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.(Prescribing For Older Adults and Pregnant Women Comprehensive Essay)

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. (Prescribing For Older Adults and Pregnant Women Comprehensive Essay)

RESOURCES

Be sure to review the Learning Resources before completing this activity. Click the weekly resources link to access the resources. 

WEEKLY RESOURCES

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.(Prescribing For Older Adults and Pregnant Women Comprehensive Essay)
• 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.(Prescribing For Older Adults and Pregnant Women Comprehensive Essay)

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?(Prescribing For Older Adults and Pregnant Women Comprehensive Essay)
• 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.(Prescribing For Older Adults and Pregnant Women Comprehensive Essay)

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! (Prescribing For Older Adults and Pregnant Women Comprehensive Essay)

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Prescribing For Older Adults and Pregnant Women Comprehensive Essay

Prescribing for older adults can be challenging, considering the changes in functional status, comorbidities, polypharmacy, and chronic health problems (Wheeler, 2020). Therefore, it is important to consider the unique needs and characteristics of the geriatric population when prescribing medication to prevent adverse drug reactions and improve therapeutic outcomes. This assignment discusses older adults’ medication prescription based on Schizophrenia and identifies an FDA-approved drug, an off-label drug, and a non-pharmacological intervention for the disorder.(Prescribing For Older Adults and Pregnant Women Comprehensive Essay)

Schizophrenia

Schizophrenia, coded as 295.90 (F20.9), is a chronic mental disorder leading to the inability to think, feel, or behave relative to an individual’s developmental age. Although it affects the general population, it is more common among older adults and is often linked to financial, physical, and social distress (Wheeler, 2020). Schizophrenia is characterized by hallucinations and delusions, social withdrawal, apathy, and difficulty with memory retention, attention, and decision-making (American Psychiatric Association [APA], 2019). Moreover, the prognosis of Schizophrenia remains elusive, although research suggests a combination of neurological, genetic, and environmental factors.(Prescribing For Older Adults and Pregnant Women Comprehensive Essay)

Risk Assessment to Inform Treatment Decision-Making

The primary purpose of a risk assessment is to determine whether the patient’s treatment needs, including drug-related needs, are met accordingly. The assessment entails gathering, researching, and interpreting information provided about the patient, their medical conditions, and drug therapies (Cipolle et al., 2023). For this assessment, it is critical to know more about the patient and their medication experience before making a treatment decision, gather relevant information to help with the decision-making and evaluate drug-related needs, including whether the drug therapy indication is appropriate, effective, and safe, and the patient’s likely adherence to the treatment regimen. These assessment areas will be used to select appropriate FDA-approved drugs, off-label drugs, and non-pharmacological treatments for Schizophrenia patients.(Prescribing For Older Adults and Pregnant Women Comprehensive Essay)

FDA-approved drug

One FDA-approved drug for Schizophrenia is Risperdal. Antipsychotic medications are the FDA-recommended first-line treatment of Schizophrenia. Risperdal is an antipsychotic medication indicated for the maintenance of Schizophrenia in adults. The benefits of taking Risperdal include treating the negative symptoms of Schizophrenia, especially auditory and visual hallucinations. In geriatric patients, Risperdal has lower anticholinergic adverse reactions compared to other antipsychotic drugs (Zolk et al., 2021). However, risks associated with Risperdal include increased mortality, like any other antipsychotic medication in patients with dementia. Patients are also at risk of feeling sleepy, having stiff muscles, limiting movement, increased headaches, weight changes, nausea, and drowsiness. The adverse response to Risperdal treatment is attributed to age-related factors among adults, and prescription should be initiated at the lowest possible dosage. Therefore, in older adults, assessing a patient’s physical attributes, including blood pressure, is vital because, in some cases, Risperdal can cause a heart attack as it causes metabolic changes.(Prescribing For Older Adults and Pregnant Women Comprehensive Essay)

Off-label drug

Many persons with Schizophrenia do not respond to standard antipsychotic medication therapy satisfactorily. Various other drugs, including valproate, are utilized in these situations. Valproate increases Gamma-aminobutyric acid (GABA) levels, the main inhibitory neurotransmitter in the human brain (Rahman & Nguyen, 2020). Numerous seizures have been successfully treated with valproate (Saini et al., 2019). Usually, bipolar disorders and migraine headache prophylaxis are also treated with valproate. By indication, different valproate dosages are advised. A starting dose of 10 to 15 mg/kg/day is advised to get the best clinical response, with weekly dose increments of 5 to 10 mg/kg/day. It is frequently advised to monitor medication levels (Rahman & Nguyen, 2020). Benefits of taking valproate include a more stable mood, reduced migraine headaches, and neurotransmitter balance restoration. However, multiple risks are associated with taking valproate, including sedation and dizziness in Schizophrenia patients. Patients are also at risk of developing blurred vision, nausea, insomnia, and in severe cases, suicidal ideation, hyperthermia, hepatotoxicity, and pancreatitis (Rahman & Nguyen, 2020). The risk-benefit analysis is on a patient basis because different patients react differently to valproate.(Prescribing For Older Adults and Pregnant Women Comprehensive Essay)

