Case Study
Evidence based practice in pediatric pharmacology entails integration of knowledge and skills at all levels of decision making. Initial weeks of encounter tend to determine the minimum working doses that can be tolerated by client with desired effects. This reduces side effects and ensures that the client receives the right dose to cause the desired effect. In this paper, the decision levels shall be reviewed, and critical thinking aspects employed at each shall be examined.
The client selected for this assessment is an African American child presenting with depression with normal developmental milestones. Other aspects of the general examination reveal that the child has high ratings in the depression scale. This criterion is used to diagnose the child as having a major depressive disorder.
Decision point one
The above child presented with significant depression. The aim of this decision point is to identify the most appropriate medication for the child, putting into consideration all patient factors influencing the drug outcomes. In this decision point, I selected Zoloft to be administered 25mg orally. This is a drug of choice in major depressive disorders in children. According to Vitiello (2012), starting with the minimum dosage and then increasing gradually is recommended to avoid adverse reactions, to identify the minimum working dose, and that the dosage given is tolerated. I chose this decision with the hopes of identifying some positive changes, however minimal, as this was the minimum starting dose for children. The child came back however with no change in the depressive symptoms.
Decision point two
The second decision point involved increasing the dosage from 25mg daily to 50 mg daily. The aim of increasing the dosage to 50 mg daily was to achieve some decrease in depressive symptoms. Being within the range, minimum desired effects are expected (Stahl, 2013). According to Vitiello (2012), antidepressant pharmacokinetics varies depending on the dose. Giving a single dose daily is more likely to have longer half-life therefore, a more persistent desired effect in the client. The depressive symptoms decreased by 50 percent with the client tolerating the medication well. Zoloft shows success in managing the condition as evidenced by the decrease in depressive symptoms.
Decision point three
Decision point three is to determine whether to maintain or increase the Zoloft until full remission of the depressive symptoms. The decision at this point is to maintain the dosage. The client’s symptoms have improved by 50% which shows the client is responding to the medication. The risks versus benefits would be discussed with the client’s guardian regarding another increase. Current studies recommend increase of dosage to “full remission”, being the main aim of treatment in contemporary psychopharmacology (Stahl, 2013). My recommendation would be to maintain current dose for 3 months and consider increasing to 75mg at that time provided client was still tolerating therapy with benefit.
Ethical considerations
Ethical issues play a great role in the psychopharmacotherapy for children in different states of America. According to Vitiello (2012), it is a mandatory requirement that the nurse practitioner discuss with the guardian of the child concerning the available modalities of treatment before prescribing any medications. The possible benefits of medication should be discussed and weighed against the risks associated with the treatment before commencing any such therapy. Legal guardians of the pediatric client are also responsible for the safe administration of the medication. In such occasions, appropriate communication techniques need to be employed to ensure clear understanding of potential treatment outcomes and the likelihood of shifting to another type of medication if one fails. Creating rapport with the client and the guardian will help solidify the practitioner –patient relationship.
References
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press
Stahl, S. M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. In J. M. Rey (Ed.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrievedfrom http://iacapap.org/wp-content/uploads/A.7-PSYCHOPHARMACOLOGY-072012.pdf
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