Taper/de-prescribing

Essay Instructions:

use the following patient examples to write a 5- to 6-page paper 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 guidelines will apply. 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.” 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. Patient 4 - Review potential side effects for elderly on benzodiazepines providing education to both the patient and the patient’s daughter. What are the risks of continuing the benzodiazepine for this patient? - How would you evaluate the patient for these side effects? - The patient and daughter agree he will need to taper off the clonazepam given the risks of continuing this medication. How would you recommend tapering off this medication? - Review with the patient and daughter potential side effects of tapering off the medication. Review with them common side effects to more serious side effects and when to seek medical attention.

Essay Sample Content Preview:

Taper/De-Prescribing Student’s Name Institutional Affiliation Course Professor Date Taper/De-Prescribing Patient 1 Answers to Questions Concerns about the patient remaining on opioid medication and clonazepam The most significant concerns of patients taking opioid and clonazepam medication include side effects, such as difficulty breathing, risk of addiction, cognitive impairment, and even death. Both opioids and clonazepam have addictive effects, particularly with prolonged use (Wang et al., 2023). Moreover, using opioids and clonazepam might raise the risk of respiratory depression, which might become life-threatening. It can also lead to drowsiness, impaired cognitive function, and sedation, which impacts the patient’s capability to accomplish daily tasks safely. Educating the patient The first thing I will consider is informing the patient about these risks and concerns and urging them to seek medication instantly if they experience unusual dizziness, slowed or trouble breathing, or extreme sleepiness. I will also offer the patient basic information on the possibility of addiction and dependence, stressing the importance of observing prescribed dosages and deliberating any concerns about misuse. I will inform the patient of the dangers of respiratory depression when they use opioids and clonazepam medication together, underscoring the necessity for caution and close monitoring by healthcare providers. Most importantly, I will inform the patient of other alternative pain management apart from medication, such as mind-body therapies, that can be safer and more effective in the long term (Dey & Vrooman, 2021). Relaxation techniques can help alleviate discomfort related to chronic pain. Response to the patient's concerns about tapering off clonazepam I recommend a gradual tapering schedule for clonazepam to reduce withdrawal symptoms and minimize the risk of rebound anxiety or panic attacks. Professionals suggest decreasing the dose by 25% each quarter of the withdrawal period or even per week (Wang et al., 2023). Such initiates will ensure that it is reduced by smaller increments as the taper period proceeds. Symptom management is also crucial, where the patient can be informed of the approaches and medications accessible to manage withdrawal symptoms and limit panic attacks throughout the tapering process. For instance, I will recommend other medications, including antidepressants, such as SSRI or SNRI (Dey & Vrooman, 2021). Such medication might be appropriate for the treatment of panic attacks. I will start with a low dose of the chosen SSRI or SNRI, such as venlafaxine or sertraline, and then gradually titrate upward based on the patient's response and tolerability. Close monitoring for both efficiency and adverse effects is essential throughout the opening phase of treatment. However, the usage might face the significant legal concern of the potential for opioid misuse and diversion (Wang et al., 2023). Provided the existing opioid epidemic and regulatory scrutiny on its prescription, healthcare providers must comply with strict guidelines for opioid prescribing, such as applying opioid agreements and considering alternative pain management approaches when necessary. Patient 2 Common Withdrawal Symptoms from Alprazolam (Xanax) Xanax is a short-acting benzodiazepine, and its withdrawal symptoms can be challenging. They comprise insomnia, despair, reduced appetite, irritability, anxiety/uneasiness, and hostility, among others (Ait-Daoud et al., 2018). Severe withdrawal symptoms comprise neurosis, fever, seizures, hallucinations, and severe anxiety or panic attacks. Patient Education Tapering off Xanax might cause individuals to experience common withdrawal symptoms, such as agitation, anxiety, sleeplessness, sweating, irritability, mild tremors, and muscle tension. Such signs are mostly manageable but can be uncomfortable sometimes. However, patients should be aware of severe symptoms, such as intense anxiety or panic attacks, seizures, hallucinations, or psychosis (Ait-Daoud et al., 2018). In case of such symptoms, I advise my patient to immediately seek medical attention since they can be life-threatening. Patients should always follow the prescribed tapering schedule closely and communicate with their healthcare providers if they face any troubling symptoms during this process. Longer-Acting Benzodiazepine for Tapering Based on the patient’s history, I would choose “diazepam (Valium) or clonazepam (Klonopin)" as a longer-benzodiazepine to support a smoother taper. In this case, the dose I will describe is Diazepam (Valium), representing the conversion dose (Reid Finlayson et al., 2022). Since Xanax 1 mg is relative to diazepam 10 mg, the daily dose of Xanax 2 mg (1mg BID) would be relative to about 20mg diazepam. Tapering...

Updated on August 22, 2024

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