Nur 6675 Week 9 Assignment Paper
Nur 6675 Week 9 Assignment Paper
Nur 6675 Week 9 Assignment Paper
Special Considerations Related to Vulnerable Populations
When considering the treatment of Bipolar 1 disorder in pregnant women, it is crucial for psychiatric mental health nurse practitioners (PMHNPs) to carefully assess the risks and benefits associated with different treatment options. The assignment aims to explore the risks and benefits of pharmacological interventions, both FDA-approved and off-label, as well as non-pharmacological interventions, taking into account the specific characteristics and potential implications for pregnant women and older adults.
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FDA-Approved, Off-Label drug, and Non-pharmacological Intervention for Bipolar I Disorder
One FDA-approved drug commonly used in treating bipolar disorder, including in pregnant women, is lamotrigine (Mari et al., 2022).Lamotrigine is an anticonvulsant medication that has demonstrated efficacy in mood stabilization. It is classified as Pregnancy Category C by the FDA, indicating that animal studies have shown adverse effects on the fetus, but limited human studies are available. PMHNPs should weigh the potential benefits of using lamotrigine to control bipolar symptoms against the potential risks to the developing fetus, discussing these considerations with the patient and ensuring informed consent.
In cases where FDA-approved medications may not be appropriate or sufficient, off-label use of certain medications can be considered. One off-label medication that has shown promise in treating bipolar disorder during pregnancy is quetiapine. Quetiapine is an atypical antipsychotic used off-label to manage bipolar symptoms (Betcher &Wisner, 2020). It is also classified as Pregnancy Category C. PMHNPs must carefully assess the risks and benefits of off-label use, considering the patient’s clinical presentation, medical history, and previous treatment response.
Non-pharmacological interventions are also valuable considerations in treating bipolar disorder during pregnancy. One such intervention is psychoeducation and counseling. Providing comprehensive education about the nature of bipolar disorder, teaching coping strategies, and discussing lifestyle modifications can be beneficial. Psychotherapy, such as cognitive-behavioral therapy (CBT) or interpersonal therapy (IPT), can help pregnant women develop skills to manage mood episodes and reduce the need for medication.
Risk Assessment for Decision Making in Treatment
When conducting a risk assessment to inform treatment decision making for pregnant women with Bipolar 1 disorder, a PMHNP must consider several factors. Firstly, they would assess the severity of the patient’s bipolar symptoms and the potential risks associated with untreated or poorly controlled mood episodes during pregnancy. They would also evaluate the patient’s medical history, including any previous adverse reactions or side effects to medications, as well as any comorbid conditions that may impact treatment choices.
For the FDA-approved medicine, lamotrigine, the benefits include its efficacy in stabilizing mood episodes and reducing the risk of relapse. By effectively managing bipolar symptoms, it can contribute to the patient’s overall well-being and quality of life. However, the risks associated with lamotrigine include the potential for adverse effects on the fetus. However, the extent of this risk is still not well-established due to limited human studies.
The benefits of the off-label drug quetiapine may include its effectiveness in managing bipolar symptoms and reducing the risk of relapse during pregnancy. It can provide a viable alternative for patients who do not respond well to or cannot tolerate other treatment options. However, like lamotrigine, quetiapine is classified as Pregnancy Category C, indicating potential risks to the fetus based on animal studies, with limited data available from human studies. Therefore, careful consideration and discussion with the patient are necessary to balance the potential benefits against the possible risks.
Clinical Practice Guidelines
Clinical practice guidelines provide evidence-based recommendations for healthcare professionals managing specific disorders. In the case of Bipolar 1 disorder in pregnant women, it is essential to determine whether particular guidelines exist to inform treatment decisions.If clinical practice guidelines explicitly addressing Bipolar 1 disorder in pregnant women exist, they will serve as a valuable resource to justify treatment recommendations (Taylor et al., 2018). These guidelines would provide comprehensive information on the available treatment options, including FDA-approved medications and off-label use, considering the risks and benefits associated with each choice. They would also offer guidance on monitoring protocols, patient education, and potential interventions.
Conclusion
Managing Bipolar I disorder in pregnant women requires a comprehensive and individualized approach. By carefully assessing the risks and benefits of pharmacological treatments, including FDA-approved medications and off-label options, as well as considering non-pharmacological interventions, healthcare providers can make informed decisions to support the well-being of these vulnerable population.
