Prescribing For Older Adults And Pregnant Women

ANSWERS

It is difficult to prescribe for the elderly.
Older people are frequently prescribed unnecessary drugs, contraindicated drugs, or the incorrect dose for their age group.
Age misconceptions may prevent them from receiving drugs with specific indications and evidence bases.

Inappropriate prescribing can be reduced by conducting regular drug reviews, using electronic prescribing, conducting regular audits, and limiting the number of prescribers.

Inappropriate prescribing for older patients includes all standard indicators of inappropriate prescribing for adults. Still, the problem is especially acute for older patients due to their frequent use of multiple medications. This increases their risk of an adverse event and means that many necessary ones may obscure unnecessary drugs. Dose, formulation, and delivery must be adjusted according to the patient’s age and frailty, and some drugs should be avoided entirely. This is familiar territory for general practitioners, who see very young patients and routinely adjust drug doses based on the British National Formulary for Children—perhaps we need an equivalent publication for older patients to emphasize the importance of age consideration. Problems arise when older patients are assumed to respond to drugs the same way an average adult does; issues occur.

Although older people have been under-represented in clinical trials of new drugs, there is solid evidence that some more unique treatments work well in this population. Warfarin reduces strokes in patients with atrial fibrillation while having no significant increase in the risk of bleeding. It is recommended for most atrial fibrillation patients over the age of 75.

In early pregnancy, exposure to a drug during the preimplantation stage is unlikely to result in a teratogenic effect due to an inbuilt recovery process in the conceptus.
If a teratogenic insult occurs and only a small number of cells are damaged, ‘compensation’ occurs, in which the remaining viable cells continue to divide to replace any damaged ones.
However, if many cells are damaged, implantation will fail, and the pregnancy will be terminated. This is referred to as the “all or nothing” or “totipotent” period.
The first ten weeks after implantation are the most critical because this is when significant structural changes and organogenesis occur. For example, the neural tube closes during this time, and major organs and limbs develop. Table 2 lists some drugs that, when used in early pregnancy, can cause structural malformations.
While the first trimester is the most vulnerable to structural malformations, some drugs may affect the fetus later in pregnancy, so caution should be exercised when prescribing throughout pregnancy. Exposure to ACE inhibitors, for example, during the second and third trimesters can result in serious side effects such as oligohydramnios, growth retardation, lung and kidney hypoplasia, and hypocalcemia. 8,9 Other drugs associated with adverse effects when used later in pregnancy are listed in Table 3.

QUESTION

Prescribing For Older Adults And Pregnant Women

APA 7 FORMAT SHOULD ONLY BE USED

NO PLAGIARISM ALLOWED

PLEASE NO INTERNET SOURCES SUCH AS WIKI, COURSE HERO

• 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.