Assignment: off label drug use

Assignment: Off-Label Drug Use in PediatricsThe unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable, since very few drugs have been specifically researched and tested with children.When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just “smaller” adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion.Photo Credit: Getty ImagesChildren even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of safety implications of the off-label use of drugs with this patient group.To PrepareReview the interactive media piece in this week’s Resources and reflect on the types of drugs used to treat pediatric patients with mood disorders.Reflect on situations in which children should be prescribed drugs for off-label use.Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics.By Day 5 of Week 11Write a 1-page narrative in APA format that addresses the following:Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.Therapy for Pediatric Clients with Mood DisordersAn African American Child Suffering From DepressionBACKGROUND INFORMATIONThe client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.Client complained of feeling “sad”Mother reports that teacher said child is withdrawn from peers in classMother notes decreased appetite and occasional periods of irritationClient reached all developmental landmarks at appropriate agesPhysical exam unremarkableLaboratory studies WNLChild referred to psychiatry for evaluationMENTAL STATUS EXAMAlert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead.You administer the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)RESOURCES§ Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.Therapy for Pediatric Clients with Mood DisordersAn African American Child Suffering From DepressionDecision Point OneBegin Zoloft 25 mg orally dailyRESULTS OF DECISION POINT ONEClient returns to clinic in four weeksNo change in depressive symptoms at allDecision Point TwoSelect what you should do next:Increase dose to 50 mg orally dailyRESULTS OF DECISION POINT TWOClient returns to clinic in four weeksDepressive symptoms decrease by 50%. Cleint tolerating wellDecision Point ThreeSelect what you should do next:Maintain current doseGuidance to StudentAt this point, sufficient symptom reduction has been achieved. This is considered a “response” to therapy. Can continue with current dose for additional 4 week to see if any further reductions in depressive symptoms are noted. An increase in dose may be warranted since this is not “full” remission- Discuss pros/cons of increasing drug dose with client at this time and empower the client to be part of the decision. There is no indication that the drug therapy should be changed to an SNRI at this point as the client is clearly responding to this therapy.

 
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