NRNP 6675 Week9 Discussion: Prescribing for Older Adults and Pregnant Women Paper

NRNP 6675 Week9 Discussion: Prescribing for Older Adults and Pregnant Women Paper

NRNP 6675 Week9 Discussion: Prescribing for Older Adults and Pregnant Women Paper

Patients affected by or at risk of mental health disorders have unique health needs that should be addressed in the care process. Psychiatric mental health nurses are responsible for adopting evidence-based interventions that optimize treatment outcomes such as safety, quality, and efficiency in the care process. They weigh the benefits and risks of the different treatment approaches based on patient characteristics. Therefore, the purpose of this paper is to explore pharmacotherapy for major depression during pregnancy.

Depression in pregnancy or perinatal depression is one of the major risks that affect the pregnant mother, unborn child, and the family as a whole. Perinatal depression affects up to 12.9% of pregnant women and may progress to the postpartum period. It has high comorbidity with disorders such as generalized anxiety disorder and obsessive-compulsive disorder (Miller et al., 2018). Pharmacotherapy is largely considered in treating perinatal depression. Currently, there is no FDA-approved drug for use in treating patients that develop depression during pregnancy. However, it is recommended that patients with a history of depression before pregnancy continue with the FDA-approved drugs during pregnancy. The drugs include escitalopram (Lexapro) and fluoxetine (Prozac). Fluoxetine and Lexapro produce their effect by inhibiting serotonin reuptake into the presynaptic neurons, hence, increasing its concentration and mood (Mitchell & Goodman, 2018). The non-FDA drugs for major depression that patients can continue using during pregnancy include other antidepressants such as Sertraline and paroxetine.

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Risk assessments should be performed before initiating a pregnant patient on antidepressants. Accordingly, healthcare providers should determine whether the prescribed drug is associated with an increased risk of teratogenicity. The drug should not predispose the fetus to birth defects over baseline (LUSSKIN et al., 2018). The other risk assessment needed in the prescription of antidepressants is the determination of whether the drug predisposes the pregnant mother to pregnancy complications. Psychiatric mental health nurse practitioners should ensure that the selected medications do not cause complications such as premature birth, miscarriage, stillbirth, or intrauterine growth restriction. The risks of neurodevelopment and neonatal complications such as neurobehavioral teratogenicity should also be assessed before the administration of the medication (Komorowski, 2022). Therefore, the healthcare provider should strive to achieve a balance between the potential risks that each drug has and the known risks of major depression to help pregnant mothers and their families to make informed decisions.

FDA-approved medications used in treating depression have considerable benefits. First, they have minimal harm and optimal benefits to the patients. The drugs have been evaluated for clinical efficacy in improving depressive symptoms. The drugs also have a high level of tolerability, which enhances outcomes such as treatment adherence by the patients. The risks of FDA-approved drugs include the fact that they may not be effective for all patients. Patients have different characteristics that affect the pharmacokinetics and pharmacotherapeutics of FDA-approved drugs. Therefore, non-FDA-approved drugs prove beneficial in such cases, as they act as alternatives for improving patient outcomes in the treatment process. However, non-FDA-approved drugs have minimal evidence-based data supporting their use, hence, the increased risk of patient harm due to side and adverse effects associated with them. Clinical practice guidelines do not exist for the treatment of perinatal depression (Molenaar et al., 2018). Therefore, some of the factors to consider in treatment include safety and risks of the available treatment and patient factors that may affect the treatment outcomes.

Overall, perinatal depression is a serious mental health problem that should be managed effectively during pregnancy. Risk assessment should be performed to determine the suitability of antidepressants. A focus should be on ensuring minimal harm and optimal benefits to the mother and fetus. Since clinical practice guidelines for depression management in pregnancy do not exist, providers should consider other alternatives such as psychotherapy if symptoms are less severe.

