Prescribing for Older Adults and Pregnant Women Paper

Prescribing for Older Adults and Pregnant Women Paper

Prescribing for Older Adults and Pregnant Women Paper

PRESCRIBING FOR OLDER ADULTS AND PREGNANT WOMEN

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.

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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.

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RESOURCES

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

LEARNING RESOURCES

Required Readings

American Psychiatric Association. (2016). The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementiaLinks to an external site.. 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 interventionsLinks to an external site.. 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 lactationLinks to an external site.. 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 databaseLinks to an external site. (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.

Boland, R. Verdiun, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.

Chapter 1, “Examination and Diagnosis of the Psychiatric Patient”

Section 1.3, “Geriatric Patients” (pp. 87-92)

Chapter 29, “End-of-Life Issues and Palliative Care”

Chapter 31, “Global and Cultural Issues in Psychiatry”

DeNisco, S. M. (2023). Role development for the nurse practitioner (3rd ed.). Jones & Bartlett Learning.

Chapter 4, “Vulnerable Populations” (pp. 99-124)

Chapter 5, “Mental Health and Primary Care: A Critical Intersection” (pp. 132-149)

Chapter 6, “Cultural Sensitivity and Global Health” (pp. 155-179)

Required Media

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

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-TR 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.

Read a selection of your colleagues’ responses.

BY DAY 6 OF WEEK 9

Respond to at least two of your colleagues on 2 different days who selected different disorders. Propose an alternative on-label, off-label, or nonpharmacological treatment for the disorders. Justify your suggestions with at least two references to the literature.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!

NRNP_675_Week9_Discussion_Rubric

NRNP_6675_Week9_Discussion_Rubric
Criteria Ratings Pts

This criterion is linked to a Learning OutcomeMain Posting:Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

44 to >39.0 pts

Excellent 90%–100%

Thoroughly responds to the Discussion question(s)… Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources… No less than 75% of post has exceptional depth and breadth… Supported by at least three current credible sources

39 to >34.0 pts

Good 80%–89%

Responds to most of the Discussion question(s)… Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module… 50% of the post has exceptional depth and breadth… Supported by at least three credible references

34 to >30.0 pts

Fair 70%–79%

Responds to some of the Discussion question(s)… One to two criteria are not addressed or are superficially addressed… Is somewhat lacking reflection and critical analysis and synthesis… Somewhat represents knowledge gained from the course readings for the module… Post is supported by fewer than two credible references

30 to >0 pts

Poor 0%–69%

Does not respond to the Discussion question(s)… Lacks depth or superficially addresses criteria… Lacks reflection and critical analysis and synthesis… Does not represent knowledge gained from the course readings for the module… Contains only one or no credible references
44 pts

This criterion is linked to a Learning OutcomeMain Posting:Writing

6 to >5.0 pts

Excellent 90%–100%

Written clearly and concisely… Contains no grammatical or spelling errors… Adheres to current APA manual writing rules and style

5 to >4.0 pts

Good 80%–89%

Written concisely… May contain one to two grammatical or spelling errors… Adheres to current APA manual writing rules and style with minor errors

4 to >3.0 pts

Fair 70%–79%

Written somewhat concisely… May contain more than two spelling or grammatical errors… Contains some APA formatting errors

3 to >0 pts

Poor 0%–69%

Not written clearly or concisely… Contains more than two spelling or grammatical errors… Does not adhere to current APA manual writing rules and style

6 pts

This criterion is linked to a Learning OutcomeMain Posting:Timely and full participation
10 to >8.0 pts

Excellent 90%–100%

8 to >7.0 pts

Good 80%–89%

Posts main Discussion by due date… Meets requirements for full participation

7 to >6.0 pts

Fair 70%–79%

6 to >0 pts

Poor 0%–69%

10 pts

This criterion is linked to a Learning OutcomeFirst Response:Post to colleague’s main post that is reflective and justified with credible sources
9 to >8.0 pts

Excellent 90%–100%

Response exhibits critical thinking and application to practice settings… Responds to questions posed by faculty… The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

8 to >7.0 pts

Good 80%–89%

Response has some depth and may exhibit critical thinking or application to practice setting.

7 to >6.0 pts

Fair 70%–79%

Response is on topic, may have some depth.

6 to >0 pts

Poor 0%–69%

Response may not be on topic, lacks depth.

9 pts

This criterion is linked to a Learning OutcomeFirst Response:Writing

6 to >5.0 pts

Excellent 90%–100%

Communication is professional and respectful to colleagues…. Response to faculty questions are fully answered, if posed…. Provides clear, concise opinions and ideas that are supported by two or more credible sources… Response is effectively written in standard, edited English.

5 to >4.0 pts

Good 80%–89%

Communication is mostly professional and respectful to colleagues…. Response to faculty questions are mostly answered, if posed…. Provides opinions and ideas that are supported by few credible sources… Response is written in standard, edited English.

4 to >3.0 pts

Fair 70%–79%

Response posted in the Discussion may lack effective professional communication…. Response to faculty questions are somewhat answered, if posed…. Few or no credible sources are cited.

3 to >0 pts

Poor 0%–69%

Responses posted in the Discussion lack effective communication…. Responses to faculty questions are missing…. No credible sources are cited.
6 pts

This criterion is linked to a Learning OutcomeFirst Response:Timely and full participation
5 to >4.0 pts

Excellent 90%–100%

4 to >3.0 pts

Good 80%–89%

3 to >2.0 pts

Fair 70%–79%

2 to >0 pts

Poor 0%–69%

5 pts

This criterion is linked to a Learning OutcomeSecond Response:Post to colleague’s main post that is reflective and justified with credible sources

9 to >8.0 pts

Excellent 90%–100%

Response exhibits critical thinking and application to practice settings…. Responds to questions posed by faculty… The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

8 to >7.0 pts

Good 80%–89%

Response has some depth and may exhibit critical thinking or application to practice setting.

