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.
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.
Prescribing for Older Adults and Pregnant Women NRNP6675 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
Prescribing for Older Adults and Pregnant Women NRNP6675 – Disruptive Mood Dysregulation Disorder in Pregnant Women Example
Extreme and persistent anger and temper outbursts characterize Disruptive Mood Dysregulation Disorder (DMDD). DMDD can greatly influence everyday functioning and social relationships and, therefore, requires prompt management.
Pharmacological and Non-pharmacological Interventions
FDA-approved drug: Sertraline – For pregnant women with DMDD, this selective serotonin reuptake inhibitor (SSRI) is generally safe and licensed to treat major depressive disorder. It helps to lessen irritability and stabilize mood (Gilliam et al., 2019).
Off-label drug: Lamotrigine – Lamotrigine is occasionally used off-label to treat mood problems, even though it is not FDA-approved for DMDD specifically. A study on pregnant, epileptic women who took this drug showed a comparatively reduced risk of birth abnormalities (Naguy & Al-Enezi, 2019). It also has mood-stabilizing effects.
Non-pharmacological intervention: Cognitive-Behavioral Therapy (CBT) is a recognized psychotherapeutic strategy for treating mood problems. It can be modified to help pregnant people with DMDD recognize and alter negative thought patterns and create coping mechanisms for emotional control without needing medication.
Risk Assessment
A thorough risk assessment is essential when choosing a course of treatment for pregnant women with DMDD to protect the health and safety of both the mother and the growing fetus. Improved mood stability and less irritability may result from using FDA-approved medications like Sertraline, improving the woman’s overall quality of life during pregnancy. However, certain risks should be considered, such as possible side effects, including nausea or shifts in sleeping patterns. SSRI use may also be connected with a modest incidence of birth abnormalities, necessitating cautious monitoring.
The benefits of the off-label medication Lamotrigine may include mood stability, but due to DMDD’s lack of FDA approval, caution is advised. Although findings suggest a low risk of birth abnormalities, the lack of data on its safety during pregnancy must be carefully considered. It is crucial to balance the potential advantages of using off-label drugs against the unidentified hazards and risks that could arise.
The risk evaluation must consider non-pharmacological therapies like Cognitive-Behavioral Therapy (CBT), which may offer benefits without imposing drug-related risks. To balance optimizing treatment benefits and limiting possible risks for the mother and the growing baby, collaborative decision-making, including healthcare providers, the pregnant woman, and her support network, is crucial (Zemestani & Fazeli Nikoo, 2019).
Practice Guidelines
There are clinical practice guidelines for DMDD, which can be useful for guiding treatment choices. Usually, the best available data from studies and consensus among experts serve as the foundation for these recommendations. Due to their well-established efficacy and safety profile, they may advise FDA-approved drugs like Sertraline as a first-line treatment for DMDD in pregnant women.
Guidelines may also advise against using off-label medications like Lamotrigine during pregnancy due to the limited knowledge available on their safety. However, since there are no particular recommendations for treating DMDD in pregnant women, it would be necessary to look at more information from studies on the use of drugs during pregnancy, potential dangers and benefits, and non-pharmacological therapies like CBT. Making informed treatment choices for this population requires consulting with psychiatric and maternal-fetal medicine experts.
References
Gilliam, F. G., Black, K. J., Carter, J., Freedland, K. E., Sheline, Y. I., Tsai, W., & Lustman, P. J. (2019). A trial of sertraline or cognitive behavior therapy for depression in epilepsy. Annals of Neurology, 86(4), 552–560. https://doi.org/10.1002/ana.25561
Naguy, A., & Al-Enezi, N. (2019). Lamotrigine Uses in Psychiatric Practice. American Journal of Therapeutics, 26(1), e96–e102. https://doi.org/10.1097/mjt.0000000000000535
Zemestani, M., & Fazeli Nikoo, Z. (2019). Effectiveness of mindfulness-based cognitive therapy for comorbid depression and anxiety in pregnancy: A randomized controlled trial. Archives of Women’s Mental Health, 23. https://doi.org/10.1007/s00737-019-00962-8
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