| Course | NR 568 Advanced Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner |
|---|---|
| Week | 5 |
| Paper type | Deprescribing plan |
| Length | About 1,100 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, Adult-Gerontology Primary Care NP (AGPCNP) |
| Updated | October 2026 |
Free sample paper for NR 568 Week 5
Deprescribing Plan: Doxazosin Off First, Then Meclizine, Diphenhydramine and Trazodone, Written as a Calendar With Amounts for a 79-Year-Old Who Gets Dizzy on Standing
Student Name
College of Nursing, Chamberlain University
NR 568: Advanced Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner
Instructor Name
Month Day, Year
Deprescribing Plan: Doxazosin Off First, Then Meclizine, Diphenhydramine and Trazodone, Written as a Calendar With Amounts for a 79-Year-Old Who Gets Dizzy on Standing
The Patient's Goal
Asked what matters most, the 79-year-old patient, whose kidneys work at stage 3b, gives one goal for this plan: to stop feeling dizzy when getting out of a chair, because the dizziness has twice nearly caused a fall in the garden. Orthostatic blood pressure today drops from 136/78 sitting to 108/66 after three minutes standing, with lightheadedness. Four entries on the list contribute to that drop or treat its consequences: doxazosin and tamsulosin (two alpha blockers), trazodone at bedtime, and over-the-counter meclizine, which the patient bought for the dizziness itself. Diphenhydramine, used two or three nights a week for sleep, adds sedation and anticholinergic effects.
Why This Entry Leads
Doxazosin comes off first, for three reasons. Its harm is nearest: it is the strongest contributor to the orthostatic drop, and the patient is already on tamsulosin, a more selective alpha blocker for the prostate, so doxazosin duplicates the class. What it was started for has changed: it was added eight years ago for blood pressure, but lisinopril and chlorthalidone now control pressure, and alpha blockers are not preferred agents for hypertension in older adults because of orthostatic hypotension (American Geriatrics Society Beers Criteria Update Expert Panel, 2023). And it has a clean exit: stopping it should raise standing pressure within days, giving a clear signal before the next step.
Steps With Days and Amounts
Week 1 (starting Monday 6 October): doxazosin 4 mg at bedtime reduced to 2 mg at bedtime.
Week 2 (Monday 13 October): doxazosin 2 mg reduced to 1 mg.
Week 3 (Monday 20 October): doxazosin stopped.
Week 5 (Monday 3 November): meclizine stopped. It has been used as needed rather than daily, so no taper is needed; the bottle goes back to the pharmacy.
Week 6 (Monday 10 November): diphenhydramine stopped, with a sleep plan (fixed wake time, no naps after 2 PM, a 30-minute wind-down without screens) started the same week.
Week 8 (Monday 24 November): trazodone 100 mg reduced to 50 mg at bedtime.
Week 10 (Monday 8 December): trazodone 50 mg reduced to 25 mg.
Week 12 (Monday 22 December): trazodone stopped, if sleep remains acceptable.
Tamsulosin stays, because the prostate symptoms are real and it is the more selective agent.
The Wait Before Reading It
Doxazosin's effect fades over two to three days after each step, so standing blood pressure is checked at home every morning and read at the end of each week, not the day after a change. Sleep changes after stopping diphenhydramine take one to two weeks to settle, so the sleep diary is read at the two-week mark. Trazodone steps are spaced two weeks apart for the same reason. Reading a result too early would mistake the transition for the outcome.
Rebound Is Not Relapse
Each removal has an expected rebound that should not be mistaken for the return of the original problem. Stopping doxazosin may raise lying blood pressure slightly; the goal is a sitting systolic below 140, which lisinopril and chlorthalidone should hold. Stopping trazodone may cause a week or two of lighter sleep; that is rebound, not a return of the insomnia that existed three years ago. Stopping diphenhydramine may cause a few restless nights. The patient and spouse are told about these in advance so that a bad week does not lead them to restart a drug.
