| Course | NR 601 Primary Care of the Maturing and Aged Family Practicum |
|---|---|
| Week | 5 |
| Paper type | Deprescribing write-up |
| Length | About 990 words, 4 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, Family Nurse Practitioner (FNP) |
| Updated | October 2026 |
Free sample paper for NR 601 Week 5
Deprescribing Write-Up: Every Medicine R.D. Takes, an Indication for Each Line, the Anticholinergic Burden Added Up and Two Medicines Chosen to Stop First
Student Name
College of Nursing, Chamberlain University
NR 601: Primary Care of the Maturing and Aged Family Practicum
Instructor Name
Month Day, Year
Deprescribing Write-Up: Every Medicine R.D. Takes, an Indication for Each Line, the Anticholinergic Burden Added Up and Two Medicines Chosen to Stop First
Everything R.D. Takes
| Medicine and dose | Indication | Still indicated? |
|---|---|---|
| Lisinopril 20 mg daily | Hypertension; albuminuria in kidney disease | Yes |
| Metformin, 1,000 mg morning and evening | Type 2 diabetes | Yes; dose appropriate for eGFR 52 |
| Atorvastatin 40 mg nightly | Cardiovascular prevention with diabetes | Reasonable; review goals |
| Omeprazole 20 mg daily | Started in hospital in 2021; no ulcer or reflux diagnosis found | No current indication |
| Oxybutynin ER 10 mg daily | Urge incontinence | Not working; harms likely |
| Diphenhydramine 25 mg most nights (over the counter) | Sleep | No; avoid in older adults |
| Aspirin 81 mg daily (over the counter) | Started on a friend's advice; no heart disease or stroke | Primary prevention at 81; review |
| Acetaminophen 500 mg as needed | Knee pain | Yes |
| Calcium with vitamin D daily | Bone health | Reasonable |
Hydrochlorothiazide was stopped three weeks ago.
An Indication for Every Line
Three lines have no current indication or a weak one: omeprazole, diphenhydramine and aspirin. One has an indication but is not achieving it and is causing harm: oxybutynin. Scott et al. (2015) describe deprescribing as a structured process that starts with exactly this review of each medicine's indication against its risks.
Burden Added Up
On the Anticholinergic Cognitive Burden scale, oxybutynin scores 3 and diphenhydramine scores 3, for a total of 6 (Boustani et al., 2008). A score of 3 or more is associated with worse thinking and more falls in older adults. R.D.'s total comes from two medicines taken in the evening and at night, which matches the "foggy" 02:30 fall.
Two Chosen, With Reasons
1. Diphenhydramine. Most harm for least gain, bought without a prescription and taken at the hour of the falls. Stopping it removes half the anticholinergic burden.
2. Oxybutynin. The other half of the burden. It has not controlled the urgency: nights are still broken by two or three urgent trips, with leaking. The Beers Criteria advise avoiding strongly anticholinergic medicines in older adults with falls or cognitive impairment (2023 American Geriatrics Society Beers Criteria Update Expert Panel, 2023).
Not chosen today:
Omeprazole. Long-term use without an indication has risks, but stopping suddenly can cause rebound acid symptoms, so it needs a taper. It does not contribute to the falls. Next visit.
Aspirin. For primary prevention at 81, recent evidence suggests bleeding risk outweighs benefit, but the decision deserves its own conversation. Next visit.
Stopping four things together would hide which stop produced any new symptom, and R.D.'s mild cognitive impairment makes a simple plan essential.
Order and Taper
Week 1: Diphenhydramine. Alternate nights for seven days, then none. The short taper is to soften rebound sleeplessness, not because withdrawal is dangerous. Replace it with a sleep routine: same bedtime, no daytime nap after 15:00, a warm drink without caffeine and the motion-sensor night light already installed.
Week 3: Oxybutynin. Stop once diphenhydramine is gone and sleep has settled, so that any change in urgency can be attributed to oxybutynin alone. No taper is needed for the extended release form. Replace it with timed voiding every two to three hours while awake, urinating before bed and on waking, and reducing fluid after 19:00 while keeping total daily fluid steady.
If urgency is worse after stopping oxybutynin, the next option is a bladder medicine without anticholinergic effects; mirabegron can raise blood pressure, so home readings would need checking.
What the Daughter Will Do
The daughter will remove the nighttime pain reliever from the bathroom cabinet after the first week, so that it is not taken from habit, and will update the pill organizer when oxybutynin stops. The daughter asked whether R.D. could use melatonin instead; I said evidence for melatonin in older adults with insomnia is limited and that the sleep routine should be tried first.
Why This Order
Diphenhydramine goes first because it is the easier conversation, it is the medicine most closely tied to the 02:30 fall and its loss is the least likely to cause a new problem. Oxybutynin goes second, after sleep has settled, because stopping it may increase urgency for a time, and two changes at night in the same week would leave R.D. sleepless and rushing at once.
What Happens to the Other Medicines
Lisinopril, metformin, atorvastatin, acetaminophen and calcium with vitamin D continue unchanged. Omeprazole and aspirin are flagged on the problem list with a date for review. Writing the date down is part of the plan; medicines left for later have a way of being left for good.
