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Prescribing for Older Adults and Pregnant Women

Prescribing for Older Adults and Pregnant Women

Mild Neurocognitive Disorder DSM-5 in the older adult population Neurocognitive dysfunction Alzheimer’s illness is responsible for dementia, a common term for a progressive deterioration in cognitive acuity extreme enough to impair everyday functioning. Alzheimer’s sickness is the greatest prevalent kind of dementia (Montgomery et al., 2018). Alzheimer’s sickness is a distinct condition. This is not the case with dementia. Dementia is a term that refers to a collection of signs associated with a deterioration in recollection, logic, or other cognitive abilities (Gates et al., 2019). There are several distinct varieties of dementia, and several diseases may induce it. Hybrid Alzheimer’s is a disorder in which the brain alterations characteristic of many types of dementia develop concurrently. Alzheimer’s illness is the leading etiology of dementia, responsible for between 60percentage of dementia.

One recommended FDA-approved drug for treating your chosen disorder.

In the United States, there have been five FDA-approved drugs that substantially improve intelligence to cure the signs of Alzheimer’s illness (memantine combination/donepezil, galantamine, donepezil, rivastigmine, and memantine) (Koola et al., 2018). Aricept (donepezil) is an FDA-approved medication classified according to the severity of the illness: moderate-to-severe or mild-to-moderate. Cholinesterase antagonists, such as donepezil, are used to treat mild- to-moderate infections. Aricept, along with other medications such as rivastigmine (Exelon) and galantamine (Razadyne), is given to block or avert the progression of signs for a brief period to help manage some behavioral issues (Poudel and Park, 2022).

One recommended off-label drug for treating your chosen disorder.

The off-label prescription I picked is Seroquel, which disrupts cognitive abilities and leads to abnormalities in perceptions, emotions, or awareness (Tripathi et al., 2018). Clinicians and pharmacists may administer and distribute an FDA-approved medicine for a sign not previously authorized by the FDA as long as a weight of evidence exists. Typically, peer-reviewed research demonstrates that it is a permissible technique within the confines of accepted standards of medical services, provided the unauthorized user does not represent experimentation.

One nonpharmacological intervention for treating your chosen disorder

 A nonpharmacological approach for elderly adults with the selected condition includes recollection medication, affirmation treatment, and cognitive therapy counseling, and the holistic treatment method includes paradigm realignment (Morales-de-Jesús et al., 2021).

Explain the risk assessment you would use to inform your treatment decision-making.

For the risk evaluation, I would begin by administering a Mini-Mental Examination and then testing the patients’ genes with the Bristol Activities of Daily Living Scale. Thus, to determine a person’s or family’s inheritable diseases, it is necessary to acquire a comprehensive family history that includes as much data as feasible on the dementia diagnosis and the age at diagnosis in supposedly afflicted relatives (Zampatti et al., 2021). Vascular: research indicates that the relationship between hypertension and the progression of dementia is relatively convoluted.

While considerable research has demonstrated that rising systolic blood pressure is related to all-cause dementia and a higher risk of Alzheimer’s disease, other research has proven that a systolic blood pressure of less than 140 mm Hg is associated with a higher risk (AAIC, 2018). Despite this and several other seemingly contradicting findings, Systolic Hypertension in Europe research found a decreased incidence of dementia in people undergoing hypertension therapy. Lifestyle measures (frequent mentally and physically activity, moderate alcohol consumption, and prevention of cigarettes and brain traumas) appear to have the potential also to lessen the incidence of dementia (Kępka et al., 2022). There is compelling evidence that estrogen should not be used alone or in conjunction with progesterone for the primary goal of lowering the risk of dementia. Some possible adverse effects include dizziness, constipation, and headaches; however, these are often transient.

What are the risks and benefits of the FDA-approved medicine?

According to Shojaei and Salari (2020), prescribing drugs “off-label” has legal and ethical ramifications. Additionally, it reminds us that pharmaceutical corporations may or may not seek FDA clearance for new indications for drugs that are already authorized for treatment in another ailment. The value of collaborative decision-making when considering complicated therapeutic choices, including the use of off-label pharmaceuticals that lack documented proof that they would work for the conditions for which they were not FDA authorized. Additionally, consult with the patient’s close relative before utilizing an off-label medicine. The advantage is that it works, and the patient improves.

Explain whether clinical practice guidelines exist for this disorder.

