Posted: July 22nd, 2024

Scenario 1: Jamie, 38-year-old homeless bipolar patient with acute psychotic episode

For your week 7 assignment, evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.

To Prepare:

Review the case studies (attachment) and answer ALL questions.
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.
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.
Directions: For each scenario below, answer the questions below using your required learning resources, clinical practice guidelines, and medscape. Explain the problem and explain how you would address the problem. 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. Use at least 3 sources for each scenario and cite sources using APA format.

SCENARIO 1

Jamie is a 38-year-old homeless bipolar patient who 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?

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Scenario 1: Jamie, 38-year-old homeless bipolar patient with acute psychotic episode

Jamie’s current medication regimen includes lithium (duration unspecified) and recently initiated imipramine 75 mg daily. Given his acute psychotic episode and bipolar diagnosis, the following treatment plan is recommended:

Discontinue imipramine immediately due to its potential to exacerbate manic symptoms in bipolar disorder (Loots et al., 2024).

Continue lithium therapy, but adjust dosage based on serum levels: Lithium carbonate 300 mg tablets Sig: Take 2 tablets (600 mg) by mouth twice daily Dispense: #120 tablets (30-day supply) Refills: 2

Add an atypical antipsychotic for acute symptom management: Olanzapine 5 mg tablets Sig: Take 1 tablet (5 mg) by mouth at bedtime, may increase to 2 tablets (10 mg) after 3 days if needed Dispense: #60 tablets (30-day supply) Refills: 1

Monitoring plan:

Assess serum lithium levels within 5-7 days of dosage adjustment, aiming for 0.6-1.2 mEq/L

Monitor renal and thyroid function every 6 months

Evaluate metabolic parameters (weight, lipids, glucose) at baseline and regularly due to olanzapine use

Schedule follow-up within 2 weeks to assess symptom improvement and medication tolerability

The combination of lithium and olanzapine has shown efficacy in managing acute mania and preventing relapse in bipolar disorder (Leucht et al., 2016). This treatment plan aims to stabilize Jamie’s acute symptoms while addressing his long-term bipolar management.

Scenario 2: AH, 68-year-old woman with rheumatoid arthritis and multiple comorbidities

Given AH’s complex medical history and worsening arthritis pain, the following treatment plan is proposed:

Continue meloxicam 15 mg daily for baseline pain management

Add a disease-modifying antirheumatic drug (DMARD) to address disease progression: Methotrexate 2.5 mg tablets Sig: Take 3 tablets (7.5 mg) by mouth once weekly Dispense: #12 tablets (28-day supply) Refills: 2

Prescribe folic acid to mitigate methotrexate side effects: Folic acid 1 mg tablets Sig: Take 1 tablet (1 mg) by mouth daily, except on methotrexate day Dispense: #30 tablets (30-day supply) Refills: 5

For additional pain relief, add a topical NSAID to minimize systemic effects: Diclofenac sodium 1% gel Sig: Apply a thin layer to affected joints four times daily as needed for pain Dispense: 1 tube (100 g) Refills: 2

Monitoring plan:

Complete blood count, liver function tests, and renal function tests at baseline and every 4-8 weeks initially, then every 3 months

Monitor for gastrointestinal symptoms due to NSAID use and Crohn’s disease

Assess pain levels and functional status at each visit

Encourage non-pharmacological interventions such as physical therapy and low-impact exercise (Yousefi et al., 2024)

This treatment plan aims to improve AH’s arthritis symptoms while considering her comorbidities. The addition of methotrexate may help slow disease progression, while the topical NSAID provides targeted pain relief with minimal systemic absorption.

Scenario 3: Sheila, 26-year-old with history of head injury and tonic-clonic seizures

Sheila’s symptoms and lab values suggest phenytoin toxicity. The calculated corrected phenytoin level, accounting for hypoalbuminemia, is approximately 15.7 mg/L (toxic range > 20 mg/L), which may not fully explain her symptoms. However, the combination of medications and potential drug interactions could be contributing to her presentation.

Treatment plan:

Discontinue Dilantin (phenytoin) temporarily

Transition to an alternative antiepileptic drug: Levetiracetam 500 mg tablets Sig: Take 1 tablet (500 mg) by mouth twice daily for 3 days, then increase to 2 tablets (1000 mg) twice daily Dispense: #120 tablets (30-day supply) Refills: 2

Continue Ritalin and Paxil at current doses

Discontinue Lasix unless there’s a clear indication for its use

Monitoring plan:

Obtain baseline complete blood count and liver function tests

Monitor seizure frequency and adverse effects

Follow up in 2 weeks to assess symptom improvement and medication tolerability

Consider therapeutic drug monitoring of levetiracetam if seizures persist or side effects occur

Levetiracetam is chosen due to its broad-spectrum efficacy and lower risk of drug interactions compared to phenytoin (Goldenholz et al., 2024). This treatment plan aims to control Sheila’s seizures while minimizing adverse effects and drug interactions.

Scenario 4: Xavi, 44-year-old man with low back pain following motor vehicle accident

Given the short duration of Xavi’s pain and the potential risks associated with opioid use, a multimodal approach to pain management is recommended:

Discontinue Lortab (hydrocodone/acetaminophen)

Prescribe a short course of an NSAID: Naproxen 500 mg tablets Sig: Take 1 tablet (500 mg) by mouth twice daily with food for 10 days Dispense: #20 tablets (10-day supply) Refills: 0

Add a muscle relaxant for short-term use: Cyclobenzaprine 10 mg tablets Sig: Take 1 tablet (10 mg) by mouth at bedtime for 7 days Dispense: #7 tablets (7-day supply) Refills: 0

Recommend over-the-counter acetaminophen 500 mg, 1-2 tablets every 6 hours as needed for breakthrough pain

Monitoring plan:

Follow up in 2 weeks to reassess pain levels and functional status

Encourage non-pharmacological interventions such as physical therapy, heat/cold therapy, and gentle stretching exercises

Educate on proper body mechanics and ergonomics

This treatment plan aims to manage Xavi’s acute pain while minimizing the risk of opioid dependence. The short duration of prescribed medications aligns with current guidelines for acute low back pain management (Franklin et al., 2024).

References

Franklin, A.D., Tsao, K., Barq, R., Kelley-Quon, L.I., Veneziano, G., & Aldrink, J.H. (2024). Updates from the Other Side of the Drape: Recent Advances in Multimodal Pain Management and Opioid Reduction Among Pediatric Surgical Patients. Journal of Pediatric Surgery.

Goldenholz, D., Brinkmann, B.H., & Westover, M.B. (2024). How accurate do self‐reported seizures need to be for effective medication management in epilepsy? Epilepsia.

Leucht, S., Cipriani, A., Spineli, L., Mavridis, D., Önder, E., & Geddes, J. (2016). Comparative efficacy and tolerability of 13 second-generation antipsychotic drugs for schizophrenia: A meta-analysis. Lancet, 388(10039), 537-548.

Loots, E., Dilles, T., Van Rompaey, B., & Morrens, M. (2024). Attitudes of patients with schizophrenia spectrum or bipolar disorders towards medication self‐management during hospitalisation. Journal of Clinical Nursing, 33(4), 1459-1469.

Yousefi, M., Noghabi, F.A., Chopra, A., Farrokhseresht, R., Yousefi, H., Kulkarni, N., & Golalipoor, E. (2024). Non-pharmacological Community Intervention, Especially Pain Management, in Rheumatoid Arthritis: A Review of the Literature. West Indian Medical Journal, 71(1).

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