Monitoring
The daughter will record on the calendar, each morning: hours slept, number of times up at night, any leaking and any fall or near fall.
Phone call from the clinic nurse at the end of week 1 and week 3.
Clinic visit at week 5, with the calendar, a Mini-Cog repeat and home blood pressure readings.
The Conversation
R.D. had bought the nighttime pain reliever for years and was worried about not sleeping. We talked about what the medicine does at night and the fall at 02:30. R.D. asked, "So the sleeping pill might be why I'm foggy?" and agreed to try. On oxybutynin, R.D. was more hesitant: "I don't want to leak more." We agreed to try for two weeks, with the bladder routine, and to restart a different medicine if it was worse. The daughter will help with the calendar and fill the organizer to reflect each change.
What Success Looks Like
At week 5: fewer than two times up at night, no falls, no worse leaking and a Mini-Cog no lower than 3.
References
2023 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
Boustani, M., Campbell, N., Munger, S., Maidment, I., & Fox, C. (2008). Impact of anticholinergics on the aging brain: A review and practical application. Aging Health, 4(3), 311-320. https://doi.org/10.2217/1745509X.4.3.311
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
Reading the NR 601 Week 5 instructions
The Week 5 write-up looks like an audit that ends in a decision. List every agent with the indication it is taken for, so the ones without a current indication stand out. Total the anticholinergic burden rather than mentioning it. Choose one or two medicines to stop, with reasons, and say why the others wait. Give an order of operations, a taper where one is standard, a monitoring interval and an account of the conversation with the patient. Most rubrics mark down a paper that identifies problem drugs and stops nothing, a clean sweep of five agents at one visit and a stop with no taper or monitoring.
How this NR 601 Week 5 example is built
The sample's table lists nine medicines with indications and whether each is still indicated. Omeprazole, diphenhydramine and aspirin lack a current indication; oxybutynin has one but is failing. The anticholinergic total of 6 is calculated from two medicines taken at night. Diphenhydramine is chosen first and oxybutynin second, with reasons, and omeprazole and aspirin are dated for later. The order and short taper are given, with a sleep routine and timed voiding as replacements. The daughter's role, the reason for the order, monitoring by calendar and calls, the conversation with R.D. and a definition of success at week five close it.
Reading the NR 601 Week 5 grading rubric
The expensive failure is a paper that identifies the problem drugs and then stops nothing; this one stops two in sequence. A clean sweep of five agents at once costs almost as much, and the paper explains why changing four medicines together would hide which caused a new symptom. A stop with no taper loses a row, while diphenhydramine is tapered over a week. Missing monitoring loses marks, and a calendar, two calls and a visit are set. Totaling the burden rather than mentioning it earns the analysis criterion. Recording the patient's hesitation shows the conversation took place. Explaining the stopping order shows the plan was sequenced for safety. Dating the medicines left for later stops them being forgotten.
NR 601 Week 5 help from the desk
Weak NR 601 Week 5 write-ups list potentially inappropriate medicines and stop there. Others stop everything at once. Many forget that some medicines need a taper. Few set a monitoring plan or describe the conversation with the patient. Anticholinergic burden is often mentioned but not added up. List every medicine with its indication, total the burden, choose one or two to stop with a reason and an order and write down how you will know whether it worked. With a different patient, the full medicine list is the place to start, and a review in this format can be built from it on request. Say who will help the patient carry out each change.
Get a NR 601 Week 5 example written to your instructions
Send the Week 5 medicine list and whatever your classroom published about the assignment, and a custom write-up is returned inside 24 to 48 hours with the first one free. It will show the indication audit, the ranking that produced the choice, and the taper written out rather than assumed.
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NR 601 Week 5 questions, answered
Which tool should the write-up use?
Sections name their own, and several established explicit criteria lists for older adults are in common use at this level. Name the tool you applied, then apply it to this patient rather than reproducing its table. A criterion flagged and then reasoned about, including the case for keeping an agent the list warns against, scores better than a screenshot of the tool.
What if a specialist started the medicine?
That belongs in the write-up rather than being a reason to skip the agent. Say who prescribed it, what the original indication was, whether it still holds, and how the recommendation would be communicated to that prescriber. Deprescribing across clinicians is mostly a communication problem, and a paper that shows the message being sent is stronger than one that assumes agreement.
Is it ever right to leave a risky drug in place?
Yes, and saying so with reasons is often the strongest paragraph in the paper. A tablet that keeps somebody sleeping, walking or eating may be worth its risk when the alternative is a fall in function nobody wanted. What is required is the same standard applied in both directions, so keeping it is argued rather than simply left unexamined.
Where can I find a free NR 601 Week 5 sample paper?
The full deprescribing write-up for R.D., with indications, anticholinergic burden and a stopping order, is on this page.
Why is diphenhydramine stopped first in the NR 601 Week 5 write-up?
It does the most harm for the least gain, is most closely tied to the 02:30 fall and is the least likely to cause a new problem when stopped.