DE-PRESCRIBING

DE-PRESCRIBING

 

A DE-PRESCRIBING

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 5- to 6-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 1: A 36-year-old male presents to your office being prescribed by his primary care physician

(PCP) for the past 3 years an opioid analgesic medication for a work accident. He has chronic pain and is attending a pain clinic. It is determined the best course of treatment for pain is to remain on opioid medication. The patient is also being prescribed clonazepam lmg BID for “relaxation” and panic attacks.

 

Patient 2: A 42-year-old female on alprazolam lmg BID for panic attacks. Panic attacks have been in

remission and the patient wants to taper off the medication. But, every time she has attempted to do so in the past, she experienced withdrawal effects. She is wondering how to safely taper off the benzodiazepine medication without having withdrawal effects.

Patient 3: A 24-year-old female prescribed lorazepam lmg 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 lmg TID, levothyroxine 75mcg q am. His daughter is wondering if he should be started on a “dementia medication.”

 

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 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 1

  • What are the concerns of the patient remaining on the opioid medication and clonazepam?
  • How might you educate the patient about these risks and concerns?

The patient agrees that he should not continue both medications in combination. He would like to “get off’ the clonazepam but worries about “bad withdrawals” that he’s heard about from stopping clonazepam “cold turkey” and is concerned about re-occurring panic attacks. How might you respond to the following:

  • How would you instruct the patient to taper off clonazepam?
  • What other medication would you recommend for the patient for the treatment of his panic attacks? Keep in mind, he will continue the opioid medication for pain relief.
  • How would you start the new recommended psychotropic medication for the patient?
  • Discuss one legal, ethical, or social consideration with the treatment plan.

 

Patient 2

  • The patient reports withdrawal symptoms when previously tapering off the alprazolam. What symptoms are common withdrawal symptoms from this medication?
  • Provide the patient education of withdrawal symptoms that range from common and less serious to withdrawal symptoms that are a cause for concern and that should prompt patient should seek medical attention.
  • Given the patient’s history of having withdrawal effects from attempting to taper off alprazolam, what longer-acting benzodiazepine would you choose to convert the patient to?
  • What is the dose you would prescribe and how would you taper off the medication?

 

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 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 Paper provides an example of those required elements.

 

 

BY DAY 7

Submit your Assignment by Day 7 of Week 5.

SUBMISSION INFORMATION

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

  1. To submit your completed assignment, save your Assignment as WK5Assgn_LastName_Firstinitial
  2. Then, click on Start Assignment near the top of the page.
  3. Next, click on Upload File and select Submit Assignment for review.

____________________________________________________ WALDEN UNIVERSITY ■

SET A COURSE FOR CHANGE’

INURS_6630_Week5_Assignment_Rubric

 

20 to >18.0 pts Excellent

The response comprehensively describes medication risks and concerns. The response comprehensively and clearly explains how the patient will be educated. The response

comprehensively and clearly explains considerations for medication tapering. The response comprehensively and clearly reflects on legal, ethical, or social considerations of the plan.

20 to >18.0 pts Excellent

The response comprehensively and clearly explains withdrawal

symptoms. The response comprehensively and clearly provides patient education information. The response

comprehensively and clearly identifies a benzodiazepine for the patient. The response

comprehensively and clearly details dosing and tapering information.

18 to >15.0 pts Good

The response clearly describes medication risks and concerns. The response clearly explains how the patient will be educated. The response clearly explains

considerations for medication tapering. The response clearly reflects on the legal, ethical, or social

considerations of the plan.

18 to >15.0 pts Good

The response clearly explains withdrawal symptoms. The response clearly provides patient education information. The response clearly identifies a benzodiazepine for the patient. The response clearly details dosing and tapering

information.

15 to >10.0 pts Fair

The response inaccurately or vaguely describes medication risks and concerns. The response

inaccurately or vaguely explains how the patient will be educated. The response

inaccurately or vaguely explains considerations for medication tapering. The response inaccurately or vaguely reflects on legal, ethical, or social

considerations of the plan.

15 to >10.0 pts Fair

The response inaccurately or vaguely explains withdrawal symptoms. The response inaccurately or vaguely provides patient education information. The response inaccurately or vaguely identifies a benzodiazepine for the patient. The response

inaccurately or vaguely details dosing and tapering information.

10 to >0 pts Poor

The response vaguely or inaccurately describes medication risks and concerns, or it is missing. The response includes inaccurate and vague examples that does not explain how the patient will be educated, or it is missing. The response vaguely or inaccurately

explains considerations for medication tapering, or it is missing. The response includes inaccurate and vague examples that does not reflect on legal, ethical, or social

considerations of the plan, or it is missing.

10 to >0 pts Poor

The response vaguely or inaccurately explains withdrawal symptoms, or it is missing. The response includes inaccurate and vague examples that does not provide patient education information, or it is missing. The response vaguely or inaccurately

identifies a benzodiazepine for the patient, or it is missing. The response includes inaccurate and vague examples that does not detail dosing and tapering information, or it is missing.

 

3/25/24, 9:48 PM Week 5: Assignment
Criteria Ratings Pts

 

Patient 3: Describes potential risks, benefits and side effects of lorazepam, as well as alternative medications that might be prescribed for the patient. Describes how the patient might discontinue lorazepam, with necessary patient education regarding discontinuing medication and patient/fetus needs.

20 to >18.0 pts Excellent

The response comprehensively and clearly describes risks, benefits and side effects of lorazepam. The response

comprehensively and clearly identifies potential alternative medications. The response

comprehensively and clearly describes how the patient might discontinue the medication. The response

comprehensively and clearly provides necessary education for discontinuing the medication for patient and fetus.

18 to >15.0 pts Good

The response clearly describes risks, benefits and side effects of lorazepam. The response clearly identifies potential alternative medications. The response clearly describes how the patient might discontinue the medication. The response clearly provides

necessary education for discontinuing the medication for patient and fetus.

1 15 to >10.0 pts Fair

The response inaccurately or vaguely describes risks, benefits and side effects of lorazepam. The response inaccurately or vaguely identifies potential alternative medications. The response

inaccurately or vaguely describes how the patient might discontinue the medication. The response

inaccurately or vaguely provides necessary education for discontinuing the medication for patient and fetus.

10 to >0 pts Poor

The response vaguely or inaccurately describes risks, benefits and side effects of lorazepam, or it is missing. The response includes inaccurate and vague examples that does not identify potential alternative medications, or some or all are missing. The response vaguely or inaccurately describes how the patient might discontinue the medication, or it is missing. The response includes inaccurate and vague examples that does not provide necessary education for discontinuing the medication for patient and fetus, or some or all are missing.

 

 

 

1
1

Patient 4: Describes potential risks and side effects of continuing benzodiazepine. Describes how to taper the medication and education 20 to >18.0 pts Excellent

The response comprehensively and clearly describes potential side effects and risks. The response

18 to >15.0 pts Good

The response clearly describes potential side effects and risks. The response clearly describes

15 to >10.0 pts Fair

The response inaccurately or vaguely describes potential side effects and risks. The response

10 to >0 pts Poor

The response vaguely or inaccurately describes potential side effects and risks, or it is

20 pts

 


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