Prescribing for Older Adults and Pregnant Women NRNP6675

Discussion: Prescribing for Older Adults and Pregnant Women NRNP6675

Prescribing for Older Adults and Pregnant Women NRNP6675

Prescribing for Older Adults and Pregnant Women Example

ZOLOFT is an FDA-approved medication for major depressive disorder. It is used to treat panic attacks, obsessive-compulsive disorder, post-traumatic stress disorder, and premenstrual syndrome. It can help improve sleep, appetite, and energy levels that can restore interest in daily living. For off-label medications, doxepin is often prescribed for depression and anxiety (Hardy & Reichenbacker, 2019). It is in the class of medications known as tricyclic antidepressants.

It works by boosting the levels of certain natural chemicals in the brain that are necessary for mental equilibrium. Doxepin can also be taken as a pill to help with insomnia. Cognitive-behavioral therapy (CBT) is a safe and effective treatment for a generalized anxiety disorder during pregnancy.

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Risk and Benefit Assessment

The main risk for Zoloft is that it can cause congenital disabilities in children. These defects include atrial septal defects, cleft palate, and omphalocele. The benefit is that the medication raises the amount of serotonin in the brain Cuomo et al. 2918). As the level of serotonin increases, so does the patient’s mood. Patients, therefore, experience improvements in appetite, sleep, mood, and energy levels.

Doxepin works on the central nervous system to increase the levels of various chemicals in the brain. The medication can improve energy levels and sleep for patients (Akmasi & Meza, 2019). The risk is that it may cause a condition that affects the heart rhythm and fainting symptoms that require medical attention immediately.

Clinical Practice Guidelines

The treatment of depression necessitates a thorough examination and accurate diagnosis. The evaluation must be based on a complete medical history, a thorough physical examination, and a thorough mental state examination (Gautam et al., 2017). All sources, especially the family, must be used to gather information about the past. The diagnosis must be documented using the most up-to-date diagnostic criteria.

References

Almasi, A., & Meza, C. E. (2019). Doxepin. https://europepmc.org/article/NBK/nbk542306

Cuomo, A., Maina, G., Neal, S. M., De Montis, G., Rosso, G., Scheggi, S. & Fagiolini, A. (2018). Using sertraline in postpartum and breastfeeding: balancing risks and benefits. Expert Opinion On Drug Safety, 17(7), 719-725. https://doi.org/10.1080/14740338.2018.1491546

Gautam, S., Jain, A., Gautam, M., Vahia, V. N., & Grover, S. (2017). Clinical practice guidelines for the management of depression. Indian Journal Of Psychiatry, 59(Suppl 1), S34.

Hardy, L. T., & Reichenbacker, O. L. (2019). A practical guide to the use of psychotropic medications during pregnancy and lactation. Archives of Psychiatric Nursing, 33(3), 254–266. https://doi.org/10.1016/j.apnu.2019.04.001

Discussion: Prescribing for Older Adults and Pregnant Women Instructions

After assessing and diagnosing a patient, PMHNPs must take into consideration special characteristics of the patient before determining an appropriate course of treatment. For pharmacological treatments that are not FDA-approved for a particular use or population, off-label use may be considered when the potential benefits could outweigh the risks.

In this Discussion, you will investigate a specific disorder and determine potential appropriate treatments for when it occurs in an older adult or pregnant woman.

To Prepare:

Choose one of the two following specific populations: either pregnant women or older adults. Then, select a specific disorder from the DSM-5 to use.

Use the Walden Library to research evidence-based treatments for your selected disorder in your selected population (either older adults or pregnant women). You will need to recommend one FDA-approved drug, one non-FDA-approved off-label drug, and one nonpharmacological intervention for treating the disorder in that population.

By Day 3 of Week 9

Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your chosen disorder in older adults or pregnant women.

Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?

Explain whether clinical practice guidelines exist for this disorder, and if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.

Support your reasoning with at least three current, credible scholarly resources, one each on the FDA-approved drug, the off-label, and a nonpharmacological intervention for the disorder.

Learning Resources

Required Readings (click to expand/reduce)

American Psychiatric Association. (2016). The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia. https://doi.org/10.1176/appi.books.9780890426807

Agency for Healthcare Research and Quality. (2019). Maternal and fetal effects of mental health treatments in pregnant and breastfeeding women: A systematic review of pharmacological interventions.

https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/protocol-pharm-pregnant-women_0.pdf

Hardy, L. T., & Reichenbacker, O. L. (2019). A practical guide to the use of psychotropic medications during pregnancy and lactation. Archives of Psychiatric Nursing, 33(3), 254–266. https://doi.org/10.1016/j.apnu.2019.04.001

National Library of Medicine. (2006 – 2020). Drugs and lactation database (LactMed). https://www.ncbi.nlm.nih.gov/books/NBK501922/

The LactMed® database is a peer-reviewed, evidence-based resource on drugs that may be used by breastfeeding mothers. It includes possible effects on nursing infants and offers drug alternatives where possible.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

Chapter 27, Psychiatry and Reproductive Medicine
Chapter 33, Geriatric Psychiatry
Stewart, J. G., & DeNisco, S. M. (2019). Role development for the nurse practitioner (2nd ed.). Jones & Bartlett Learning.

Chapter 3, Vulnerable Populations
Chapter 4, Mental Health and Primary Care: A Critical Intersection
Chapter 5, Cultural Sensitivity and Global Health
Required Media (click to expand/reduce)

American Psychiatric Association. (2020). Geriatric telepsychiatry [Video]. https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/toolkit/geriatric-telepsychiatry

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