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References
Betcher, H. K., & Wisner, K. L. (2020). Psychotropic Treatment During Pregnancy: Research Synthesis and Clinical Care Principles. Journal of women’s health (2002), 29(3), 310–318. https://doi.org/10.1089/jwh.2019.7781
Mari, L., Placidi, F., Romigi, A., Tombini, M., Del Bianco, C., Ulivi, M., Liguori, C., Manfredi, N., Castelli, A., Mercuri, N. B., & Izzi, F. (2022). Levetiracetam, Lamotrigine, and carbamazepine: Which monotherapy during pregnancy? Neurological Sciences: Official journal of the Italian Neurological Society and the Italian Society of Clinical Neurophysiology, 43(3), 1993–2001. https://doi.org/10.1007/s10072-021-05542-2
Taylor, C. L., Broadbent, M., Khondoker, M., Stewart, R. J., & Howard, L. M. (2018). Predictors of severe relapse in pregnant women with psychotic or bipolar disorders. Journal of psychiatric research, 104, 100–107. https://doi.org/10.1016/j.jpsychires.2018.06.019
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WEEK 9: AT A GLANCE
SPECIAL CONSIDERATIONS RELATED TO VULNERABLE POPULATIONS
DISCUSSION
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RESOURCES
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LOOKING AHEAD
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INTRODUCTION
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.
LEARNING OBJECTIVES
Students will:
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.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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.
Read a selection of your colleagues’ responses.
BY DAY 6 OF WEEK 9
Respond to at least two of your colleagues on 2 different days who selected different disorders. Propose an alternative on-label, off-label, or nonpharmacological treatment for the disorders. Justify your suggestions with at least two references to the literature.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!
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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”
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 telepsychiatryLinks to an external site. [Video]. https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/toolkit/geriatric-telepsychiatry
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- NRNP_6675_Week9_Discussion_Rubric
NRNP_6675_Week9_Discussion_Rubric Criteria Ratings Pts 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 ptsExcellent 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 ptsGood 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 ptsFair 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 ptsPoor 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 This criterion is linked to a Learning OutcomeMain Posting:Writing 6 to >5.0 ptsExcellent 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 ptsGood 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 ptsFair 70%–79% Written somewhat concisely… May contain more than two spelling or grammatical errors… Contains some APA formatting errors
3 to >0 ptsPoor 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 This criterion is linked to a Learning OutcomeMain Posting:Timely and full participation 10 to >8.0 ptsExcellent 90%–100% Meets requirements for timely, full, and active participation… Posts main Discussion by due date
8 to >7.0 ptsGood 80%–89% Posts main Discussion by due date… Meets requirements for full participation
7 to >6.0 ptsFair 70%–79% Posts main Discussion by due date
6 to >0 ptsPoor 0%–69% Does not meet requirements for full participation… Does not post main Discussion by due date
10 pts 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 ptsExcellent 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 ptsGood 80%–89% Response has some depth and may exhibit critical thinking or application to practice setting.
7 to >6.0 ptsFair 70%–79% Response is on topic, may have some depth.
6 to >0 ptsPoor 0%–69% Response may not be on topic, lacks depth.
9 pts This criterion is linked to a Learning OutcomeFirst Response:Writing 6 to >5.0 ptsExcellent 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 ptsGood 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 ptsFair 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 ptsPoor 0%–69% Responses posted in the Discussion lack effective communication…. Responses to faculty questions are missing…. No credible sources are cited.
6 pts This criterion is linked to a Learning OutcomeFirst Response:Timely and full participation 5 to >4.0 ptsExcellent 90%–100% Meets requirements for timely, full, and active participation… Posts by due date
4 to >3.0 ptsGood 80%–89% Meets requirements for full participation… Posts by due date
3 to >2.0 ptsFair 70%–79% Posts by due date
2 to >0 ptsPoor 0%–69% Does not meet requirements for full participation… Does not post by due date
5 pts 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 ptsExcellent 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 ptsGood 80%–89% Response has some depth and may exhibit critical thinking or application to practice setting.
7 to >6.0 ptsFair 70%–79% Response is on topic, may have some depth.
6 to >0 ptsPoor 0%–69% Response may not be on topic, lacks depth.
9 pts This criterion is linked to a Learning OutcomeSecond Response:Writing 6 to >5.0 ptsExcellent 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 ptsGood 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 ptsFair 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 ptsPoor 0%–69% Responses posted in the Discussion lack effective communication…. Responses to faculty questions are missing…. No credible sources are cited.
6 pts This criterion is linked to a Learning OutcomeSecond Response:Timely and full participation 5 to >4.0 ptsExcellent 90%–100% Meets requirements for timely, full, and active participation… Posts by due date
4 to >3.0 ptsGood 80%–89% Meets requirements for full participation… Posts by due date
3 to >2.0 ptsFair 70%–79% Posts by due date
2 to >0 ptsPoor 0%–69% Does not meet requirements for full participation… Does not post by due date
5 pts Total Points: 100
