1. Compare and contrast methadone and buprenorphine. Include mechanism of action, and pros/cons.
2. Do you plan or have a desire to work with substance use disorders in an in-depth All components must be discussed to receive full credit as complete.
3. Why is it important for all PMHNP’s to be knowledgeable regarding substance use disorder detox and maintenance therapy?

Sample solution

Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell. 

In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.

God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.

Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.

To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.

 

References

Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.

Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies4(8), 487.

Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.

Let’s address these questions related to substance use disorders and their treatment.

1. Methadone vs. Buprenorphine: Comparison and Contrast

  • Mechanism of Action:
    • Methadone: A full mu-opioid agonist. It binds strongly to mu-opioid receptors, activating them and reducing cravings and withdrawal symptoms. Its long half-life allows for once-daily dosing.  
    • Buprenorphine: A partial mu-opioid agonist.

      It binds strongly to mu-opioid receptors but activates them less fully than methadone. Its high binding affinity displaces other opioids, preventing their effects. Buprenorphine also has a ceiling effect, reducing the risk of overdose.  

Let’s address these questions related to substance use disorders and their treatment.

1. Methadone vs. Buprenorphine: Comparison and Contrast

  • Mechanism of Action:
    • Methadone: A full mu-opioid agonist. It binds strongly to mu-opioid receptors, activating them and reducing cravings and withdrawal symptoms. Its long half-life allows for once-daily dosing.  
    • Buprenorphine: A partial mu-opioid agonist.

      It binds strongly to mu-opioid receptors but activates them less fully than methadone. Its high binding affinity displaces other opioids, preventing their effects. Buprenorphine also has a ceiling effect, reducing the risk of overdose.  

  • Pros and Cons:
    • Methadone:
      • Pros: Highly effective in reducing opioid cravings and withdrawal, long-standing evidence base, can be used for severe opioid use disorder.  
      • Cons: Full agonist, carries a risk of overdose, requires daily clinic visits in many settings, potential for QT prolongation, significant withdrawal during abrupt discontinuation.  
    • Buprenorphine:
      • Pros: Lower risk of overdose due to partial agonist effect and ceiling effect, can be prescribed in office-based settings, less severe withdrawal than methadone, available in various formulations (sublingual, buccal, implants, injections).  
      • Cons: Can precipitate withdrawal if taken too soon after other opioids, less effective for individuals with very high opioid tolerance, can be misused, can be more expensive.
  • Key Differences Summarized
    • Methadone is a full agonist, Buprenorphine is a partial agonist.  
    • Methadone has a higher overdose risk.  
    • Buprenorphine has a ceiling effect.  
    • Buprenorphine can be prescribed in more settings.  

2. Personal Plans/Desires Regarding Substance Use Disorder Work:

  • This is a personal reflection, and will vary from person to person.
  • For example:
    • “Yes, I plan to work with substance use disorders in an in-depth manner. I believe that addressing these disorders requires a holistic approach, including medication-assisted treatment, therapy, and social support. I am particularly interested in working with underserved populations and individuals with co-occurring mental health disorders. I want to be able to help patients to have a better quality of life. I also want to work to help reduce the stigma surrounding substance use disorders.”
    • “While I recognize the importance of treating substance use disorders, my primary focus will be on other areas of psychiatric mental health nursing. However, I will maintain a strong understanding of substance use disorder treatment to effectively collaborate with interdisciplinary teams and provide appropriate referrals.”

3. Importance of Substance Use Disorder Knowledge for PMHNPs:

  • Prevalence of Co-occurring Disorders: Substance use disorders frequently co-occur with mental health disorders. PMHNPs must be able to recognize and address both conditions to provide comprehensive care.  
  • Impact on Treatment: Substance use can significantly impact the effectiveness of mental health treatment. Understanding substance use disorders allows PMHNPs to tailor treatment plans and monitor for potential interactions.  
  • Detoxification and Withdrawal: PMHNPs should be knowledgeable about the signs and symptoms of withdrawal from various substances and the appropriate management strategies. They should also understand the importance of safe detoxification.
  • Maintenance Therapy: PMHNPs need to be familiar with medication-assisted treatment (MAT) options, such as methadone and buprenorphine, and their role in preventing relapse.  
  • Prevention and Harm Reduction: PMHNPs can play a crucial role in preventing substance use disorders through education and screening. They can also implement harm reduction strategies to minimize the negative consequences of substance use.  
  • Holistic Care: Substance use disorders affect all aspects of a patient’s life. PMHNPs must consider the social, economic, and environmental factors that contribute to substance use.  
  • Patient Safety: Unmanaged withdrawal can be life threatening. PMHNPs must be able to assess, and manage these patients.
  • Community Health: Substance use effects the whole community, and PMHNPs can be a valuable part of improving community health.

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