7 to >6.0 pts

Fair 70%–79%

Response is on topic, may have some depth.

6 to >0 pts

Poor 0%–69%

Response may not be on topic, lacks depth.

9 pts

This criterion is linked to a Learning OutcomeSecond Response:Writing

6 to >5.0 pts

Excellent 90%–100%

Communication is professional and respectful to colleagues…. Response to faculty questions are fully answered, if posed…. Provides clear, concise opinions and ideas that are supported by two or more credible sources… Response is effectively written in standard, edited English.

5 to >4.0 pts

Good 80%–89%

Communication is mostly professional and respectful to colleagues…. Response to faculty questions are mostly answered, if posed…. Provides opinions and ideas that are supported by few credible sources… Response is written in standard, edited English.

4 to >3.0 pts

Fair 70%–79%

Response posed in the Discussion may lack effective professional communication…. Response to faculty questions are somewhat answered, if posed…. Few or no credible sources are cited.

3 to >0 pts

Poor 0%–69%

Responses posted in the Discussion lack effective communication…. Responses to faculty questions are missing…. No credible sources are cited.

6 pts

This criterion is linked to a Learning OutcomeSecond Response:Timely and full participation

5 to >4.0 pts

Excellent 90%–100%

4 to >3.0 pts

Good 80%–89%

Meets requirements for full participation… Posts by due date

3 to >2.0 pts

Fair 70%–79%

Posts by due date

2 to >0 pts

Poor 0%–69%

5 pts

Total Points: 100

Prescribing for Older Adults and Pregnant Women Sample

The selected condition is post-traumatic stress disorder (PTSD) among elderly patients. PTSD is a mood disorder that develops following an individual’s traumatic exposure. The FDA has approved paroxetine for use in treating PTSD in elderly patients. Venlafaxine is an off-label antidepressant that can be used for PTSD in elderly patients(de Moraes Costa et al., 2020; Pless Kaiser et al., 2019). Cognitive behavioral therapy is an example of a non-pharmacological intervention for PTSD in elderly patients(Peter &Jule, 2023). Combined therapy involving pharmacological and non-pharmacological interventions produces optimal outcomes for PTSD patients.

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Risk assessment should be performed before prescribing pharmacological and non-pharmacological agents to elderly patients diagnosed with PTSD. The provider must weigh the benefits and risks that each agent carries. For example, the risk of adverse effects such as suicidal thoughts, attempts, and plans should be weighed against the benefits of the different antidepressants for PTSD. Most elderly patients have comorbid conditions that might also affect the selection of an appropriate treatment. The comorbidities also increase the risk of drug interactions and the development of adverse effects(de Moraes Costa et al., 2020). As a result, a PMHNP should consider the impact of the existing treatments on the desired outcomes in PTSD management.

FDA-approved drugs have a high safety and efficacy level. Patients are assured of minimal risk of harm and optimum benefits, including symptom resolution. However, FDA-approved drugs may not be effective in some patients, leading to a need for off-label drugs. FDA-approved drugs for PTSD also carry the risk of suicidal thoughts, attempts, and plans among some patients. The benefits of off-label drugs include them acting as alternative drugs for patients who do not respond to FDA-approved drugs. However, they carry an increased risk of harm due to their low safety and efficacy profiles(Ferianto&Karyo, 2020; Li et al., 2023). Clinical guidelines for use in treating PTSD in elderly patients do not exist. I will utilize evidence from peer-reviewed sources such as journals to make informed decisions about treating elderly patients with PTSD.

References

de Moraes Costa, G., Zanatta, F. B., Ziegelmann, P. K., Soares Barros, A. J., & Mello, C. F. (2020). Pharmacological treatments for adults with post-traumatic stress disorder: A network meta-analysis of comparative efficacy and acceptability. Journal of Psychiatric Research, 130, 412–420. https://doi.org/10.1016/j.jpsychires.2020.07.046

Ferianto, K., & Karyo. (2020). Differences of Effectiveness of Autogenic and Supportive Therapy on Post Traumatic Stress Disorder in Post Flood Elderly (Rengel Village, Rengel, Tuban District). Science Midwifery, 9(1, Oktober), Article 1, Oktober.

Li, J., Gao, L., Bao, R., Ji, R., He, Q., Tang, X., Zhang, W., &Qu, Z. (2023). Comparative efficacy for different age groups of psychological or psychosocial treatments on post-traumatic stress disorder: Protocol for systematic review, meta-analysis and meta-regression analysis. BMJ Open, 13(1), e066569. https://doi.org/10.1136/bmjopen-2022-066569

Peter, C., & Jule, A. (2023).A systematic review of pharmacological and non-pharmacological interventions for the treatment of post-traumatic stress disorder.Archives of Clinical Psychiatry, 50(1), Article 1. https://archivespsy.com/menu-script/index.php/ACF/article/view/2005

Pless Kaiser, A., Cook, J. M., Glick, D. M., & Moye, J. (2019). Posttraumatic Stress Disorder in Older Adults: A Conceptual Review. Clinical Gerontologist, 42(4), 359–376. https://doi.org/10.1080/07317115.2018.1539801

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