PRESCRIBING FOR OLDER ADULTS AND PREGNANT WOMEN
SPECIAL CONSIDERATIONS RELATED TO VULNERABLE POPULATIONS
The psychiatric mental health nurse practitioner assumes probably no greater responsibility than the responsibility of prescribing medications. While someone can be harmed by psychotherapy, the level and intensity of the harm generally does not come to the same level of harm that can occur from improper prescribing. The PMHNP must understand his/her responsibility both at a state and federal level when it comes to prescribing medications. It is of critical importance to understand the risks and benefits of the medications prescribed and their varying potential effects on special populations such as children/adolescents, pregnant women, or older adults.
This week, you examine the special considerations when prescribing for pregnant women and older adults.
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Recommend psychopharmacological and nonpharmacological interventions for older adults and pregnant women in mental health settings
· Evaluate the risks and benefits of pharmacological treatment for older adults and pregnant women
· Justify clinical decision making related to pharmacological treatment of older adults and pregnant women in mental health settings
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.
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.
· 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.
· 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
· American Psychiatric Association. (2016).
The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia
Links 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 interventions
Links to an external site.
. https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/protocol-pharm-pregnant-women_0
· Hardy, L. T., & Reichenbacker, O. L. (2019).
A practical guide to the use of psychotropic medications during pregnancy and lactation
Links 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 database
Links 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.
· 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
· American Psychiatric Association. (2020).
Geriatric telepsychiatry Links to an external site.
[Video].
https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/toolkit/geriatric-telepsychiatry
Assignment
Rubric
Details
Rubric
NRNP_6675_Week9_Discussion_Rubric
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NRNP_6675_Week9_Discussion_Rubric
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Criteria |
Ratings |
Pts |
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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 |
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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 |
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This criterion is linked to a Learning OutcomeMain Posting:Timely and full participation |
10 to >8.0 pts Excellent 90%–100% Meets requirements for timely, full, and active participation… Posts main Discussion by due date 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% Posts main Discussion by due date 6 to >0 pts Poor 0%–69% Does not meet requirements for full participation… Does not post main Discussion by due date |
10 pts |
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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 |
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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. |
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This criterion is linked to a Learning OutcomeFirst Response:Timely and full participation |
5 to >4.0 pts Excellent 90%–100% Meets requirements for timely, full, and active participation… Posts by due date 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% Does not meet requirements for full participation… Does not post by due date |
5 pts |
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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. |
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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. |
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This criterion is linked to a Learning OutcomeSecond Response:Timely and full participation |
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Total Points: 100 |
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