Question: As an advance practice nurse, it is important to examine…

Question Question: As an advance practice nurse, it is important to examine… Question: As an advance practice nurse, it is important to examine and evaluate different clinical guidelines for a particular condition that you will encounter in practice. You may find there is more than one for a particular disease or condition. You must be aware of these and be able to evaluate these using evidence based practice in your advanced practice role. For example, if you have been diagnosed with allergic rhinitis, there are guidelines for prescribing. Answer:My goals are to work in the addiction and substance abuse fields of healthcare, incorporating other mental health treatment as needed. Alcoholism is a very difficult disease process to treat, with a negative stereotype & stigma. Most people see alcohol use disorder as something that people choose to continue doing and don’t understand the brain chemistry, emotional attachment and life difficulties surrounding this disorder. With alcohol withdrawal and typically we will treat them with Lorazapam/Ativan using the CIWA protocol. However, there isn’t much done beyond that to assist with referral to inpatient treatment or chronic treatment.               For me, researching the topic of management of alcohol use disorder outside of the acute hospital setting has been enlightening. In 2018, the American Psychological Association (APA) released new guidelines for first and second line treatment. It stated that “the estimated lifetime prevalence rate for alcohol use disorder in the US is 29 percent” (2018). The APA recommends Naltrexone and acamprosate for moderate to severe alcohol use disorder when non pharmacologic approaches have not been effective. These medications act on the NMDA and glutamate receptors to decrease craving, anxiety, and insomnia (Kalk & Lingford-Hughes, 2014). Second line treatment is Disulfiram, which causes a reaction to alcohol if ingested within 12-24 hours (APA, 2018). Third line of treatment is Topiramate and Gapapentin, to be used after trying the first line treatment (APA, 2018). They also recommend participation in Alcoholics Anonymous or another similar program, but this is not a pharmacological intervention, so won’t be discussed.               Kranzler and Soyka (2018) report that “medications are prescribed to less than 9% of patients who are likely to benefit from them, given evidence that they exert clinically meaningful effects and their inclusion in clinical practice guidelines as first line treatments”. They also report that typically patients with alcohol use disorder also commonly receive counseling. “Naltrexone, which can be given once daily, reduces the likelihood of a return to any drinking by 5% and binge-drinking risk reduced by 10%” (Kranzler and Soyka, 2018).               Treatment of alcohol use disorder is a complicated subject, but one that I want to understand more so I can provide comprehensive, evidence-based treatment to my future patients. As a Nurse Practitioner, you are able to prescribe all of the medications listed here without further specific continuing education or training. As a PMHNP, the best course of treatment is a combination of counseling, medication management to control anxiety, withdrawals, craving, insomnia, and blocking of receptors that cause agitation and withdrawal symptoms. There seems to be a general consensus on the best course of action for treatment of this disorder.ReferencesAmerican Psychological Association. (2018). APA Releases New Practice Guideline on Treatment of           Alcohol Use Disorder. Doi: https://www.psychiatry.org/newsroom/news-releases/apa-releases-         new-practice-guideline-on-treatment-of-alcohol-use-disorderKalk, N. & Lingford-Hughes, A. (2014). The clinical pharmacology of acamprosate. British Journal of                          Clinical Pharmacology. 77(2). 315-323. Doi: https://dx.doi.org/10.1111%2Fbcp.12070Kranzler, H. & Soyka, M. (2018). Diagnosis and Pharmacotherpy of Alcohol Use Disorder. Journal of                         American Medical Association. 320(8). 815-824. doi:10.1001/jama.2018.11406Instruction: Please make a constructive comment using evidenced based practice with a reference.There is a question and answer and we are asking for constructive comments on the basis if the answer. I would like to withdraw this question because by now I have already taken care of this question. Thank you. Health Science Science Nursing NRSE MISC Share QuestionEmailCopy link Comments (0)