week 5- DE-PRESCRIBING
Introduction 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? A clear and comprehensive purpose statement and introduction and conclusion are provided, which delineates all required criteria. 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 1mg BID for “relaxation” and panic attacks. • 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: A 42-year-old female on alprazolam 1mg 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. • 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: 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. • 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: 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.” • 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. Conclusion 3/25/24, 11:27 PM Week 5: Assignment Criteria Patient 1: Describes concerns for patient remaining on the medication and how these risks and concerns will be addressed to the patients. Describes how to assist Patient 1 in tapering medication, as well as what other medication might be prescribed with considerations of legal, ethical, or social considerations to the plan. Ratings 20 to >18.0 pts Excellent 18 to >15.0 pts Good 15 to >10.0 pts Fair 10 to >0 pts Poor The response comprehensively The response clearly describes The response inaccurately or The response vaguely or describes medication risks and concerns. The medication risks and concerns. The response vaguely describes medication risks and concerns. inaccurately describes medication risks response comprehensively clearly explains how the patient The response inaccurately or and concerns, or it is missing. The and clearly explains how the patient will be will be educated. The response clearly explains vaguely explains how the patient will be educated. response includes inaccurate and vague examples educated. The response comprehensively considerations for medication tapering. The The response inaccurately or vaguely explains that does not explain how the patient will be and clearly explains response clearly reflects on the considerations for medication educated, or it is missing. The considerations for medication tapering. The legal, ethical, or social considerations of tapering. The response inaccurately or response vaguely or inaccurately explains response comprehensively the plan. vaguely reflects on legal, ethical, considerations for medication or social considerations of the plan. tapering, or it is missing. The response includes and clearly reflects on legal, ethical, or social considerations of the plan. Patient 2: Describes common withdrawal symptoms and patient education information. Describes which benzodiazepine might be prescribed to convert the patient, as well as the specific dosing and tapering information. Pts 20 pts inaccurate and vague examples that does not reflect on legal, ethical, social 10 to >0 or pts 20 to >18.0 pts Excellent 18 to >15.0 pts Good 15 to >10.0 pts Fair The response comprehensively The response clearly explains The response inaccurately or considerations of Poor the plan, or it is The response missing.or vaguely and clearly explains withdrawal withdrawal symptoms. The response clearly vaguely explains withdrawal symptoms. The inaccurately explains withdrawal symptoms. The response provides patient education response inaccurately or symptoms, or it is missing. The comprehensively and clearly provides patient information. The response clearly identifies a vaguely provides patient education information. The response includes inaccurate and vague examples education information. The response benzodiazepine for the patient. The response response inaccurately or vaguely identifies that does not provide patient education comprehensively clearly details a benzodiazepine information, or it is https://waldenu.instructure.com/courses/106706/assignments/1287946?module_item_id=3957043 20 pts 5/9 3/25/24, 11:27 PM Week 5: Assignment Criteria Ratings and clearly identifies a benzodiazepine for dosing and tapering information. for the patient. The response inaccurately or missing. The response vaguely or inaccurately the patient. The response comprehensively vaguely details dosing and tapering identifies a benzodiazepine for the patient, or it is and clearly details dosing and information. missing. The response includes tapering information. 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. Pts inaccurate and vague examples that 10 does to >0not ptsdetail 20 to >18.0 pts Excellent 18 to >15.0 pts Good 15 to >10.0 pts Fair The response The response The response comprehensively and clearly describes risks, clearly describes risks, benefits and side effects information, inaccurately or vaguely or or it is vaguely describes missing. inaccurately risks, benefits and describes risks, benefits and side effects of of lorazepam. The response side effects of lorazepam. The benefits and side effects of lorazepam. The response comprehensively clearly identifies potential alternative response inaccurately or vaguely identifies lorazepam, or it is missing. The response and clearly identifies potential medications. The response clearly potential alternative includes inaccurate and alternative medications. The response describes how the patient might discontinue the medications. The response inaccurately or vague examples that does not identify potential comprehensively and clearly medication. The response clearly vaguely describes how the patient alternative medications, or describes how the patient might discontinue the provides necessary education for might discontinue the medication. The response some or all are missing. The response medication. The response comprehensively discontinuing the medication for patient and fetus. inaccurately or vaguely provides necessary vaguely or inaccurately describes how and clearly provides necessary education for discontinuing the the patient might discontinue the education for discontinuing the medication for medication for patient and fetus. medication, or it is missing. The response patient and fetus. 