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.

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.
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.

Resources

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 dementiaLinks 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 interventionsLinks to an external site.. 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 lactationLinks 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 databaseLinks 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.

Boland, R. Verdiun, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.

Chapter 1, “Examination and Diagnosis of the Psychiatric Patient”
Section 1.3, “Geriatric Patients” (pp. 87-92)
- Chapter 29, “End-of-Life Issues and Palliative Care”
Chapter 31, “Global and Cultural Issues in Psychiatry”

DeNisco, S. M. (2023). Role development for the nurse practitioner (3rd ed.). Jones & Bartlett Learning.

Chapter 4, “Vulnerable Populations” (pp. 99-124)
Chapter 5, “Mental Health and Primary Care: A Critical Intersection” (pp. 132-149)
Chapter 6, “Cultural Sensitivity and Global Health” (pp. 155-179)

Required Media

American Psychiatric Association. (2020). Geriatric telepsychiatryLinks to an external site. [Video]. https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/toolkit/geriatric-telepsychiatry