Prescribing for Older Adults and Pregnant Women

Selected Population and Disorder

The aging population is usually characterized as persons aged over 65 who often suffer from protracted disorder and thus are under various medications. Lau et al. (2020) note that such populations have increased chances of developing drug-related complications owing to a multitude of constructs like altered drug pharmacodynamics and pharmacokinetics. This fact in turn implies complications of incorrect prescriptions and administering of drugs. The selected disorder for the subsequent discussion is schizophrenia, which necessitates optimized drug therapy for the chosen population.

FDA Sanctioned Medication: Risks and Benefits

Aripiprazole is an FDA-approved drug used to manage schizophrenia. According to Gettu and Saadabadi (2021), this medication belongs to the second-generation antipsychotics predominantly employed for symptomatic management of psychosis in patients with schizophrenia. The risks associated with the drug include akathisia, which may limit its clinical uses. Gettu and Saadabadi (2021) further note that the application of Aripiprazole necessitates caution in the chosen population since it can exacerbate other comorbidities. Nonetheless, there are several benefits of this medication. First, it decreases psychiatric hospitalization rates and enhances cognitive functions. Furthermore, it has the potential to decrease vascular risk features and lipid plasma levels. Finally, the drug wields favorable overall safety and tolerability compared to other atypical antipsychotics. These benefits make Aripiprazole a preferred selection for the older population.

Off-Label Prescription: Dangers and Benefits

Individuals with schizophrenia may continue to exhibit the symptoms of the disorder even following treatment plans based on FDA-approved medications. Owing to the severity of the disorder and the limitations associated with antipsychotic drugs, off-label prescriptions such as sodium valproate often serve as a potential alternative to FDA-sanctioned medications. According to Saini et al. (2019), the drug is a mood stabilizer employed to treat bipolar ailments but is not a sanctioned treatment method for schizophrenia. The risks associated with sodium valproate include diminished blood platelets, nystagmus, fluid retention in the limbs like legs and arms, and trouble breathing. Despite these concerns, the drug is known for its beneficial influence on symptoms of acute schizophrenia after a few weeks of usage (Saini et al., 2019). It also wields anti-aggressive fortes and reduces impulsive conduct typical for persons with schizophrenia.

Non-Pharmacological Measure

An appropriate non-pharmacological measure in treating the selected disorder is cognitive-behavioral therapy (CBT). According to Gautam et al. (2018), CBT strategies are intended to modify delusional beliefs, and their potential to control hallucinations has been reported broadly. The intervention suits the needs of older patients and assists in reducing cognitive susceptibilities, increasing the ability to cope with stress and adhere to the treatment plan.

Risk Valuation

Making prescriptions for the elderly population is associated with certain risks. In informing my patients, I would depend on preliminary risk evaluation. Indeed, all medications necessitate caution owing to the age-connected changes in pharmacokinetics, i.e. absorption and metabolism, and pharmacodynamics that may alter the physiologic impacts of the drugs. Proper dosage would also guide my decisions. In most instances, increased volume of distribution might result from the proportional increase in body fat relative to skeletal muscles with aging. Diminished drug clearance can also result from the natural decline in renal function with aging, even in the absence of renal disorders. Last, understanding the drugs-ailments interactions linked with antipsychotics is crucial, since the frequent use of numerous medications (polypharmacy) can contribute to the incidence of manifold comorbidities (polymorbidity).

Clinical Practice Guidelines

It is essential to follow practical guidelines regarding the treatment of schizophrenia in elderly patients. Atypical antipsychotics are endorsed as the most frequently chosen option to manage the disorder. According to Gautam et al. (2018), these drugs are safe and more effective compared to conventional antipsychotics. Prescriptions like Aripiprazole should always be employed in accordance with the recommendations for the FDA-sanctioned drug. Other guidelines concern issues like medical comorbidities and management of drug side effects in the chosen population.

References

Gautam, S., Jain, A., Gautam, M., & Gautam, A. (2018). Clinical practice guideline for management of psychoses in elderly. Indian Journal of Psychiatry, 60(Suppl 3), S363–S370. https://doi.org/10.4103/0019-5545.224475

Gettu, N., & Saadabadi, A. (2021). Aripiprazole. StatPearls Publishinghttps://www.ncbi.nlm.nih.gov/books/NBK547739/

Lau, S., Lun, P., Ang, W., Tan, K. T., & Ding, Y. Y. (2020). Barriers to effective prescribing in older adults: Applying the theoretical domains framework in the ambulatory setting–a scoping review. BMC Geriatrics, 20(1), 1-13. https://doi.org/10.1186/s12877-020-01766-7

Saini, A., Aggarwal, G., Pardal, P. K., & Gupta, A. (2019). Effect of adjunctive sodium valproate in patients of acute schizophrenia. International Journal of Contemporary Medical Research, 6(5), E1-E4. http://dx.doi.org/10.21276/ijcmr.2019.6.5.21

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