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Prescribing for Older Adults and Pregnant Women

After assessing and diagnosing a patient, PMHNPs must take into consideration special characteristics of the patient before determining an appropriate course of treatment. For pharmacological treatments that are not FDA-approved for a particular use or population, off-label use may be considered when the potential benefits could outweigh the risks. In this Discussion, you will investigate a specific disorder and determine potential appropriate treatments for when it occurs in an older adult or pregnant woman.

To Prepare

Pregnant Women/Bipolar

• Choose one of the two following specific populations: either pregnant women or older adults. Then, select a specific disorder from the DSM-5-TR to use.
• Use the Walden Library to research evidence-based treatments for your selected disorder in your selected population (either older adults or pregnant women). You will need to recommend one FDA-approved drug, one non-FDA-approved “off-label” drug, and one nonpharmacological intervention for treating the disorder in that population.
• Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your chosen disorder in older adults or pregnant women.
• Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
• Explain whether clinical practice guidelines exist for this disorder, and if so, use them to justify your recommendations.

Population: Pregnant Women

Disorder: Bipolar Disorder

Evidence-based treatments for bipolar disorder in pregnant women include pharmacological and non-pharmacological interventions. Some FDA-approved medications that have been used in pregnant women with bipolar disorder include lithium, lamotrigine, and some antipsychotic medications. However, there is limited research on the safety of these medications during pregnancy, and the risks and benefits must be carefully considered on a case-by-case basis. Non-pharmacological interventions that may be used in pregnant women with bipolar disorder include psychotherapy and electroconvulsive therapy (ECT).

Recommendations:

1. FDA-approved drug: Lamotrigine – Lamotrigine has been FDA-approved for the treatment of bipolar disorder in adults and has been used in pregnant women with bipolar disorder. It has a relatively low risk of causing birth defects and has been associated with better pregnancy outcomes compared to other mood stabilizers.
2. Off-label drug: Quetiapine – Quetiapine is an atypical antipsychotic that has been used off-label for the treatment of bipolar disorder during pregnancy. It has been associated with a lower risk of causing birth defects compared to some other antipsychotic medications.
3. Nonpharmacological intervention: Psychotherapy – Psychotherapy can be an effective treatment for bipolar disorder in pregnant women. Cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) are two types of psychotherapy that have been studied in pregnant women with bipolar disorder.