What is the importance of de-prescribing?

Assignment

What is the importance of de-prescribing? How might you assist a patient to taper from a medication safely or transition to a new medication?

In this Assignment, you will use the following patient examples to write a 4-5 page paper on considerations you have for how you might de-prescribe. Support your answers with five (5) evidence-based, peer-reviewed scholarly literature resources outside of Required Learning Resources in this course.

Note: APA style format guidelines will apply.

Patient Examples:

Patient 3: A 24-year-old female prescribed lorazepam 1mg TID for generalized anxiety disorder. She recently found out she is pregnant (9 weeks gestation). She was referred to you by her OB-GYN to discuss this medication for her current situation. The patient is wondering if she can stay on the lorazepam through her pregnancy and postpartum, as it is an effective medication for anxiety symptoms. She plans to exclusively breastfeed for the first 6 months postpartum. She has not had any other trials of medication to treat anxiety as lorazepam has been effective.

Patient 4: A 71-year-old-male who comes to see you at the insistence of his daughter. His daughter expresses concern of memory loss and is wondering if he has the beginning stages of dementia. He is forgetful and seems to be tripping on things or walking into walls, although he has lived in the same home for the past 35 years. The patient does not agree with his daughter but does admit he has had a “few stumbles and falls” lately. Medication reconciliation shows the following medications: metoprolol ER 50mg q day, omeprazole 20mg q day, clonazepam 1mg TID, levothyroxine 75mcg q am. His daughter is wondering if he should be started on a “dementia medication.”

To prepare for this Assignment:

• Review the assigned Learning Resources for this week.
• Review the definitions presented in your text and resources for de-prescribing and tapering.
• Consider the importance of de-prescribing.
• Based on the example(s) provided, consider how you might de-prescribe a patient.

The Assignment

Answer the following questions using the patient examples described above.

Patient 3

• Review the potential risks, benefits, and side effects of continuing lorazepam throughout the pregnancy and postpartum for both the patient and fetus.
• Review other alternative medications to treat generalized anxiety disorder. Include risks, benefits, and potential side effects to both the patient and the developing fetus. Keep in mind, the patient is looking to breast feed for 6 months postpartum.
• The patient agrees that it would be safest for her pregnancy and fetus to discontinue the lorazepam. How would you recommend she discontinue lorazepam? Provide education on potential side effects from tapering off the medication, including common side effects to more serious side effects and when to seek medical attention.
• The patient would like to forgo medications at this time, given she is early in her pregnancy and is concerned about “damage” to the fetus if she were to continue medications. Provide education to the patient about the risks of untreated anxiety symptoms during pregnancy for both the patient and the fetus.

Patient 4

• Review potential side effects for elderly on benzodiazepines providing education to both the patient and the patient’s daughter. What are the risks of continuing the benzodiazepine for this patient?
• How would you evaluate the patient for these side effects?
• The patient and daughter agree he will need to taper off the clonazepam given the risks of continuing this medication. How would you recommend tapering off this medication?
• Review with the patient and daughter potential side effects of tapering off the medication. Review with them common side effects to more serious side effects and when to seek medical attention.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Walden Writing Center Sample PaperLinks to an external site. provides an example of those required elements.

Learning Resources

Readings

• Goldin, D. S. (2023). Fast facts for psychopharmacology for nurse practitioners. Springer Publishing.
  • Chapter 6, “Anxiolytics and Anti-Anxiety Medications“ (pp. 85–110)
  • Chapter 11, “Sleep Disorders” (pp. 228–247)
• Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Cambridge University Press.
  • Chapter 8, “Anxiety Trauma and Treatment” (pp. 359–378)
  • Chapter 10, “Disorders of Sleep and Wakefulness and Their Treatment: Neurotransmitter Networks for Histamine and Orexin” (pp. 401–448)
• Community Behavioral Health. (2019, February). Clinical guidelines for tapering benzodiazepinesLinks to an external site.. https://cbhphilly.org/wp-content/uploads/2019/02/Helping-Patients-Taper-from-Benzodiazepines-FINAL-3.pdf
• National Center for PTSD. (2013). Effective treatments for PTSD: Helping patients taper from benzodiazepinesLinks to an external site.. https://www.va.gov/painmanagement/docs/OSI_6_Toolkit_Taper_Benzodiazepines_Clinicians.pdf
• Ogbonna, C. I. & Lembke, A. (2017). Tapering patients off of benzodiazepinesLinks to an external site.. American Family Physician, 96(9), 606–608. https://www.aafp.org/pubs/afp/issues/2017/1101/p606.html
• Drugs.comLinks to an external site.. (2023). https://www.drugs.com/
  Note: Please use the following resource to check the most up-to-date box warnings, FDA approvals and indications, recommendations for follow-up evaluations, changes, etc.
• Anxiolytic Medication Table
  Note: Utilize the following medication table to familiarize yourself with the medications aligned with the topics presented this week.

*Indicates off-label use

Note: Also review SSRI/SNRI and TCA tables from previous weeks.

Contact Us

Enjoy 24/7 customer support for any queries or concerns you have.

Phone: +1 213 3772458

Email: support@gradeessays.com