Non-pharmacological Intervention

A common non-pharmacological intervention for Schizophrenia is cognitive behavioral therapy (CBT). CBT is commonly used with Schizophrenia patients to improve cognitive and judgment impairments and distractibility (Boland & Verduin, 2021). Further reports have shown its effectiveness in ameliorating hallucinations and delusions. In addition, CBT is more effective among patients who have insight into their condition and after treating acute episodes of Schizophrenia. CBT incorporates self-monitoring, identified coping skills, and cognitive restructuring to improve well-being among Schizophrenia patients. A study by Sharma et al. (2020) demonstrated improved psychotic features and problematic behaviors among Schizophrenia patients. Another study by Laws et al. (2018) demonstrated some therapeutic effects on functioning among Schizophrenia patients. These results suggest that CBT is an effective non-pharmacological intervention for Schizophrenia independent of combined therapy.(Prescribing For Older Adults and Pregnant Women Comprehensive Essay)

Clinical Practice Guidelines for Schizophrenia

Multiple clinical practice guidelines exist for Schizophrenia to offer recommendations necessary to optimize patient care. Schizophrenia assessment guidelines require a robust evaluation of the patient and their caregiver(s), including history and physical and mental state examination. The current diagnostic criteria should be adopted during the assessment to enhance reliability and better utilization of evidence-based recommendations (Grover et al., 2019). The assessment should also elicit information on symptoms, symptoms severity, other medical conditions and comorbidities, substance abuse, risk of harm to others and self, and functioning levels. When assessing caregivers, one should focus on their knowledge about the illness, attitudes and beliefs about the treatment regimen, and how the illness impacts them personally and their social resources (Grover et al., 2019). In this case, the assessment should be an ongoing process for this patient population.(Prescribing For Older Adults and Pregnant Women Comprehensive Essay)

Guidelines for developing a treatment plan for Schizophrenia require including the treatment settings, treatment regimen to be used, and areas they will address. The process should involve patients, caregivers, and providers (Grover et al., 2019). Treatment plans should also be practical, needs-based, flexible, viable and consistently re-examined and adjusted when necessary. Providers have multiple options to select from to manage Schizophrenia. The guidelines recommend antipsychotic medications, somatic treatments, adjunctive medications, and psychosocial interventions (Grover et al., 2019). However, the provider should assess the efficacy of the selected treatment option per patient, considering past treatment response, treatment cost and affordability, psychiatric and medical comorbidity, side effects, patient and family preferences, administration route, non-adherence, concomitant medications, and treatment resistance.(Prescribing For Older Adults and Pregnant Women Comprehensive Essay)

References

American Psychiatric Association (APA). (2019). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Publishing

Boland, R., & Verduin, M. (2021). Kaplan & Sadock’s Concise Textbook of Clinical Psychiatry. Lippincott Williams & Wilkins.

Cipolle, R. J., Strand, L. S., & Morley P. C. (2023). Chapter 6. The Assessment. McGraw Hill Medical. https://accesspharmacy.mhmedical.com/content.aspx?bookid=491&sectionid=39674906/(Prescribing For Older Adults and Pregnant Women Comprehensive Essay)

Grover, S., Chakrabarti, S., Kulhara, P., & Avasthi, A. (2019). Clinical Practice Guidelines for Management of Schizophrenia. Indian Journal of Psychiatry, 59(Suppl 1), S19–S33. https://doi.org/10.4103/0019-5545.196972

Laws, K. R., Darlington, N., Kondel, T. K., McKenna, P. J., & Jauhar, S. (2018). Cognitive Behavioural Therapy for Schizophrenia-outcomes for functioning, distress, and quality of life: a meta-analysis. BMC Psychology, 6(1), 1-10. https://doi.org/10.1186%2Fs40359-018-0243-2(Prescribing For Older Adults and Pregnant Women Comprehensive Essay)

Rahman, M., & Nguyen, H. (2020). Valproic acid. In. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK559112/

Saini, A., Aggarwal, G., Pardal, P. K., & Gupta, A. (2019). Effect of Adjunctive Sodium Valproate in Patients of Acute Schizophrenia. Available at: https://www.ijcmr.com/uploads/7/7/4/6/77464738/ijcmr_2489.pdf (Accessed 8 March 2023)

Sharma, S., & Halder, S. (2020). Establishing efficacy of CBT in elderly treatment-resistant chronic Schizophrenia: a case report. International Journal of Indian Psychȯlogy, 8(2). http://dx.doi.org/10.25215/0802.088

Wheeler, K. (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. Springer Publishing Company.(Prescribing For Older Adults and Pregnant Women Comprehensive Essay)

Zolk, O., Greiner, T., Schneider, M., Heinze, M., Dahling, V., Ramin, T., … & Seifert, J. (2022). Antipsychotic drug treatment of Schizophrenia in later life: Results from the European cross-sectional AMSP study. The World Journal of Biological Psychiatry, 23(5), 374-386. https://doi.org/10.1080/15622975.2021.2011403(Prescribing For Older Adults and Pregnant Women Comprehensive Essay)