Using this information, please answer the questions below.
patient is suffering from Substance Abuse Disorder.
Based on the patient’s history of marijuana use, his high-stress lifestyle, and the psychiatric history (previous diagnoses of anxiety and depression), there is a strong indication that substance use disorder, especially related to alcohol or marijuana, may be a contributing factor to his symptoms.
You had mention other diagnosis of GAD and Hypertensive Crisis.
While the patient does exhibit some symptoms that could overlap with GAD, such as anxiety, mood swings, and sleep disturbances, these symptoms are more likely secondary to substance withdrawal rather than indicative of GAD. The patient’s tremors, nausea, palpitations, and irritability began acutely after recent marijuana use, which aligns more with marijuana withdrawal symptoms than with GAD. GAD is typically characterized by chronic worry, restlessness, and muscle tension, but this patient’s symptoms seem to be more acuteand linked to substance use, not a longstanding anxiety disorder.
Additionally, GAD does not typically cause the severe physical symptoms of nausea, tremors, and diaphoresis seen here, which are more consistent with withdrawal.
Regarding hypertensive crisis, while the patient’s blood pressure is elevated at 174/101 mmHg, it does not meet the threshold for a hypertensive emergency (which is generally defined as a blood pressure over 180/120 mmHg). Furthermore, hypertensive crises are often accompanied by severe symptoms such as severe headache, chest pain, blurred vision, or confusion, none of which are present in this patient. The patient’s blood pressure elevation, although concerning, is not at a level that typically leads to end-organ damage associated with a hypertensive crisis. Moreover, the acute onset of symptoms like tremors, nausea, and palpitations, combined with the patient’s history of substance use, points toward substance withdrawal as the more likely cause. Additionally, the patient’s diastolic pressure (101 mmHg) does not indicate the severe elevation seen in hypertensive crises, making it unlikely that a hypertensive emergency is driving his symptoms.
Below is my management plan for this patient:
MANAGEMENT PLAN:
DIAGNOSTIC TESTING:
Laboratory Tests:
Comprehensive metabolic panel (CMP)- elevated liver enzymes (ALT, AST) due to cirrhosis, mild electrolyte imbalances, and normal kidney function
Complete blood count (CBC)- mild anemia or thrombocytopenia (due to cirrhosis), normal WBC count
Liver Function test- elevated liver enzymes, elevated bilirubin, and low albumin, consistent with cirrhosis.
Urine toxicology screen- Positive for THC (marijuana use), amphetamines and oxycodone.
PHQ-9- moderate depression due to mood swings, stress, and physical symptoms (fatigue, poor concentration).
MSME- Mild cognitive impairment, due to stress, sleep disturbance, or substance use (especially noted short-term memory difficulties).
MEDICATIONS AND TREATMENT:
Drug: Dronabinol (synthetic THC)
Dose: 2.5 mg orally, once a day.
Sig: Take one tablet by mouth with full glass of water daily.
Dispense: 7 tablets
Refills: 0
Dronabinol, as a synthetic form of THC, is thought to mimic the effects of marijuana in the brain. It can reduce withdrawal symptoms and cravings in individuals trying to quit marijuana use. This approach is based on the idea that slowly tapering off THC in a controlled setting might reduce withdrawal symptoms and help with cravings. Must check patient’s allergy as it contains sesame oil. His medication is on a titration schedule. For the first week, you will take 1 tablet daily. During weeks 2-4: 5 mg orally, once a day. After 4 weeks a new assessment would be completed and based on patient response, you will remain at 5mg or started with the max dose of 10mg per day. (O’Donnell, 2023)
Treatment:
To support the management plan for the patient, I will reference the most current clinical practice guidelines on the management of substance use disorders (SUD). These guidelines include recommendations from organizations like the American Society of Addiction Medicine (ASAM), Substance Abuse and Mental Health Services (SAMHSA) and National Institute on Drug Abuse (NIDA), which suggest the use of psychosocial therapies as the cornerstone of treatment for Substance Abuse. (SAMHSA, 2020) Cognitive Behavioral Therapy (CBT) is effective interventions for helping individuals reduce marijuana use and address the underlying triggers and cravings. Initiate Cognitive Behavioral Therapy (CBT) to address the patient’s marijuana use. These interventions aim to help the patient identify triggers, develop coping strategies, and increase motivation to quit. (NIDA, 2023)
SUGGESTED CONSULTS/ REFERRALS:
Psychiatry for mental health and mood disorder management.
