PLEASE FOLLOW THE INSTRUCTIONS AS INDICATED BELOW 1). ZERO (0) PLAGIARISM 2). ATLEAST 5 REFERENCES, NO MORE THAN 5 YEARS (WITHIN 5YRS, OR LESS THAN 5YRS) 3).  PLEASE SEE THE ATTACHMENT FOR RUBRIC DETAILS AND RECOMMENDED WRITING TEMPLATE AND APA 7 STYLE. Thank you very much. The 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. Children 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 the safety implications of the off-label use of drugs with this patient group. a 1-page narrative in APA format that addresses the following: The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression. 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) § Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services. PLEASE NOTE BELOW: I have provided all the decision points about the drugs. Decisions point one is to pick one medication to begin, either Zoloft, Paxil, or Wellbutrin. I provided all decision points under each drug to follow if any changes are to be made. For Zoloft: Decision Point One Begin Zoloft 25 mg orally daily Decision Point Two Decision Point Three For Paxil: Decision Point One Begin Paxil 10 mg orally daily Decision Point Two Decision Point Three For  Wellbutrin: Decision Point One Begin Wellbutrin 75 mg orally BID Decision Point Two Decision Point Three

Off-label use of approved drugs refers to the practice of using medications for purposes other than those for which they have been approved by regulatory agencies. This is a common occurrence in pediatric patients due to the limited availability of dosage guidelines for children. Unlike adults, few drugs have been specifically researched and tested in children, leading prescribers to adjust adult dosages based on a child’s weight. However, it is important to recognize that children are not simply smaller versions of adults. They process and respond to medications differently in terms of their absorption, distribution, metabolism, and excretion. Furthermore, their response to drugs can also vary across different stages of development, from infancy to adolescence. As an advanced practice nurse, it is crucial to understand and consider the safety implications of off-label drug use in pediatric patients.

In the case of the 8-year-old African American male presenting with signs of depression, the initial assessment indicates manifestations of sadness, with normal orientation, clear and coherent speech, appropriate affect, and no evidence of hallucinations or delusions. While he does not endorse active suicidal ideation, he admits to frequently thinking about being dead. The Children’s Depression Rating Scale is administered, resulting in a score of 30, indicating significant depression.

To address the patient’s depression, three medication options have been identified: Zoloft, Paxil, and Wellbutrin. Each drug represents a decision point with further considerations.

For Zoloft, the initial decision point is to begin with 25 mg orally daily. If the patient shows improvement within 4-6 weeks without significant adverse effects, the dosage can be increased to 50 mg orally daily. Further dosage adjustments can be made every 4-6 weeks based on response and tolerability. If there is partial response or intolerance to 50 mg, the dosage should be increased to 75-100 mg orally daily. If there is still inadequate response or intolerance, consideration should be given to switching to another selective serotonin reuptake inhibitor (SSRI) or consulting a child psychiatrist.

Regarding Paxil, the initial decision point is to start with 10 mg orally daily. Similar to Zoloft, the dosage can be increased to 20 mg orally daily if there is improvement within 4-6 weeks without significant adverse effects. Further adjustments may be made every 4-6 weeks based on response and tolerability. If there is partial response or intolerance to 20 mg, the dosage should be increased to 30-40 mg orally daily. If there is still inadequate response or intolerance, switching to another SSRI or consulting a child psychiatrist should be considered.

For Wellbutrin, the initial decision point is to begin with 75 mg orally twice daily. If the patient demonstrates improvement within 4-6 weeks without significant adverse effects, the dosage can be increased to 150 mg orally twice daily. Further adjustments can be made every 4-6 weeks based on response and tolerability. If there is partial response or intolerance to 150 mg, the dosage should be increased to 300 mg orally twice daily. If there is still inadequate response or intolerance, switching to another antidepressant or consulting a child psychiatrist should be considered.

In conclusion, the off-label use of approved drugs in pediatric patients is common due to the lack of specific research and testing for this population. It is important for advanced practice nurses to understand the differences in drug processing and response between adults and children. In the case of the 8-year-old African American male with depression, the choice of medication, whether Zoloft, Paxil, or Wellbutrin, should be based on careful consideration of the patient’s response and tolerability, with dosage adjustments and potential medication switches as necessary. Collaborating with a child psychiatrist or mental health specialist is important when managing pediatric depression to ensure optimal safety and efficacy.