20 pts dosing Poor and tapering The response includes inaccurate and vague examples that does not provide necessary https://waldenu.instructure.com/courses/106706/assignments/1287946?module_item_id=3957043 6/9 3/25/24, 11:27 PM Week 5: Assignment Criteria Ratings Pts education for discontinuing the medication for Patient 4: Describes potential risks and side effects of continuing benzodiazepine. Describes how to taper the medication and education regarding the tapering. 20 to >18.0 pts Excellent 18 to >15.0 pts Good 15 to >10.0 pts Fair The response comprehensively The response clearly describes The response inaccurately or patient and 10 to >0 ptsfetus, or some or all Poor are missing. The response vaguely or and clearly describes potential side effects and potential side effects and risks. The response vaguely describes potential side effects and risks. inaccurately describes potential side risks. The response comprehensively clearly describes how to taper the The response inaccurately or effects and risks, or it is missing. and clearly describes how to taper the medication. The response clearly provides vaguely describes how to taper the medication. The The response vaguely or inaccurately medication. The response comprehensively necessary patient education for tapering. response inaccurately or vaguely provides describes how to taper the medication, or it and clearly provides necessary patient necessary patient education for is missing. The response education for tapering. tapering. includes inaccurate and vague examples 20 pts that does not provide necessary patient education for Paper demonstrates critical thinking and synthesis of literature with five (5) evidence-based, peer reviewed scholarly references Written Expression and Formatting— tapering, or all are 1some to >0 or pts 5 to >4.0 pts Excellent 4 to >3.0 pts Good 3 to >1.0 pts Fair Paper demonstrates Paper demonstrates Paper demonstrates Paper demonstrates no critical thinking and synthesis of literature with five some critical thinking and/or vague synthesis of vague critical thinking and/or little synthesis of critical thinking and/or synthesis of literature with (5) evidencebased, peer literature with four (4) evidence- literature with three (3) two (2) or less evidence-based, reviewed scholarly references outside of course based, peer reviewed scholarly references outside evidence-based, peer reviewed scholarly peer reviewed scholarly references. resources. of course resources. references. 5 to >4.0 pts Excellent 4 to >3.0 pts Good 3 to >1.0 pts Fair https://waldenu.instructure.com/courses/106706/assignments/1287946?module_item_id=3957043 missing. Poor 1 to >0 pts Poor 5 pts 5 pts 7/9 3/25/24, 11:27 PM Week 5: Assignment Criteria Ratings Pts Paragraph Development and Organization: Paragraphs and sentences follow writing standards for Paragraphs and sentences follow writing standards Paragraphs and sentences follow writing standards Paragraphs and sentences follow writing Paragraphs make clear points that support well- flow, continuity, and clarity. A clear and comprehensive for flow, continuity, and clarity 80% of the time. Purpose, for flow, continuity, and clarity 60%–79% standards for flow, continuity, and clarity less developed ideas, flow logically, and purpose statement, introduction, and introduction, and conclusion of the of the time. Purpose, than 60% of the time. No demonstrate continuity of ideas. Sentences are conclusion is provided which delineates all Assignment is stated yet is brief and not introduction, and conclusion of the Assignment is purpose statement, introduction, or carefully focused— neither long and required criteria. descriptive. vague or off topic. conclusion was provided. rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided, which delineates all required criteria. Written Expression and Formatting— English writing standards: Correct grammar, mechanics, and proper punctuation 5 to >4.0 pts Excellent 4 to >3.0 pts Good 3 to >1.0 pts Fair 1 to >0 pts Poor Uses correct Contains one or Contains several Contains many (five or grammar, spelling, and punctuation with two grammar, spelling, and punctuation (three or four) grammar, spelling, and more) grammar, spelling, and punctuation errors that no errors. errors. punctuation errors. interfere with the reader’s 5 pts understanding. Written Expression and Formatting: The paper follows 5 to >4.0 pts Excellent 4 to >3.0 pts Good 3 to >1.0 pts Fair 1 to >0 pts Poor correct APA format for title page, headings, font, Uses correct APA Contains one or Contains three or Contains many format with no errors. two APA format errors. four APA format errors. (five or more) APA format errors. spacing, margins, indentations, page 5 pts numbers, parenthetical/in-text citations, and reference list. https://waldenu.instructure.com/courses/106706/assignments/1287946?module_item_id=3957043 8/9 3/25/24, 11:27 PM Criteria Week 5: Assignment Ratings Pts Total Points: 100 https://waldenu.instructure.com/courses/106706/assignments/1287946?module_item_id=3957043 9/9
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