Decision Point One: Vivitrol 380mg IM in the Gluteal Area Every 4 Weeks
Decision Point One: Vivitrol 380mg IM in the Gluteal Area Every 4 Weeks
The patient presents with alcohol dependence. Vivitrol (Naltrexone) is an opioid antagonist. It is used in the management of opioid dependence and alcohol use disorders. It was selected because it maintains effectiveness in altering the reinforcing effects of alcohol that induce euphoria and cause impulsivity toward consuming it (Sharma et al., 2020). Depot injection of Naltrexone 380mg provides more favorable outcomes as they eliminate the need for daily pills that may be troublesome to persons with alcohol dependence. The patient, in this case, may benefit from IM Naltrexone.
Antabuse (disulfiram) and Campral (acamprosate) have also been used in managing alcohol use disorders. Disulfiram was not considered in this case because of its poor toxicological profile. Also, it has been linked with severe adverse events such as metallic taste, fatigue, headache, and even death. Lanz et al. (2023) report that disulfiram is not a safe option for all alcoholics and should only be used when other options are unavailable. Further, acamprosate was not considered, in this case, because of its high pill burden that may discourage compliance. This medication is taken in three divided doses and may not be favorable to patients with alcohol dependence under home-based care. Additionally, acamprosate use has been linked with side effects such as suicidal ideation and anxiety that may be particularly troublesome for patients with alcohol dependence as it may drive them to even more alcohol consumption (Donoghue et al., 2022). Therefore, this medication may thus not be favorable for this patient.
The aim of using Vivitrol was to eliminate alcohol dependence on the patient. Vivitrol is an opioid antagonist that alters the reinforcing effects of alcohol on inducing euphoria. It also modifies the hypothalamic-pituitary-adrenal axis, causing profound suppression of alcohol consumption (Sharma et al., 2020). It is for this reason that this option was selected.
An ethical consideration that may impact the treatment plan and communication with this patient is confidentiality. One of the patient’s concerns is the 50,000 dollars she had plucked from her retirement that her husband is unaware of, despite her husband being important in her treatment process.
Decision Point Two: Disulfiram 250mg Tab Orally Daily
Disulfiram is an FDA-approved medication used in treating alcohol dependence. It maintains effectiveness in discouraging alcohol use in patients motivated to quit alcohol (Sarkar et al., 2022). It acts by creating an unpleasant physiological effect that will demotivate alcoholics to consume alcohol. The patient, in this case, can benefit from disulfiram due to her motivation to quit alcohol.
The effectiveness of disulfiram in discouraging alcohol use prompted its inclusion in this case. The other available options were intramuscular Vivitrol and acamprosate. Vivitrol use in this patient may be discouraged due to its cost implications, the risk of injection site injury, and other risks associated with its use, such as hepatitis. Vivitrol, like other opioids, also presents the risk for opioid withdrawal upon concluding its use. Acamprosate is another medication option for treating chronic alcohol use and dependence. However, its use is not favored in this case due to pharmacokinetic considerations. This medication is taken in divided doses and may present compliance challenges in persons struggling with alcohol addiction.
This intervention was aimed at eliminating alcohol dependence in the patient. Disulfiram discourages alcohol consumption by eliciting unpleasant physiologic responses upon alcohol use. These responses are a consequence of alcohol dehydrogenase inhibition and include palpitations, diaphoresis, hypotension, and tachycardia (Burnette et al., 2022). These responses will discourage a motivated person from quitting alcohol use.
An ethical concern that may impact the management process is beneficence and non-maleficence. The patient presented with alcohol dependence. Disulfiram use in alcohol dependence has been associated with severe adverse effects and even death. Healthcare providers thus have to weigh the benefits versus risks of using this medication on their patients. This medication should only be used under close supervision by caregivers as an ethical obligation to prevent harm and promote the well-being of the patient.
Decision Point Three: Acamprosate 666mg PO Three Times Daily
Acamprosate is an FDA-approved medication for treating chronic alcohol use and alcohol dependence. It is taken in divided doses and is effective in reducing alcohol withdrawal-associated distress. This medication has a tolerable safety profile and is not impacted by alcohol use (Donoghue et al.