References

Komorowski, J. (2022). Chapter 17—Antidepressants in pregnancy. In D. Mattison & L.-A. Halbert (Eds.), Clinical Pharmacology During Pregnancy (Second Edition) (pp. 311–321). Academic Press. https://doi.org/10.1016/B978-0-12-818902-3.00014-2

LUSSKIN, S. I., KHAN, S. J., ERNST, C., HABIB, S., FERSH, M. E., & ALBERTINI, E. S. (2018). Pharmacotherapy for Perinatal Depression. Clinical Obstetrics and Gynecology, 61(3), 544–561. https://doi.org/10.1097/GRF.0000000000000365

Miller, E. S., Grobman, W. A., Culhane, J., Adam, E., Buss, C., Entringer, S., Miller, G., Wadhwa, P. D., Keenan-Devlin, L., & Borders, A. (2018). Antenatal depression, psychotropic medication use, and inflammation among pregnant women. Archives of Women’s Mental Health, 21(6), 785–790. https://doi.org/10.1007/s00737-018-0855-9

Mitchell, J., & Goodman, J. (2018). Comparative effects of antidepressant medications and untreated major depression on pregnancy outcomes: A systematic review. Archives of Women’s Mental Health, 21(5), 505–516. https://doi.org/10.1007/s00737-018-0844-z

Molenaar, N. M., Kamperman, A. M., Boyce, P., & Bergink, V. (2018). Guidelines on treatment of perinatal depression with antidepressants: An international review. Australian & New Zealand Journal of Psychiatry, 52(4), 320–327. https://doi.org/10.1177/0004867418762057

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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.

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.

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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.

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Rubric Detail

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Name: NRNP_6675_Week9_Discussion_Rubric

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		Excellent 90%–100%	Good 80%–89%	Fair 70%–79%	Poor 0%–69%
Main 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.		40 (40%) – 44 (44%) 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	35 (35%) – 39 (39%) 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	31 (31%) – 34 (34%) 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	0 (0%) – 30 (30%) 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
Main Posting: Writing		6 (6%) – 6 (6%) Written clearly and concisely Contains no grammatical or spelling errors Adheres to current APA manual writing rules and style	5 (5%) – 5 (5%) Written concisely May contain one to two grammatical or spelling errors Adheres to current APA manual writing rules and style with minor errors	4 (4%) – 4 (4%) Written somewhat concisely May contain more than two spelling or grammatical errors Contains some APA formatting errors	0 (0%) – 3 (3%) Not written clearly or concisely Contains more than two spelling or grammatical errors Does not adhere to current APA manual writing rules and style
Main Posting: Timely and full participation		9 (9%) – 10 (10%) Meets requirements for timely, full, and active participation Posts main Discussion by due date	8 (8%) – 8 (8%) Posts main Discussion by due date Meets requirements for full participation	7 (7%) – 7 (7%) Posts main Discussion by due date	0 (0%) – 6 (6%) Does not meet requirements for full participation Does not post main Discussion by due date
First Response: Post to colleague’s main post that is reflective and justified with credible sources		9 (9%) – 9 (9%) 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 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting.	7 (7%) – 7 (7%) Response is on topic, may have some depth.	0 (0%) – 6 (6%) Response may not be on topic, lacks depth.
First Response: Writing		6 (6%) – 6 (6%) 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 (5%) – 5 (5%) 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 (4%) – 4 (4%) 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.	0 (0%) – 3 (3%) Responses posted in the Discussion lack effective communication. Responses to faculty questions are missing. No credible sources are cited.
First Response: Timely and full participation		5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation Posts by due date	4 (4%) – 4 (4%) Meets requirements for full participation Posts by due date	3 (3%) – 3 (3%) Posts by due date	0 (0%) – 2 (2%) Does not meet requirements for full participation Does not post by due date
Second Response: Post to colleague’s main post that is reflective and justified with credible sources		9 (9%) – 9 (9%) 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 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting.	7 (7%) – 7 (7%) Response is on topic, may have some depth.	0 (0%) – 6 (6%) Response may not be on topic, lacks depth.
Second Response: Writing		6 (6%) – 6 (6%) 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 (5%) – 5 (5%) 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 (4%) – 4 (4%) 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.	0 (0%) – 3 (3%) Responses posted in the Discussion lack effective communication. Responses to faculty questions are missing. No credible sources are cited.
Second Response: Timely and full participation		5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation Posts by due date	4 (4%) – 4 (4%) Meets requirements for full participation Posts by due date	3 (3%) – 3 (3%) Posts by due date	0 (0%) – 2 (2%) Does not meet requirements for full participation Does not post by due date
Total Points: 100

Name: NRNP_6675_Week9_Discussion_Rubric