Off-label drug use in pediatrics and case study analysis

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1. Introduction

2.Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.

3. Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. 

4. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

5. conclusion

See the attachment for full instruction

Topic: OFF-LABEL DRUG USE IN PEDIATRICS

Write a narrative in APA format that addresses the following:

1. Introduction

2.Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.

3. Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence.

4. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

5. conclusion

Note: Discuss the above question thoroughly and follow the rubric accordingly

Examples of off-label drugs

Drug (Brand name)                                 Common on-label use                           Common off-label use

bupropion (Wellbutrin)                          depression                                             bipolar

diphenhydramine (Benadryl)                allergy sx, insomnia                               N/V related to pregnancy

escitalopram (Lexapro)                          depression, anxiety                               bipolar

fluoxetine (Prozac)                                 depression, OCD, bipolar                     autism spectrum disorders

montelukast (Singulair)                          asthma                                                    COPD

quetiapine (Seroquel)                            schizophrenia, bipolar                           insomnia

  

Case Study

BACKGROUND INFORMATION

The 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 Mother reports that teacher said child is withdrawn from peers in class

·
 Mother notes decreased appetite and occasional periods of irritation

·
 Client reached all developmental landmarks at appropriate ages

·
 Physical exam unremarkable

·
 Laboratory studies WNL

·
 Child referred to psychiatry for evaluation

MENTAL STATUS EXAM

Alert & 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)

Decision Point One

Select what you should do:

Begin Zoloft 25 mg orally daily (selected answer)

Begin Paxil 10 mg orally daily.

Begin Wellbutrin 75 mg orally BID.

RESULTS OF DECISION POINT ONE

·
 Client returns to clinic in four weeks.

·
 No change in depressive symptoms at all

Decision Point Two

Select what you should do next:

Increase dose to 37.5 mg orally daily.

Increase dose to 50 mg orally daily. (Selected answer)

Change to Prozac 10 mg orally daily.

RESULTS OF DECISION POINT TWO

·
 Client returns to clinic in four weeks

·
 Depressive symptoms decrease by 50%. Client tolerating well.

Decision Point Three

Select what you should do next:

Maintain current dose. (Selected answer)

Increase to 75 mg orally daily.

Change to a SNRI

Guidance to Student
At 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.

Rubric for grading

Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples. = The response accurately and thoroughly explains in detail the circumstances under which children should be prescribed drugs for off-label use. … The response includes accurate and specific examples that fully support the explanation provided.

Explain strategies to making off-label use and dosage of drugs safer for children from infancy to adolescence and descriptions and names of off-label drugs that require extra care and attention when used in pediatrics. Be specific. = The response accurately and clearly describes in detail strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. … The response includes accurate, complete, and detailed descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. = Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation. = Uses correct grammar, spelling, and punctuation with no errors

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list. = Uses correct APA format with no errors

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