Assignment: Medicine Monograph: Eskatamine on Major Depression Disorder

Assignment: Medicine Monograph: Eskatamine on Major Depression Disorder

Assignment: Medicine Monograph: Eskatamine on Major Depression Disorder

Eskatamine on Major Depression Disorder

Major Depression Disorder (MDD) has been a significant challenge among most individuals in the world. For instance, Popova et al. (2019) state that in the United States, approximate of 7.1% adults have had instances of MDD episodes. Generally, MDD leads to psychosocial functioning impairment where individuals may contemplate committing suicide. The condition is more prone to older adults whose behaviors and moods become affected, including their physical function, such as their sleep routine. MDD becomes prone to the patients because the patients never seek treatment at an early stage. However, those who seek treatment at the onset of the disorder are taught by the physicians how to function and cope with the treatments. The common treatment for MDD is administering biogenic amine antidepressants, which have presented various limitations since the treatment does not completely do away with suicidal tendencies, thus making the patients remain symptomatic. In that case, the monograph presents Eskatemine as the best alternative in treating MDD. Hence, the paper aims to evaluate Eskatamine’s dosage, administration, and cost, pharmacodynamics/pharmacokinetics, safety and efficacy, and discussion.

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Eskatamine’s Dosage, Administration, and Cost

Eskatamine dosage varies with the type of depression the patient has been diagnosed with, where, in this case, it is the MDD. Hence, the dosage for major depressive disorder should be within the first four weeks with two times 84 mg intranasally. The healthcare provider should assess the treatment benefit to determine the need for treatment change.

During administering the eskatamine drug, the healthcare provider may reduce the dose to 56mg intranasally twice a week, especially due to intolerable symptoms. However, the healthcare provider might limit the drug use if the patient does not improve suicidal thoughts after four weeks. Hence, it would be essential for the healthcare provider to ensure that the patient does not take food two hours before the treatment and avoid taking any drinks thirty minutes before the drug administration. Also, the healthcare providers should ensure that the patients who need nasal decongestants should use those agents one hour before using eskatamine. Due to the effectiveness of eskatamine, the healthcare providers should ensure that the older adults are administered oral antidepressants for MDD patients with acute behaviors or suicidal ideation.

The cost for eskatamine relies on value-based prices where the cost-effectiveness threshold of eskatamine per dosage lies between  $50,000/QALY- $150,000/QALY. These costs vary due to the outcome that the administered dose has to the patients. Also, Bahr et al. (2019) assert that the eskatamine dose is more likely to be subjected to cost rise within the next five years. Hence, there is a likelihood for the eskatamine to be scarce in the United States in terms of cost-effectiveness. That is despite its current effective treatment for MDD due to its higher prices.

Pharmacodynamics/Pharmacokinetics

            Esketamine acts on the central nervous system (CNS) where it suppresses depressive symptoms. However, the exact mechanism by which this medicine acts as an antidepressant to suppress depression symptoms is unknown. The medicine has a rapid absorption rate than other antidepressants since it is administered through nasal spray. The bioavailability of this medicine is about 48% following nasal spray administration. A person takes between 20 and 40 minutes time to attain peak plasma concentration after the last nasal spray (Molero et al., 2018). Approximately 709 of esketamine is distributed in the body following administration via the intravenous route. Various enzymes including cytochrome P450 (CYP) enzymes, CYP3A4, and CYP2B6 metabolize esketamine to noresketamine metabolite (Molero et al., 2018). Finally, excretion of this drug involves the release of less than 1% of the total dosage of nasal esketamine via the urine (Molero et al., 2018).

Safety and Efficacy

Treatment-resistant depression current treatment options have proved to have various limitations on patients’ safety and efficacy. In that regard, Popova et al. (2019) address the effectiveness of eskatamine in addressing the unmet medical requirements for patients with depression since it proves to be more efficient to the patients’ needs. Hence, the study involves a comparison of various antidepressants to eskatamine where they evaluate their efficacy and safety. From the study, the authors support eskatamine nasal spray safety and efficacy. From their observation, Popova et al. (2019) assert that eskatamine has proved its safety and efficacy in treating patients that experience treatment-resistant depression. For instance, the authors point out various trials on a flexible-dose study where most examined eskatemine’s short-term safety and efficacy. As a result, there is no concrete information concerning how eskatamine can maintain the patients’ condition on long-term safety.