Substance use specialist for marijuana use disorder and withdrawal management.
Hepatology for liver disease (cirrhosis) management.
Cardiology for atrial fibrillation and hypertension management.
Primary care/internal medicine for chronic disease management and coordination of care.
Nutritional consultation for diet management, liver health, and gastrointestinal symptoms.
Substance use recovery programs (e.g., outpatient, IOP) for marijuana use disorder treatment.
CLIENT EDUCATION:
Explain that marijuana use disorder occurs when a person uses marijuana in ways that negatively impact their daily life, health, or responsibilities. Common signs include cravings, withdrawal symptoms (e.g., irritability, anxiety, difficulty concentrating), and the continued use of marijuana despite negative consequences. (SAMHSA, 2020)
Marijuana affects your mental health, contributing to anxiety, depression, and irritability.
Chronic marijuana use can negatively affect your cognitive abilities (memory, concentration) and overall motivation.
Withdrawal symptoms (e.g., tremors, nausea, mood swings) can occur when trying to quit or reduce use.
Hypertension increases your risk of heart disease, stroke, and kidney problems. It is important to manage your blood pressure through lifestyle changes (e.g., diet, exercise) and medications.
Lifestyle changes include reducing sodium in your diet, maintaining a healthy weight, limiting alcohol intake, and managing stress.
A-fib is an irregular heartbeat that can cause symptoms such as palpitations, fatigue, and shortness of breath. It increases the risk of stroke, and you may need to take anticoagulants to prevent blood clots.
Cirrhosis is scarring of the liver that can result from chronic liver damage (e.g., alcohol use, viral hepatitis). It may lead to complications like ascites, liver failure, and hepatic encephalopathy.
Avoid substances that can further damage the liver, including alcohol and excessive medications that are metabolized by the liver.
Ensure regular follow-up appointments with your primary care provider , psychiatrist, hepatologist, and cardiologist to monitor liver function, blood pressure, A-fib, and mental health.
Its important to stay consistent with prescribed medications and therapy sessions. If you experience any side effects or feel that something isn’t working, let your healthcare provider know immediately.
FOLLOW UP:
If you still have symptoms after a few days (usually 3–5 days), you should come back to the clinic. Re-evaluation is required in 7 days after start of medication to monitor for any signs and symptoms of withdrawal and possible increase of medication or refill of current dosage. If you develop hallucinations, delusions, severe tremors, diaphoresis, vomiting more
Answer these questions:
a. Pathophysiology: Write a summary of the underlying pathophysiology of Substance Use Disorder
b. Pharmacology: Write a summary of how the pharmacological agent chosen Dronabinol acts to reverse or control disease pathology
c. Additional analysis: Describe how clinical practice guidelines from American Society of Addiction Medicine (ASAM), Substance Abuse and Mental Health Services (SAMHSA) and National Institute on Drug Abuse (NIDA) were used to make a diagnosis of Substance Use Disorder and management plan.
d. Follow-up and referrals: Describe what actions should be taken at the time of follow-up. If applicable, describe the client’s symptoms and response to the plan of care at the follow-up visit.
e. Quality: Discuss any information you learned in the weekly discussion of Substance Use that impacted your approach to the creation of the client’s management plan or would inform your care of a future client with a similar disorder.
f. Coding and billing: Identify all appropriate ICD-10 codes for the client.
Sources from last 5 years please
