Week 9 _ PRESCRIBING FOR OLDER ADULTS AND PREGNANT WOMEN

Instructions:

Respond to your colleague. Propose an alternative on-label, off-label, or nonpharmacological treatment for the disorders. Justify your suggestions with at least two references to the literature. 

**minimum of two (2) scholarly references are required for each reply cited within the body of the reply & at the end**

Reply # 2

Myrlande Dessalines

Initial Post

FDA-Approved drug, Off-Label Drug, and Nonpharmacological Interventions

Major neurocognitive disorder due to Alzheimer’s disease (AD) with behavioral disturbance [331.0 (G30.9)] is the most common cause of dementia found in older adults. They experience evident decline in memory and learning and have a steady and progressive decline in cognition (American Psychiatric Association, 2013). Donepezil (Aricept) is FDA-approved for AD whether mild, moderate, or severe, where it inhibits acetylcholinesterase, and improves the availability of acetylcholine (Liu et al., 2022). Risperidone is utilized as an off-label drug for behavioral disturbances in dementias, where it is indicated for patients with AD receiving short-term treatment with symptoms with aggressive behavior (Oliveira et al., 2021). Nonpharmacological interventions include keeping individuals who are diagnosed with AD engaged with a set routine and schedule. It is important that they are provided with various trainings to assist with memory training utilizing memory aids, as well as music and dance therapy (Park & Cohen, 2019).

Risk Assessments to Inform Treatment Decision-Making. Risks and Benefits of FDA-Approved Medicine and Off-Label drug

Risk assessments that would be utilized in making an informed treatment plan would primarily involve the stage as to where patient is in the progression of AD. Safety is a priority when assessing patients, and ensuring that they receive adequate treatment that will assist in slowing the progression, versus promoting adverse treatments. Low doses of medications must be started and utilized with the older adults as it can eliminate harsh side effects that may be experienced. There are always risks involved when medications are prescribed—whether they are FDA-approved or used off-label. However, there is greater safety when using those which are FDA-approved as there has been extensive evidence-based research to support the benefits versus the risks. When using off-label drugs there is greater risk in harm as research has not fully developed or supported its use for disease process.

Clinical Practice Guidelines for Alzheimer’s Disease

There are clinical practice guidelines in place for Alzheimer’s disease. These guidelines have been established by the official Alzheimer’s Association which has partnered with a plethora of healthcare agencies and organizations. These clinical guidelines provide suggestions and clinical tips on safety, as well as research on differentiating between various forms of dementia from one another (Park & Cohen, 2019). The guidelines in place also provide education and direction on the rationalization of various pharmacological guidelines, as it relates to AD.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental

disorders (5th ed.). DSM-5.  https://doi.org/10.1176/appi.books.9780890425596 Links to an external site.

Liu, L., Zhu, Y., Fu, P., & Yang, J. (2022). A network pharmacology based research on the

mechanism of donepezil in treating Alzheimer’s disease. Frontiers in Aging Neuroscience, 14, 822480.  https://doi.org/10.3389/fnagi.2022.822480 Links to an external site.

Oliveira, L. de F., Camargos, E. F., Martini, L. L. L., Machado, F. V., & Novaes, M. R. C. G.

(2021). Use of psychotropic agents to treat agitation and aggression in Brazilian patients with Alzheimer’s disease: A naturalistic and multicenter study. Psychiatry Research, 295, 113591.  https://doi.org/10.1016/j.psychres.2020.113591 Links to an external site.

Park, J., & Cohen, I. (2019). Effects of exercise interventions in older adults with various types

of dementia: Systematic review. Activities, Adaptation & Aging, 43(2), 83–117.  https://doi.org/10.1080/01924788.2018.1493897