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 m...
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-p P
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
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 1mg BID for “relaxation” and panic attacks.
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.
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.
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 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.
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