Advanced Pharmacology week 11 response 2

Advanced Pharmacology week 11 response 2

Title       Advanced Pharmacology week 11 response 2

Prefered Language style               English (U.S.)

Type of document           Essay

Number of pages/words              1 Page Double Spaced (approx 275 words per page)

Subject area         Pharmacology

Academic Level Master

Style      APA

Number of sources/references 3

Order description:

 

Please respond to Gayla post by who provided a different rationale than you did, in one or more of the following ways:

 

Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional research. and use the readings for at least 2 of the references

Learning Resources

This page contains the Learning Resources for this week.

 

Required Readings

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

 

Review Chapter 4, “Principles of Pharmacotherapy in Pediatrics” (pp. 53-63)

This chapter explores concepts relating to drug selection, administration, and interaction for pediatric patients. It also compares age-related pharmacokinetic differences in children and adults.

 

 

Chapter 17, “Ophthalmic Disorders” (pp. 221-243)

This chapter examines the causes, pathophysiology, diagnostic criteria, and drug treatment for four ophthalmic disorders: blepharitis, conjunctivitis, keratoconjunctivitis sicca, and glaucoma. It also explores methods of monitoring patient response to treatment.

 

 

Chapter 43, “Attention-Deficit/Hyperactivity Disorder” (pp. 743-756)

This chapter explains the process of diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD). It also identifies drugs for treating patients with ADHD, including proper dosages, selected adverse events, and special considerations for each drug.

 

 

Chapter 51, “Immunizations” (pp. 906-926)

This chapter explores vaccines that are licensed for use in the United States and provides a recommended vaccination schedule for pediatric patients and adults.

 

 

Chapter 52, “Smoking Cessation” (pp. 927-943)

This chapter examines clinical implications of smoking. It also covers various approaches for aiding patients who are dependent on nicotine but want to stop smoking.

 

 

Chapter 54, “Weight Loss” (pp. 945-956)

This chapter begins by reviewing patient factors that contribute to obesity. It also examines drug therapy for initiating weight loss in patients, as well as alternative non-drug treatments.

Bazzano, A. T, Mangione-Smith, R., Schonlau, M., Suttorp, M. J., & Brook, R. H. (2009). Off-label prescribing to children in the United States outpatient setting. Academic Pediatrics, 9(2), 81–88.

 

Note: Retrieved from the Walden Library databases.

 

 

 

This study examines the frequency of off-label prescribing to children and explores factors that impact off-label prescribing.

 

Mayhew, M. (2009). Off-label prescribing. The Journal for Nurse Practitioners, 5(2), 122–123.

 

Note: Retrieved from the Walden Library databases.

 

 

 

This article reviews the prevalence of off-label prescribing, including its benefits and risks. It also explores issues regarding the safety of off-label prescribing and when it is unavoidable.

 

Drugs.com. (2012). Retrieved from http://www.drugs.com/

 

 

 

This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.

 

Required Media

Laureate Education, Inc. (Executive Producer). (2012). Advanced pharmacology – Final course review. Baltimore, MD: Author

 

Gayla post

 

10 hours ago Gayla Cragg

Cragg DB 11

COLLAPSE

Off-Label Prescribing for Children

 

The ability to obtain the Food and Drug Administration approval for a drug to be used in children requires evidence-based proof that the medication is beneficial for this population and without significant risk. Unfortunately, the aspect of completing a research trial on young children would be challenging due to the potential risk. Medications often do not have appropriate dosage ranges listed in drug reference information due to the lack of FDA approval (Balan, Hassali, & Mak, 2017). Also, insurance companies’ pharmaceutical formularies may require providers to choose alternative medications (Mayhew, 2009). These factors have led to the need for and use of medications off-label. This practice can be a risky proposition as children’s bodies process medications differently than adults.

 

Drugs Commonly Used Off-Label

 

Examples of medications which have been used off-label include Loratadine, Amoxicillin, Amoxicillin/Clavulanate potassium, Azithromycin, Cetirizine, Albuterol, and Montelukast (Bazzano, Mangione-Smith, Schonlau, Suttorp, & Brook, 2009).

 

Amoxicillin is an Aminopenicillin (Amoxicillin, 2018). Amoxicillin/Clavulanate potassium is a beta-lactamase inhibitor (Augmentin, 2018). Azithromycin is a macrolide antibiotic (Azithromycin, 2017). These are common antibiotics which would be used for common infections such as upper respiratory and sinus infections.

