Prescribing for Children and Adolescents NRNP 6665
Prescribing For Children And Adolescents With Eating Disorders Example Approach
Eating disorders are psychological illnesses characterized by unusual feeding habits. Types of eating disorders include bulimia, anorexia nervosa, avoidant restrictive food eating disorder, and binge eating disorder. The management of eating disorders in children and adolescents can be pharmacological or non-pharmacological (Hay, 2020). Fluoxetine is an FDA-approved drug that is used in pharmacological management. An off-label drug that can be used is olanzapine. Additionally, cognitive behavioral therapy can be used in non-pharmacological management.
The risk score for eating disorders will inform my decision for treatment. Risk assessment for eating disorders can be done using the Sick, Control, One, Fat & Food (SCOFF) Questionnaire. This is a 5-item questionnaire that asks if an individual induces vomiting, loses control over the amount they eat, if they have lost more than 15 pounds in three months if they think they are fat, yet they are thin, and if food controls their life (Kutz et al., 2020). If two or more questions are answered positively, the patient is started on treatment.
According to Himmerich et al. (2021), fluoxetine is useful in managing eating disorders in that it alleviates anxiety or depression associated with the disease. The disadvantage of using fluoxetine is that it can cause insomnia, dry mouth, tremors, and weakness. Olanzapine also alleviates anxiety (Copur & Copur, 2020). However, it can cause respiratory depression, hyperglycemia, and anticholinergic effects like miosis.
The World Federation of Societies of Biological Psychiatry recommends antidepressants, antipsychotics, antiepileptics, and antihistamines to manage eating disorders. It also recommends combining pharmacological with non-pharmacological treatment. Fluoxetine is an antidepressant in the class of selective serotonin reuptake inhibitors. Olanzapine is a second-generation antipsychotic. These medications can be given along with psychotherapy.
References
- Çöpür, S., & Çöpür, M. (2020). Olanzapine in the treatment of anorexia nervosa: a systematic review. The Egyptian Journal of Neurology, Psychiatry, and Neurosurgery, 56(1), 1-7. https://doi.org/10.1186/s41983-020-00195-y
- Hay, P. (2020). The current approach to eating disorders: a clinical update. Internal Medicine Journal, 50(1), 24–29. https://doi.org/10.1111/imj.14691
- Himmerich, H., Kan, C., Au, K., & Treasure, J. (2021). Pharmacological treatment of eating disorders, comorbid mental health problems, malnutrition, and physical health consequences. Pharmacology & Therapeutics, 217, 107667. https://doi.org/10.1080/14740338.2018.1395854
- Kutz, A. M., Marsh, A. G., Gunderson, C. G., Maguen, S., & Masheb, R. M. (2020). Eating disorder screening: a systematic review and meta-analysis of diagnostic test characteristics of the SCOFF. Journal Of General Internal Medicine, 35(3), 885–893. https://doi.org/10.1007/s11606-019-05478-6
Week 3: Assignment 1 PRESCRIBING FOR CHILDREN AND ADOLESCENTS INSTRUCTIONS
Off-label prescribing is when a physician gives you a drug that the U.S. Food and Drug Administration (FDA) has approved to treat a condition different than your condition. This practice is legal and common. In fact, one in five prescriptions written today are for off-label use.
—Agency for Healthcare Research and Quality
Psychotropic drugs are commonly used for children and adolescents to treat mental health disorders, yet many of these drugs are not FDA approved for use in these populations. Thus, their use is considered “off-label,” and it is often up to the best judgment of the prescribing clinician. As a PMHNP, you will need to apply the best available information and research on pharmacological treatments for children in order to safely and effectively treat child and adolescent patients.
Sometimes this will come in the form of formal studies and approvals for drugs in children. Other times you may need to extrapolate from research or treatment guidelines on drugs in adults. Each individual patient case will need to be considered independently and each treatment considered from a risk assessment standpoint. What psychotherapeutic approach might be indicated as an initial treatment? What are the potential side effects of a particular drug?
For this Prescribing for Children and Adolescents NRNP 6665 Assignment, you consider these questions and others as you explore FDA-approved (“on label”) pharmacological treatments, non-FDA-approved (“off-label”) pharmacological treatments, and nonpharmacological treatments for disorders in children and adolescents.
Reference:
Agency for Healthcare Research and Quality. (2015). Off-label drugs: What you need to know. https://www.ahrq.gov/patients-consumers/patient-involvement/off-label-drug-usage.htmlLinks to an external site.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
TO PREPARE
- Your Instructor will assign a specific disorder for you to research for this Assignment.
- Use the Walden library to research evidence-based treatments for your assigned disorder in children and adolescents. You will need to recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating this disorder in children and adolescents.
THE ASSIGNMENT (1–2 PAGES)
- Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents.
- 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. If not, explain what information you would need to take into consideration.
- Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Attach the PDFs of your sources.