The FDA has authorized galantamine, rivastigmine, and donepezil to treat mild to severe Alzheimer’s disease (Koola et al., 2018). They are included in the Guidelines for Neurocognitive Disorder. New prospective randomized research has been done to evaluate the effectiveness of memantine and cholinesterase inhibitors in treating impairments associated with dementia. Various dementias were examined in this investigation. According to the guideline, donepezil is also allowed for moderate Alzheimer’s dementia.

Conclusion

Memory, logic, and other mental abilities are all affected by dementia. The FDA has authorized Aricept (donepezil) to cure mild- to moderate illnesses. Thorough family background is essential for determining a person’s or family’s genetic predisposition. Either using estrogen on its own or in conjunction with progesterone to reduce the chance of developing dementia is a strong recommendation. Altering one’s daily habits, such as getting physical activity and drinking in moderation, may lower one’s chance of developing dementia. Off-label prescribing may have both legal and ethical ramifications. It is possible that pharmaceutical corporations may not seek FDA clearance for new uses of a medicine if it has already been authorized for another usage. Dizziness, constipation, and headaches are all possible adverse effects.

References

AAIC. (2018). Study Shows Intensive Blood Pressure Control Reduces Risk of Mild Cognitive Impairment (MCI) and the Combined Risk of MCI and Dementia. (2018, 0 0). AAIC; aaic.alz.org. https://aaic.alz.org/releases_2018/AAIC18-Wed-developing-topics.asp

Gates, N. J., Vernooij, R. W., Di Nisio, M., Karim, S., March, E., Martinez, G., & Rutjes, A. W. (2019). Computerized cognitive training for preventing dementia in people with mild cognitive impairment. Cochrane Database of Systematic Reviews, (3).

Kępka, A., Ochocińska, A., Borzym-Kluczyk, M., Chojnowska, S., Skorupa, E., Przychodzeń, M., & Waszkiewicz, N. (2022). Healthy Food Pyramid as Well as Physical and Mental Activity in the Prevention of Alzheimer’s Disease. Nutrients, 14(8), 1534.

Koola, M. M., Nikiforuk, A., Pillai, A., & Parsaik, A. K. (2018). The galantamine-memantine combination is superior to the donepezil-memantine combination in Alzheimer’s disease: critical dissection with an emphasis on kynurenic acid and mismatch negativity. Journal of geriatric care and Research, 5(2), 57.

Koola, M. M., Nikiforuk, A., Pillai, A., &Parsaik, A. K. (2018). The galantamine-memantine combination is superior to the donepezil-memantine combination in Alzheimer’s disease: critical dissection with an emphasis on kynurenic acid and mismatch negativity. Journal of geriatric care and Research, 5(2), 57–67.

Montgomery, W., Goren, A., Kahle-Wrobleski, K., Nakamura, T., & Ueda, K. (2018). Alzheimer’s disease severity and its association with patient and caregiver quality of life in Japan: results of a community-based survey. BMC Geriatrics, 18(1), 1-12.

Morales-de-Jesús, V., Gómez-Adorno, H., Somodevilla-García, M., &Vilariño, D. (2021, August). Conversational System as Assistant Tool in Reminiscence Therapy for People with Early-Stage of Alzheimer’s. In Healthcare (Vol. 9, No. 8, p. 1036). Multidisciplinary Digital Publishing Institute.

Poudel, P., & Park, S. (2022). Recent Advances in the Treatment of Alzheimer’s Disease Using Nanoparticle-Based Drug Delivery Systems. Pharmaceutics, 14(4), 835.https://doi.org/10.3390/pharmaceutics14040835

Shojaei, A., &Salari, P. (2020). COVID-19 and off-label use of drugs: an ethical viewpoint. DARU Journal of Pharmaceutical Sciences, 28(2), 789-793.

Tripathi, A., Kar, S. K., & Shukla, R. (2018). Cognitive deficits in schizophrenia: understanding the biological correlates and remediation strategies. Clinical Psychopharmacology and Neuroscience, 16(1), 7.

Zampatti, S., Ragazzo, M., Peconi, C., Luciano, S., Gambardella, S., Caputo, V., …&Giardina, E. (2021). Genetic counseling improves the molecular characterization of dementing disorders. Journal of Personalized Medicine, 11(6), 474.https://doi.org/10.3390/jpm11060474

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Question 


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.

Prescribing for Older Adults and Pregnant Women

Prescribing for Older Adults and Pregnant Women

·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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