Discussion and Conclusion

This medicine is associated with advantages or disadvantages. The major advantage of this medicine involves a rapid absorption rate since it is administered via nasal spray. Additionally, it has a relatively higher bioavailability of approximately 48% following nasal spray administration (Molero et al., 2018). Furthermore, a person takes a relatively shorter period (between 20 and 40 minutes) to attain peak esketamine plasma concentration after nasal administration (Molero et al., 2018). Finally, this medicine has an excretion rate of less than 1% implying that the highest percentage is utilized by the body (Molero et al., 2018). On the contrary, this medication is associated with physical dependence in which individuals manifest withdrawal signs and symptoms after prolonged use. This medicine is recommended for the practice due to its efficacy in managing the symptoms of persistent depression among individuals diagnosed with this condition.

References

Bahr, R., Lopez, A., & Rey, J. A. (2019). Intranasal esketamine (SpravatoTM) for use in treatment-resistant depression in conjunction with an oral antidepressant. Pharmacy and Therapeutics, 44(6), 340.

Molero P, Ramos-Quiroga JA, Martin-Santos R, Calvo-Sanchez E, Gutierrez-Rojas L, & Meana J, J. (2018). Antidepressant Efficacy and Tolerability of Ketamine and Esketamine: A Critical Review. CNS Drugs; 32(5):411-420. doi: 10.1007/s40263-018-0519-3.

Popova, V., Daly, E. J., Trivedi, M., Cooper, K., Lane, R., Lim, P., … & Singh, J. B. (2019). Efficacy and safety of flexibly dosed esketamine nasal spray combined with a newly initiated oral antidepressant in treatment-resistant depression: a randomized double-blind active-controlled study. American Journal of Psychiatry, 176(6), 428-438.

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Medication Monograph Instructions

1. A medication monograph is a detailed and research-based explanation of a single medication. In this course, the required medication monograph cannot be the most common medications substantially covered in class.
2. Your monograph must include the following:
3. Introduction
   1. Problems/condition the medication will addressed
   2. Population (children, elderly, homeless, incarcerated, persons on antipsychotics, diverse culture and ethnicity, etc.)
   3. The incidence and/or prevalence of the problem/condition. Complications/problems if left untreated
   4. The common medication class of treatment/cure for the problem/condition, if available. If not available, give reasons (costs, unknown problem etiology, etc.).  The reason the medication proposed will be another choice or alternative (more effective, etc.).
4. Dosage, Administration and Cost
   1. How this drug is administered, in what form
   2. Cost for different dosages and forms
   3. Safe and efficacious dose
   4. FDA approved or off-label use for the problem proposed
5. Pharmacodynamics/Pharmacokinetics
   1. The site of action of this drug, how it acts on the site, what is the theoretical explanation for efficacy of the drug against the problem proposed
   2. Discuss the absorption, bioavailability, distribution, metabolism, and excretion of drug
6. Safety and Efficacy
   1. Most common side effects
   2. Adverse effects
   3. Precautions and Contraindications
   4. Drug interactions (liver CYP system)
7. Discussion and Conclusion
   1. Advantaged or disadvantages of the medicine
   2. Recommendations for practice

III. Make sure your monograph is supported by relevant studies from peer-reviewed journals

1. Use APA format

V. Submit your monograph in the assignment dropbox for grading AND in the discussion forum for your peers to read.

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Mediation Monograph Grading Rubric

 

Criteria	19-25	13-18	6-12	0-5
Organization and Structure	Follows required formatting with consistent logical flow	Follows required formatting with less than 100% logical flow	Follows required format but flow is not logical	Does not follow required format and without logical flow.
Style and Mechanics	<2 grammatical errors, follows APA format for citations and references Use of consistent professional voice	3-4 grammatical errors but follows APA formatting and use consistent professional voice	5-6 grammatical errors, APA formatting is inconsistent, uses jargon and informal voice	>6 grammatical errors, APA formatting is non-existent and uses jargons and informal voice.
Introduction	Provides a clear background of the problem with at least 3 literature citations	Provides a clear background of the problem with 1 -2 literature citation,	Provides confusing background of the problem with 1 -2 literature citations	Provides confusing background of the case without literature citations
Medication Information	Presents all required information clearly and succinctly with at least 3 research evidence	Presents all the required data and information but has irrelevant information.  Provides at least 3 research evidence	Missing required data and information, mixed with irrelevant information. Provides at least 2 research evidence	No required data and information Present only irrelevant information Provides at least 2 research evidence
Discussion	Logically and concisely ties the introduction and medication information and the existent literature and makes relevant recommendations to the reader.	Haphazardly ties the introduction, medication information and the existent literature but provides relevant recommendations to the reader.	Haphazardly ties the introduction, medication information and the existent literature and provides irrelevant recommendations to the reader.	Fails to tie the introduction, medication information and the existent literature; recommendations are irrelevant and non-existent.