The Threshold for Putting It Back
Each entry has a written threshold for returning.
Doxazosin: restart only if sitting systolic pressure stays above 150 on home readings for two weeks after the step, and only after considering a different blood pressure agent first.
Trazodone: restart at the last tolerated dose if the patient sleeps less than five hours a night for more than two weeks despite the sleep plan, or if mood worsens.
Diphenhydramine and meclizine: no restart; if dizziness persists after doxazosin is gone, it is evaluated as a symptom rather than treated with an anticholinergic.
What the Patient Is Asked to Notice
The patient and spouse keep a one-page record each morning: standing blood pressure and pulse after three minutes, any dizziness on rising (none, mild, needed to sit), hours slept and one word about mood. They are asked to call for any fall, fainting, chest pain, or blood pressure over 170 systolic. The spouse removes stopped bottles from the pill box on each step date.
Why One at a Time
Removing four entries at once, a pattern deprescribing guidance warns against (Scott et al., 2015), would leave no way to know which change caused an improvement or a new problem, and it risks several rebounds at the same time. Evidence-based deprescribing processes recommend reviewing each drug against the patient's goals, prioritizing those with the greatest harm and least benefit, and stopping one at a time with monitoring (Reeve et al., 2014).
Risks of the Plan Itself
A deprescribing plan carries its own risks, and naming them is part of the plan. Stopping doxazosin could unmask higher blood pressure; the home readings and the restart threshold guard against that. Stopping trazodone could worsen sleep and, indirectly, mood; the sleep diary and the mood word each morning guard against that. Stopping meclizine could leave dizziness from another cause untreated; if dizziness continues after the alpha blocker is gone, it will be evaluated for inner ear, cardiac or neurological causes. A visit every fourth week, with phone calls between visits, reviews the plan, so that problems are caught at the step that caused them.
Expected Outcome
If the plan works, the standing blood pressure drop should fall below 20 mm Hg, dizziness on rising should stop, and the regimen should shrink by four entries with no loss of blood pressure control. Sleep may be lighter for a few weeks, then settle.
The plan is shared with the patient and spouse as a printed calendar, one row per week, with the change, the dose and what to record that week.
Communication
The cardiologist who started doxazosin receives a letter before the first step. The urologist is told that tamsulosin remains. The pharmacist removes doxazosin and trazodone from automatic refills on their stop dates and notes the over-the-counter products on the profile.
References
American Geriatrics Society Beers Criteria Update Expert Panel. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052-2081. https://doi.org/10.1111/jgs.18372
Reeve, E., Shakib, S., Hendrix, I., Roberts, M. S., & Wiese, M. D. (2014). Review of deprescribing processes and development of an evidence-based, patient-centred deprescribing process. British Journal of Clinical Pharmacology, 78(4), 738-747. https://doi.org/10.1111/bcp.12386
Scott, I. A., Hilmer, S. N., Reeve, E., Potter, K., Le Couteur, D., Rigby, D., Gnjidic, D., Del Mar, C. B., Roughead, E. E., Page, A., Jansen, J., & Martin, J. H. (2015). Reducing inappropriate polypharmacy: The process of deprescribing. JAMA Internal Medicine, 175(5), 827-834. https://doi.org/10.1001/jamainternmed.2015.0324
NR 568 Week 5 instructions, in plain terms
The deprescribing plan usually asks you to choose which medication to stop first and to write out how the reduction will happen. Expect the prompt to ask for priorities, taper schedules, monitoring and what to do if symptoms return. Start with the patient's goal. Explain why the first entry leads, for example because its harm is nearest or its original purpose has ended. Move one entry at a time, with dates and amounts for each step. Say how long to wait before judging each step. Describe the rebound you expect so it is not mistaken for relapse. Write the threshold for putting a drug back. Tell the patient what to notice and record, and inform the other prescribers involved.
