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.(Medical Prescription 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. 

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.(Medical Prescription 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.

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.(Medical Prescription for Older Adults and Pregnant Women Comprehensive Essay)
• 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. (Medical Prescription for Older Adults and Pregnant Women Comprehensive Essay)

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! (Medical Prescription for Older Adults and Pregnant Women Comprehensive Essay)

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Medical Prescription for Older Adults and Pregnant Women Comprehensive Essay

Prescribing for Older Adults and Pregnant Women

Patient characteristics play a critical role when prescribing medication. Prescribers should put many considerations when prescribing for pregnant and older women, considering the impact of the medication on the patient’s conditions. This assignment explores generalized anxiety (GAD) disorder among older adults, recommends an FDA-approved and off-label drug, risk assessment for decision-making, and GAD clinical guidelines.(Medical Prescription for Older Adults and Pregnant Women Comprehensive Essay)

Recommend one FDA-approved drug, one off-label drug, and one non-pharmacological intervention for GAD in older adults.

The prevalence of GAD among older adults stands at 11.2% as of 2019 (National Center for Health Statistics, 2020). Escitalopram is FDA approved GAD treatment (Crocco et al., 2017). GAD improves anxiety symptoms and prevents symptoms relapse in older adults (Crocco et al., 2017). An off-label drug for GAD is quetiapine. Various studies have shown a superior quality of quetiapine in managing GAD in older adult patients (Maneeton et a., 2016). The most non-pharmacological intervention for GAD among older adults is cognitive-behavioral therapy (CBT). Studies have shown that CBT is helpful in GAD treatment in older adults and is usually compatible with pharmacological interventions to reduce GAD symptoms over short periods (Hallet a., 2020).(Medical Prescription for Older Adults and Pregnant Women Comprehensive Essay)

The risk assessment for 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?

Medication benefit-risk assessment is central to decision-making in health care. For this case, a text-mining analysis of information on contraindications, dosage, and perceived adherence to the proposed medication would be a priority (Reaney et al., 2019). A comprehensive understanding of the drug interactions would be crucial in identifying the associated risk and benefits to aid definitive decision-making. In this case, checking the patient’s allergies and potential response to prescribed drugs would limit the possibility of adverse reactions and increase medication administration safety.(Medical Prescription for Older Adults and Pregnant Women Comprehensive Essay)

Escitalopram is well tolerated and helps reduce anxiety symptoms. Besides, Escitalopram combines well with CBT to reduce pharmacotherapy use (Crocco et al., 2017). Escitalopram’s side effects include nausea and somnolence (Asakura et al., 2016). Quetiapine is effective GAD treatment, improving sleep disturbance and depressive symptoms (Maan et a., 2021). However, quetiapine has low tolerability and acceptability with side effects such as abdominal pain, lethargy, dyspnea, constipation, weight gain, hyperglycemia, leukopenia, etc. (Maan et a., 2021)(Medical Prescription for Older Adults and Pregnant Women Comprehensive Essay)

Existing clinical guidelines for GAD and recommendations justification.

There is no universally clinical guideline for GAD in the USA. However, there exist several evidence-based clinical practice guidelines for this GAD. It is vital to consider drug dosage, possible adverse reactions, and comorbid conditions in this case. The Anxiety and Depression Association of America recommend first-line pharmacotherapy (Selective serotonin reuptake inhibitors (SSRIs), psychotherapy, combined treatment, and adjunct therapy for GAD among older adults (Anxiety and Depression Association of America [ADAA], 2016).(Medical Prescription for Older Adults and Pregnant Women Comprehensive Essay)

Escitalopram is an SSRI associated with essential benefits such as a low propensity to cause cognitive side effects, sedation, or dependency, which justifies its recommendation. Adjective interventions (ADAA, 2016; Strawn et al., 2018) are also recommended justifying Quetiapine recommendation. Moreover, CBT is recommended for the effective treatment of GAD, as it helps cope with stress, manage fears, and have better relationships (ADAA, 2016), justifying its recommendation.(Medical Prescription for Older Adults and Pregnant Women Comprehensive Essay)

References

Asakura, S., Hayano, T., Hagino, A., & Koyama, T. (2016). A randomized, double-blind, placebo-controlled study of Escitalopram in Japan patients with social anxiety disorder. Current Medical Research and Opinion, 32(4), 749-757.(Medical Prescription for Older Adults and Pregnant Women Comprehensive Essay)

Crocco, E. A., Jaramillo, S., Cruz-Ortiz, C., & Camfield, K. (2017). Pharmacological management of anxiety disorders in the elderly. Current Treatment Options in Psychiatry, 4(1), 33-46. https://dx.doi.org/10.1007%2Fs40501-017-0102-4

Hall, J., Kellett, S., Berrios, R., Bains, M. K., & Scott, S. (2016). Efficacy of cognitive-behavioral therapy for generalized anxiety disorder in older adults: systematic review, meta-analysis, and meta-regression. The American Journal of Geriatric Psychiatry, 24(11), 1063-1073. https://doi.org/10.1016/j.jagp.2016.06.006(Medical Prescription for Older Adults and Pregnant Women Comprehensive Essay)

Maan, J. S., Ershadi, M., Khan, I., & Saadabadi, A. (2021). Quetiapine. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459145/

Maneeton, N., Maneeton, B., Woottiluk, P., Likhitsathian, S., Suttajit, S., Boonyanaruthee, V., & Srisurapanont, M. (2016). Quetiapine monotherapy in the acute treatment of generalized anxiety disorder: a systematic review and meta-analysis of randomized controlled trials. Drug Design, Development, and Therapy, 10, 259. https://dx.doi.org/10.2147%2FDDDT.S89485(Medical Prescription for Older Adults and Pregnant Women Comprehensive Essay)

National Center for Health Statistics. (September 2020). Available at: https://www.cdc.gov/nchs/products/databriefs/db378.htm (Accessed March 20, 2022)

Reaney, M., Bush, E., New, M., Paty, J., Roborel de Climens, A., Skovlund, S. E., … & Gater, A. (2019). The potential role of individual-level benefit-risk assessment in treatment decision making: a DIA study endpoints community workstream. Therapeutic Innovation & Regulatory Science, 53(5), 630-638. https://doi.org/10.1177/2168479018807448(Medical Prescription for Older Adults and Pregnant Women Comprehensive Essay)

Anxiety and Depression Association of America (March 2016). Clinical Practice Review for GAD. https://adaa.org/resources-professionals/practice-guidelines-gad