### Scenario 1
**Patient:** Jamie, 38-year-old homeless bipolar patient with an acute psychotic episode, currently on lithium and imipramine.
**Assessment:**
– Lithium is a standard treatment for bipolar disorder, but needs monitoring due to narrow therapeutic index.
– Imipramine is a tricyclic antidepressant, which can interact with lithium and may increase the risk of serotonin syndrome.
**Treatment Plan:**
1. **Lithium:**
– Continue lithium at current dose.
– Monitor serum lithium levels, renal function, and thyroid function every 3 months.
2. **Imipramine:**
– Taper off imipramine gradually due to risk of serotonin syndrome and adverse interactions with lithium.
**Prescription:**
– Lithium 300 mg PO TID
– #90 (30 days supply)
– 2 refills
– Monitor lithium levels in 5 days.
– Imipramine taper:
– Imipramine 75 mg PO daily for 1 week, then 50 mg daily for 1 week, then 25 mg daily for 1 week, then discontinue.
**Monitoring:**
– Regular follow-up appointments to monitor mental status, lithium levels, and side effects.
– Monitor for signs of lithium toxicity (tremors, polyuria, polydipsia, GI distress).
**References:**
1. APA Practice Guidelines for the Treatment of Patients With Bipolar Disorder, Second Edition.
2. Lexicomp Online, Lithium.
3. UpToDate, Imipramine: Drug Information.
### Scenario 2
**Patient:** AH, 68-year-old woman with rheumatoid arthritis (RA), Crohn’s disease, incontinence, and well-controlled type 2 diabetes.
**Assessment:**
– Current RA treatment: Meloxicam 15 mg PO daily.
– Increased arthritis pain.
– Crohn’s disease requires careful consideration of NSAID use.
**Treatment Plan:**
1. **Meloxicam:**
– Continue meloxicam 15 mg PO daily.
– Monitor for GI symptoms and renal function.
2. **Additional Medication for RA:**
– Consider adding a disease-modifying antirheumatic drug (DMARD) such as methotrexate.
**Prescription:**
– Meloxicam 15 mg PO daily
– #30 (30 days supply)
– 2 refills
– Methotrexate 10 mg PO weekly
– #4 (1 month supply)
– 2 refills
**Monitoring:**
– CBC, LFTs every 2-4 weeks initially, then every 8-12 weeks once stable.
– Monitor for signs of infection, hepatic toxicity, and hematologic abnormalities.
**References:**
1. American College of Rheumatology (ACR) guidelines for the management of rheumatoid arthritis.
2. UpToDate, Methotrexate: Drug Information.
3. Lexicomp Online, Meloxicam.
### Scenario 3
**Patient:** Sheila, 26-year-old with history of head injury and tonic-clonic seizures, experiencing “funny” eye movements, uncoordination, blurred vision, lethargy. Current medications: Ritalin, Dilantin, Paxil, Lasix.
**Assessment:**
– Symptoms suggest phenytoin (Dilantin) toxicity, exacerbated by hypoalbuminemia.
– Current Dilantin level: 11 µg/mL (therapeutic range: 10-20 µg/mL).
**Treatment Plan:**
1. **Phenytoin:**
– Adjust dosage based on corrected phenytoin level.
– Corrected phenytoin level = Total phenytoin level / (0.2 * albumin + 0.1) = 11 / (0.2 * 2 + 0.1) ≈ 27.5 µg/mL (toxic).
2. **Discontinue/adjust other medications as needed.**
**Prescription:**
– Phenytoin 200 mg PO BID (reduce dose due to toxicity).
– #60 (30 days supply)
– 2 refills
**Monitoring:**
– Repeat phenytoin levels in 5 days.
– Monitor CBC, liver function, and signs of toxicity.
**References:**
1. Epilepsy Foundation: Phenytoin.
2. Lexicomp Online, Phenytoin.
3. UpToDate, Seizure Management.
### Scenario 4
**Patient:** Xavi, 44-year-old male with low back pain post-MVA, requesting Lortab refill.
**Assessment:**
– Acute pain management requires appropriate opioid use, but with caution to avoid dependence.
**Treatment Plan:**
1. **Lortab (Hydrocodone/Acetaminophen):**
– Prescribe a short course with careful monitoring.
– Consider non-opioid analgesics and physical therapy.
**Prescription:**
– Lortab 5/325 mg PO q6h PRN pain
– #20 (5 days supply, 4 doses/day)
– No refills
**Monitoring:**
– Pain assessment in 5 days.
– Discuss non-pharmacologic pain management strategies.
– Evaluate for signs of opioid misuse.
**References:**
1. CDC Guidelines for Prescribing Opioids for Chronic Pain.
2. Lexicomp Online, Hydrocodone/Acetaminophen.
3. UpToDate, Management of Acute Pain.
Week 9: Women’s and Men’s Health, and Ear, Eyes, and Skin
1. Review the case studies (attachment) and answer ALL questions.
1. When recommending medications, write out a complete prescription for each medication. What order would you send to a pharmacy? Include drug, dose, route, frequency, special instructions, # dispensed (days supply), refills, etc. Also state if you would continue, discontinue or taper the patient’s current medications.
1. Use clinical practice guidelines in developing your answers. Please review all Required Learning Resources. Use the Medscape app or website to complete assignment.
Include at least three references to support each scenario and cite them in APA format. Please include in-text citations. You do not need an introduction or conclusion paragraph
SCENARIO 1
Jamie is a 38-year-old homeless bipolar patient that presents with an acute psychotic episode. He tells you that he has been on lithium for years and was recently started on imipramine 75 mg daily by someone at a free clinic. What treatment plan would you develop for Jamie? How would you monitor therapy?
SCENARIO 2
A 68-year-old woman AH has a history of rheumatoid arthritis and has been taking meloxicam 15 mg po daily for 2 years. Other pertinent past medical history includes: occasional incontinence, Crohn’s disease with frequent exacerbations, and well-controlled diabetes type 2. Recently, her arthritis pain has been much worse and she is requesting additional medication for her rheumatoid arthritis. What treatment plan would you develop for AH? How would you monitor therapy?
SCENARIO 3
Sheila is a 26-year-old with history of head injury and tonic clonic seizures. She is seen today with complaints of “funny” eye movements, feeling uncoordinated, blurred vision, and feeling lethargic. Her current medications include Ritalin 10 mg po BID, Dilantin 300 mg po BID, Paxil 20 mg po daily, Lasix 20 po daily Lab Values from today Dilantin level of 11 Albumin 2 WBC 9.9 Plt 177 Na 141 K 4.2 Hg 13.2. What do you think is causing the patient’s symptoms? What lab values and calculated corrected medication level support your diagnosis? What is your treatment plan for this patient?
SCENARIO 4
Xavi is a 44-year-old man with complaints of low back pain following a motor vehicle accident. The accident occurred 10 days ago. He rates his pain 8 out of 10. He was prescribed Lortab 5 / 325 in the ER. He is requesting a refill of the Lortab today and indicates it just barely makes him comfortable. What treatment plan would you implement for Xavi? What days supply would you prescribe?
"Place your order now for a similar assignment and have exceptional work written by our team of experts, guaranteeing you "A" results."
