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First Decision After reviewing the case, it was decided to start the patient on Seroquel XR 100mg orallyat bedtime. Because the patient is exhibiting symptoms of a manic episode, it would be beneficial to start Seroquel. According to Rosenthal and Burchum (2018), Seroquel is an antipsychotic used to treat acute manic episodes and help stabilize mood when used long term. Although lithium is considered the first line treatment for bipolar, the decision not to continue with Lithium was made because the patient admitted she was not compliant and stopped taking her lithium after being discharged. Risperdal would not be started because the patient had a positive CYP2D6 *10 allele when genetic testing was done. According to Dodgen, Eloff,
Mataboge, Roos, van Staden, and Pepper (2015), the CYP2D6 *10 allele is associated with decreased function and influences the pharmacokinetics of Risperdal in east Asian population. The use of Risperdal for this patient could result in poor metabolism and the medication not being effective. Second Decision After four weeks, the patient returns to clinic feeling generally good with a positive resultof more sleep at night. The patient however has gained two to three pounds with complaints of constipation and dry mouth and would like her medication changed due to these adverse effects.