin for myasthenia gravis and myoclonus problems. This is due to the potential of gabapentin to induce symptoms similar to myasthenia gravis.

Research on mice revealed alterations in electrophysiological reactions in mice with experimentally induced myasthenia gravis. Additionally, another study indicates that this condition can potentially trigger or exacerbate myoclonus.

Pregnancy Class

Gabapentin is categorized as a pregnancy category B3 drug by AU TGA. These drugs are prescribed to a small group of pregnant and childbearing women, and there have been no reported cases of fetal malformation or harmful effects associated with their use (Evoy et al., 2020). There is currently no evidence to suggest that the drug used in antiepileptic therapy poses any developmental risks for pregnant women.

Studies conducted on animals indicate comparable or reduced levels of developmental toxicity when administered certain doses. The potential harm caused by uncontrolled epilepsy far surpasses the risk of having a congenital disability. It is recommended to initiate folic acid supplementation four weeks before conception and maintain it for twelve weeks after conception.

It is important to provide women who may become pregnant with guidance regarding potential fetal abnormalities. Additionally, it is recommended that they maintain treatment with a single medication at the lowest effective dosage.

Cost Analysis Of The Drug

The cost of gabapentin can vary depending on various factors, including the treatment plan, insurance coverage, the specific form of gabapentin, and the pharmacy where it is purchased. This product has different forms, such as capsules, tablets, and liquid solutions. The cost of gabapentin cream can vary based on the ingredients used, the amount of cream needed, and the specific compounding pharmacy chosen.

The drug has been authorized for the treatment of postherpetic neuralgia and partial seizures. For a more cost-effective approach to managing drug expenses, exploring options such as obtaining a 3-month supply, utilizing mail-order pharmacy services, or opting for generic medications instead of brand-name alternatives like Gralise or Neurontin may be beneficial. To obtain financial assistance, consider visiting reputable websites such as Medicine Assistance Tool and NeedyMeds (Evoy et al., 2020).

Patient Case Study

A 59-year-old woman of Caucasian descent has a medical background of major depressive disorder (MDD) and generalized anxiety disorder (GAD). She has been admitted to the hospital on four occasions in the past due to her struggles with depression and anxiety. The patient has a medical background that includes Hashimoto’s thyroiditis, Sjögren’s syndrome, and autoimmune diabetes. Her family has a history of major depressive disorder (MDD), generalized anxiety disorder (GAD), and bipolar disorder.

Previous treatment attempts with different medications, including benzodiazepines, were unsuccessful or poorly tolerated. After several unsuccessful attempts at cognitive behavioral therapy, the patient has been prescribed clonazepam for a mild generalized anxiety disorder at the age of 52. The patient experienced suicidal ideation following a three-month tapering of benzodiazepines prior to their presentation. After successfully discontinuing benzodiazepines, the patient was discharged from the hospital and prescribed gabapentin (Martin & Gainer, 2022).

Patient Education.

It is important to educate the patient on Gabapentin, including its appropriate dosage and potential side effects. It is recommended to take extended-release tablets at bedtime in order to minimize any potential negative effects. It is important to avoid abruptly discontinuing gabapentin as this can lead to an increased risk of seizures. The patient should refrain from engaging in activities that require focus and concentration until the effects have been assessed. Reporting signs of depression, suicidal thoughts, unusual behavior, alcohol intake, and hypersensitivity, such as fever or enlarged lymph nodes, is crucial (Evoy et al., 2020).

Nurse Practitioner Role

Nursing practitioners focus on patient care by addressing multiple facets of gabapentin treatment, such as dosage, schedule, education, safety measures, pain management, and emotional support. The authors also highlight the significance of exercising caution, implementing safety measures, and providing mental health support when needed (Rissardo et al., 2023). The patient was initially prescribed gabapentin at a dose of 300mg BID for a month. However, the patient subsequently experienced heightened anxiety as a result of psychosocial stressors.

The dosage of gabapentin was subsequently raised to 600mg twice a day, and amitriptyline was stopped after one month. The patient experienced a significant reduction in anxiety levels within 48 hours of adjusting the gabapentin dosage. Subsequently, she maintained a state of remission for 70 days while solely on gabapentin treatment (Costales & Goodin, 2021). Following this period, she began experiencing symptoms of depression and was prescribed venlafaxine. The patient continues to take gabapentin and venlafaxine.

Monitoring and Follow-Up

Effective monitoring of gabapentin treatment involves evaluating baseline creatinine levels prior to and throughout therapy, delivering comprehensive patient education, and implementing regular screenings for depression, behavioral alterations, and suicidal tendencies (Rissardo et al., 2023). A follow-up appointment has been scheduled for the patient in two weeks to monitor their treatment progress. At the 3-month follow-up, a patient diagnosed with Generalised Anxiety Disorder (GAD) showed improvement when prescribed a daily dose of 100mg of gabapentin three times a day (TID). Additionally, the patient was also receiving a daily dose of 20mg of diazepam.

References

• Costales, B., & Goodin, A. (2021). Outpatient Off-Label gabapentin use for psychiatric indications among U.S. adults, 2011–2016. Psychiatric Services (Washington, D.C. Print), 72(11), 1246–1253. https //doi.org/10.1176/appi.ps.202000338
• Evoy, K. E., Sadrameli, S., Contreras, J., Covvey, J. R., Peckham, A. M., & Morrison, M. D. (2020). Abuse and misuse of pregabalin and gabapentin a Systematic review update. Drugs, 81(1), 125–156. https //doi.org/10.1007/s40265-020-01432-7
• Hong, J. S. W., Atkinson, L. Z., Al‐Juffali, N., Awad, A., Geddes, J., Tunbridge, E. M., Harrison, P. J., & Cipriani, A. (2021). Gabapentin and pregabalin in bipolar disorder, anxiety states, and insomnia Systematic review, meta-analysis, and rationale. Molecular Psychiatry, 27(3), 1339–1349. https //doi.org/10.1038/s41380-021-01386-6
• Horne, A., Vincent, K., Hewitt, C., Middleton, L., Koscielniak, M., Szubert, W., Doust, A., & Daniels, J. (2020). Gabapentin for chronic pelvic pain in women (GaPP2) a multicentre, randomized, double-blind, placebo-controlled trial. Lancet (British Edition), 396(10255), 909–917. https //doi.org/10.1016/s0140-6736(20)31693-7
• Martin, J. C., & Gainer, D. (2022, September 1). Psychiatric uses of gabapentin. PubMed Central (PMC). https //www.ncbi.nlm.nih.gov/pmc/articles/PMC9507147/
• Pauly, N., Delcher, C., Slavova, S., Lindahl, E., Talbert, J., & Freeman, P. R. (2020). Trends in gabapentin prescribing in a commercially insured U.S. adult population, 2009-2016. Journal of Managed Care & Specialty Pharmacy, 26(3), 246–252. https //doi.org/10.18553/jmcp.2020.26.3.246
• Rissardo, J. P., De Matos, U. M. A., & Caprara, A. L. F. (2023). Gabapentin-Associated Movement Disorders A Literature Review. Medicines, 10(9), 52. https //doi.org/10.3390/medicines10090052
• Russo, M., Graham, B. A., & Santarelli, D. M. (2022). Gabapentin—Friend or foe? Pain Practice (Print), 23(1), 63–69. https //doi.org/10.1111/papr.13165