Prescribing for Children and Adolescents Example 2
Separation anxiety Disorder (SAD) is a developmental phenomenon; nonetheless, it manifests with excessive severity at a disproportionate age or inappropriate manner. SAD is characterized by great concern, worry, and even dread of separation from a close individual, whether actual or predicted (Feriante & Bernstein, 2020). Separation anxiety appears naturally between the ages of 6 and 12 months, persisting until around three and then lessening under normal conditions. The US Food and Drug Administration has not yet approved any drugs to treat Separation Anxiety Disorder.
Fluoxetine can be used as an off-label drug. Although some evidence supports using fluoxetine to treat separation Anxiety disorder, healthcare professionals should assess the medication’s potential advantages against its side effects (McNeil et al., 2022). This is based on the recommendations from consensus guidelines based on randomized controlled trials. Cognitive behavioral therapy is a non-drug treatment that I would suggest. It may help children learn how to deal with their anxiety better. The objective is also to assist a child in dealing with things that might make them anxious.
Numerous validated screening methods for childhood anxiety disorders are widely available. The Screen for Child Anxiety-Related Emotional Disorders (SCARED) is what I would employ. The five subscale scores for the five most prevalent children’s anxiety disorders, SAD among them, make up the overall score. The SCARED evaluation instrument is considered a consistent, trustworthy, accurate, and sensitive indicator of anxiety. The SCARED screening tool has demonstrated strict invariance of measurements and test-retest solid reliability.
The use of fluoxetine has risks and benefits accompanying the off-label drug. Concerns about safety due to side effects (like an increased risk of suicidal thoughts or plans or lowered inhibitions that lead to aggression) prevent their use in pediatric populations right now unless the individual’s reaction is closely monitored or if the patient has responded well to SSRIs or SNRIs in the past (Bernstein, 2020). Except for fluoxetine, which seems to have an excellent risk-benefit ratio, the risks of giving SSRIs to children outweigh the benefits. Fluoxetine may hurt the gastrointestinal system more than other SSRIs. It should not be given to kids who are physically aggressive, whose families have a past of suicidal or parasuicidal thoughts or actions, or who are more likely to hurt themselves.
Current professional guidelines for treating SAD depend. If the symptoms are minimal, encouragement, support, and awareness may be enough to assist the patient in getting back to their regular routines. Maintaining consistent routines for eating, sleeping, and exercising while removing irregular ones should be encouraged. Validated screening techniques should be used to examine anxiety symptoms periodically to check for changes. Cognitive behavioral therapy is advised as the first-line therapy when treatment is necessary (Feriante & Bernstein, 2020; Silk et al., 2020).
There are no drugs with an FDA-labeled prescription for SAD, but selective serotonin reuptake inhibitors (SSRIs) are frequently prescribed and proven effective at managing anxiety disorders (Ramsey et al., 2019). According to the American Academy of Child and Adolescent Psychiatry (AACAP), patients with separation anxiety aged 6 to 18 years old may benefit more from receiving combination treatment (CBT and an SSRI) than either CBT alone or an SSRI alone (Walter et al., 2020). Serotonin-norepinephrine reuptake inhibitors (SNRIs) may also be prescribed to patients with separation anxiety who are between the ages of 6 and 18.
References
Bernstein, B. E. (2020). Separation anxiety and school refusal medication: Tricyclic antidepressants, selective serotonin reuptake inhibitors, anxiolytic agents, antihistamines, beta-adrenergic blocking agents, anticonvulsants, alpha-adrenergic agents. Emedicine.medscape.com. https://emedicine.medscape.com/article/916737-medication#3
Feriante, J., & Bernstein, B. (2020). Separation anxiety. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560793/
McNeil, D. W., Preston, D. L., Blackwood, M., & Porter, H. (2022). Fluoxetine use for the treatment of anxiety-induced vomiting in 3-year-old children with complex trauma and developmental concerns: A case report. https://doi.org/10.21203/rs.3.rs-2049898/v1
Ramsey, L. B., Bishop, J. R., & Strawn, J. R. (2019). Pharmacogenetics of treating pediatric anxiety and depression. Pharmacogenomics, 20(12), 867–870. https://doi.org/10.2217/pgs-2019-0088
Silk, J. S., Pramana, G., Sequeira, S. L., Lindhiem, O., Kendall, P. C., Rosen, D., & Parmanto, B. (2020). Using a smartphone app and clinician portal to enhance brief cognitive behavioral therapy for childhood anxiety disorders. Behavior Therapy, 51(1), 69–84. https://doi.org/10.1016/j.beth.2019.05.002
Walter, H. J., Bukstein, O. G., Abright, A. R., Keable, H., Ramtekkar, U., Ripperger-Suhler, J., & Rockhill, C. (2020). Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 59(10), 1107–1124. https://doi.org/10.1016/j.jaac.2020.05.00
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