Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your chosen disorder in older adults or pregnant women
Discussion: 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.
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 “of f-label” drug, and one nonpharmacological int ervention 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.
Verified Expert and Explanation
Prescribing for Older Adults
According to the DSM-5 TR, Delirium is a psychiatric disorder, manifesting as disturbance in cognition, disorientation, and loss of ability to focus or pay attention. While the disorder may affect anyone, it is prevalent in the elderly. The DSM-5 TR tool defines this particular disorder as a condition characterized by altered baseline cognition, and disruption of awareness of one’s attention (Oh et al., 2017). When managing patients with this particular disorder, clinicians may use pharmacological or non-pharmacological interventions to help boost the patient’s memory.
Recommended Interventions for the Disorder
FDA-Approved Drug Including Its Risks and Benefits
Haloperidol is the FDA-approved drug for treating delirium. This drug provides an effective intervention for the delirium considering that it increases the dopamine’s turnover, and it inhibits its effects by blocking the dopamine receptors. Using this drug to treat delirium can bring various benefits such as clear thinking, reduced nervousness, and improved mental functioning (Girard et al., 2018). Additionally, the drug minimizes the patients’ risks of inflicting self-harm.
However, its use may lead to adverse effects including persistent headaches, increased anxiety, sleep problems, and drowsiness. In certain cases, the elderly may develop neuroleptic malignant, and be susceptible to falls especially if after taking the drug, they develop orthostatic hypotension.
Off-Label Drug Including Its Risks and Benefits
Dexmedetomidine provides an off-label pharmacological intervention for delirium. The drug helps produce sympatholysis, anxiolysis and sedation, and in the process, it minimizes the release of norepinephrine considering that it works as a selective α 2 agonist. The use of this medication in the management of the delirium in seniors is crucial particularly among intensive care patients. Just like most medications used to treat the disorder, Dexmedetomidine can result to dizziness (Fondeur et al., 2022). However, serious effects may range from the rise in the patient’s blood pressure (B.P.) levels, and sometimes, to the extreme decline in B.P.
Non-Pharmacological Intervention
The non-pharmacological intervention involves taking away the conditions that may affect the patient’s sleep. Delirium, as a cognitive disorder, may worsen among patients experiencing sleeping problems. Thus, the removal of the factors that may affect the patient’s sleep, and replacing them with ones that can enhance sleep, can lead to the improvement in the patient’s cognition. Reducing the light and the noise levels are some of the measures that clinicians can use to help improve the patient’s cognition and their memory (Linke et al., 2020). Early mobilization equally provides the means of addressing memory problems in patients.
The Risk Assessment to Use to Inform the Treatment Decision-Making
The Benefit-Risk Assessment would be useful in informing the treatment decisions. With this assessment, the provider identifies the drug that has fewer side effects, but is more effective in terms of managing delirium symptoms.
Whether Clinical Practice Guidelines Exist for the Disorder and Use them to Justify the Recommendations
The recommendations presented to support patients with delirium follow the guidelines issued by the Society of Critical Care Medicine (SCCM). Part of these guidelines includes early mobilization of the patients in ICU settings to improve the patients’ cognition, and prevent the memory loss problem from worsening (Linke et al., 2020).
Conclusion
In conclusion, Haloperidol and Dexmedetomidine represent the FDA-approved, and off-label drug for treating delirium respectively. While the former is a popular intervention for the disorder, the latter is commonly used among ICU patients to relieve the symptoms of cognitive loss that are prevalent in patients with delirium. While there are various interventions that can help support the patient, early mobilization provides an effective non-pharmacological means of managing memory loss.
References
Fondeur, J., Escudero Mendez, L., Srinivasan, M., Hamouda, R. K., Ambedkar, B., Arzoun, H., Sahib, I., & Mohammed, L. (2022). Dexmedetomidine in Prevention of Postoperative Delirium: A Systematic Review. Cureus, 14(6), e25639. https://doi.org/10.7759/cureus.25639.
Girard, T. D., Exline, M. C., Carson, S. S., Hough, C. L., Rock, P., Gong, M. N., Douglas, I. S., Malhotra, A., Owens, R. L., Feinstein, D. J., Khan, B., Pisani, M. A., Hyzy, R. C., Schmidt, G. A., Schweickert, W. D., Hite, R. D., Bowton, D. L., Masica, A. L., Thompson, J. L., Chandrasekhar, R., … MIND-USA Investigators (2018). Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness. The New England journal of medicine, 379(26), 2506–2516. https://doi.org/10.1056/NEJMoa1808217.
Linke, C. A., Chapman, L. B., Berger, L. J., Kelly, T. L., Korpela, C. A., & Petty, M. G. (2020). Early Mobilization in the ICU: A Collaborative, Integrated Approach. Critical care explorations, 2(4), e0090. https://doi.org/10.1097/CCE.0000000000000090.
Oh, E. S., Fong, T. G., Hshieh, T. T., & Inouye, S. K. (2017). Delirium in Older Persons: Advances in Diagnosis and Treatment. JAMA, 318(12), 1161–1174. https://doi.org/10.1001/jama.2017.12067.
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