How this NR 568 Week 5 example is built
The sample opens with the goal of standing up without dizziness and an orthostatic drop from 136 to 108. Doxazosin leads because it is the largest contributor, duplicates tamsulosin and no longer serves its original purpose. A calendar follows: doxazosin halved weekly and stopped by 20 October, meclizine stopped on 3 November, diphenhydramine on 10 November with a sleep plan, and trazodone tapered in two-week steps to a stop on 22 December. Sections cover waiting periods, expected rebound, restart thresholds for each drug, a morning record for the household, the reason for moving one at a time, the plan's own risks and letters to the cardiologist, urologist and pharmacist.
Reading the NR 568 Week 5 grading rubric
Deprescribing plans are usually assessed on whether reductions are specific, whether entries move one at a time, whether the lead entry is justified, whether waiting periods and restart thresholds are stated and whether the patient knows what to watch. A plan written as intention, with drugs named but no amounts or dates, loses the most, so each step here carries both. Justifying why doxazosin leads shows prioritization rather than a random order. Waiting periods matched to each drug's offset prevent premature judgments. Separating rebound from relapse protects the plan from being undone in a bad week. Restart thresholds give clear limits. A morning record for the household and letters to each prescriber show the plan can be carried out. Deprescribing evidence supports the method.
NR 568 Week 5 help from the desk
The costliest version of this plan names drugs for reduction with no amounts, no dates and only a promise to review later. Just as costly is stopping several drugs at once, which leaves any change in symptoms impossible to explain. Many plans do not say why one drug goes first. Some read results the day after a change, before the effect has settled. Others mistake predictable rebound for the return of the original problem and restart the drug. Begin with the patient's goal, justify the lead entry, write each step with a date and dose, set waiting periods and thresholds and tell the patient what to watch. Tell us which medicines you hope to reduce and a plan in this format can follow.
Get a NR 568 Week 5 example written to your instructions
Send the Week 5 case, the regimen and any plan template your classroom uses, and a custom example is written to it and returned inside 24 to 48 hours, the first one free. It comes back as days and amounts rather than as intentions, with the waiting period and the restart threshold both written into it.
More NR 568 papers and AGPCNP samples
- NR 568 Week 1: Citalopram Dose Discussion Post
- NR 568 Week 2: Medication List Review
- NR 568 Week 3: Clarithromycin Interaction Analysis
- NR 568 Week 4: Allopurinol in CKD Case Analysis
- NR 568 Week 6: Adverse Effect Write-up
- NR 568 Week 7: Polypharmacy Case Study
- NR 568 Week 8: Pharmacotherapy Synthesis
NR 568 Week 5 questions, answered
How long should the waiting period be?
Long enough that what you are looking at is the absence of the drug. The working rule is several times the agent's clearance time before any conclusion is drawn, and longer where the effect being removed took weeks to establish itself. Reading the result on day two gives a false answer in both directions, and a plan naming the interval with its reasoning earns more than one that reviews in a month.
What if the patient does not want the drug stopped?
Then that is a finding and it belongs in the plan. A reduction the person declines is not a clinical failure, and recording what they said, what mattered to them about it and what was agreed instead reads as management rather than as a plan that collapsed. A trial reduction with a clear route back is often what such a conversation produces, and a plan offering one has somewhere to go.
Which drug should come off first when several are candidates?
Rank them by the harm that is nearest, not by which conversation would be easiest. An entry causing a problem the patient has today outranks one carrying a risk in the abstract, and an entry whose original reason has plainly ended outranks both when nothing else is pressing. Say why the one you picked leads, since that sentence is what separates a plan from a list of things somebody dislikes.
Where can I find a free NR 568 Week 5 sample paper?
The calendar-style plan above, starting with doxazosin and moving one medicine at a time, is the complete NR 568 Week 5 sample. A plan for another patient can be written from their list.
Why does doxazosin come off first in the NR 568 Week 5 plan?
It contributes most to the dizziness on standing, duplicates the tamsulosin the patient also takes and no longer serves the blood pressure purpose it was started for.