 

Cetirizine and loratadine are antihistamines (Cetirizine, 2017; Loratadine, 2018). Both medications are used to treat allergies, which is another common need in children.

 

Albuterol is an adrenergic bronchodilator, which is used to relax the muscles and improve airflow in the lungs (Albuterol, 2017). Montelukast is a leukotriene modifier, which is helpful in preventing allergen response, especially with asthma symptoms (Montelukast, 2017). Again, upper respiratory infections and asthma are common conditions which children require treatment for acute and chronic illness.

 

Advanced practice nurses and other healthcare professionals should continue to advocate for research on commonly used off-label medications to fully understand their safety and efficacy (Bazzano et al., 2009).

 

The Rationale for the use of Drugs Off-Label

 

Off-label prescribing should be considered when the failure to provide treatment would cause more risk than the potential for risk from using the off-label medication. Also, the advance-practice nurse and parent should discuss the off-label use of the drug, as well as the risks versus benefits of the drug (Balan, Hassali, & Mak, 2017). This decision rationale and discussion should be documented in the patient record.

 

Safety Mechanisms when Using Drugs Off-Label

 

When prescribing an off-label drug, the advanced practice nurse should be aware of the potential effects of the drug, as well as check for drug interactions if the patient is on multiple medications. Baseline data should be taken, such as height, weight, and vital signs. Appropriate blood tests should be ordered, especially if similar testing would be done on other age groups. Lambert (2010) discussed the care provided by Dr. Kifuji for her patient. Dr. Kifuji acknowledged not checking her patient’s blood pressure or pulse during a visit (Lambert, 2010). Often many decisions can be placed under a microscope in a court of law. However, would have to take the child’s vital led the doctor to recognize a dangerously low blood pressure or pulse? This example provides good practice for an advanced practice nurse to learn from when assessing, diagnosing, and prescribing medications off-label. The importance of completing a comprehensive physical exam, medical history, and documenting the results in the patient’s record cannot be understated. The final thought would be to carefully document decisions made. Another area of concern with Dr. Kifuji’s example was the number of times the mother called in for medication adjustments. Often prescribers may desire to please the parent’s expectation for changing a prescription (Balan, Hassali, & Mak, 2017). This decision to change medications would be best done in an office visit setting, where careful discussion, assessment, and documentation can be completed.

 

References

 

Albuterol – FDA prescribing information, side effects and uses. (2017). Retrieved August 7, 2018, from https://www.drugs.com/albuterol.html

 

Amoxicillin – FDA prescribing information, side effects and uses. (2018). Retrieved August 7, 2018, from https://www.drugs.com/amoxicillin.html

 

Augmentin – FDA prescribing information, side effects and uses. (2018). Retrieved August 7, 2018, from https://www.drugs.com/augmentin.html

 

Azithromycin – FDA prescribing information, side effects and uses. (2017). Retrieved August 7, 2018, from https://www.drugs.com/azithromycin.html

 

Balan, S., Hassali, M. A., & Mak, V. L. (2017, November/December). Non-regulatory related factors leading to off-label prescribing in children: A concept map. Research in Social & Administrative Pharmacy, 13(6), 1219-1221.

 

Bazzano, A. F., Mangione-Smith, R., Schonlau, M., Suttorp, M. J., & Brook, R. H. (2009). Off-label prescribing to children in the United States outpatient setting. Academic Pediatrics, 9(2), 81-88. doi:10.1016/j.acap.2008.11.010

 

Cetirizine – FDA prescribing information, side effects and uses. (2017). Retrieved August 7, 2018, from https://www.drugs.com/zyrtec.html

 

Lambert, L. (2010, April 10). Rebecca Riley’s doctor on the defense. Patriot Ledger. Retrieved from http://www.patriotledger.com/news/x905416295/Rebecca-Riley-sdoctor-on-the-defense?zc_p=0

 

Loratadine – FDA prescribing information, side effects and uses. (2018). Retrieved August 7, 2018, from https://www.drugs.com/loratadine.html

 

Mayhew, M. (2009). Off-label prescribing. The Journal for Nurse Practitioners, 5(2), 122–123.

 

Montelukast – FDA prescribing information, side effects and uses. (2017). Retrieved August 7, 2018, from https://www.drugs.com/mtm/montelukast.html