Description

Directions: For each of the scenarios below, answer the questions below using your required learning resources, clinical practice guidelines, medscape and JNC 8. 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
Donald is a 60-year-old male presenting with dyspnea (shortness of breath), chronic productive cough, wheezing, and fatigue. He smokes 1 pack of cigarettes per day for the last 40 years. Post-bronchodilator FEV1/FVC ratio < 0.70 confirms persistent airflow limitation. What treatment plan would you implement for this patient? What medication(s) would you prescribe? How would you monitor the effectiveness of this plan?

SCENARIO 2
Allen is a 49 year-year-old man seeking evaluation for “a burning sensation in my chest,” often after eating and worse at night. He has frequent feelings of bloating and occasional nausea. Allen consumes a diet high in fatty foods and caffeine. He drinks alcohol socially on weekends.
PMH includes asthma, diabetes, and hypertension. His current medications include prn albuterol, metformin 1000 mg po BID, nifedipine ER 60 mg po daily. How would you improve his drug therapy plan? What changes would you make? What is your working diagnosis and what medication would you prescribe? What information would you provide to the patient at his visit?

SCENARIO 3
Jessica is a 37-year-old female diagnosed with mild persistent asthma. During her visit today, she reports having to use her albuterol 4 days per week over the past month. Over the past week she has been using albuterol at least once per day. She reports being awakened by a cough five nights during the last month. Her current medications include fluticasone HFA 44 mcg, two puffs BID; albuterol MDI two puffs Q 4–6 H PRN shortness of breath; Medrol Dosepak, metformin 500 mg PO BID, Inderal LA 160 mg po daily. How would you step up therapy for this patient? What medication changes would you make? How would you monitor the effectiveness of this plan? What patient teaching would you provide?

SCENARIO 4
June is a 71-year-old female and has Alzheimer’s Disease x 2 years. She presents with daytime dizziness, fatigue and increasing forgetfulness. Consider her labs and provide an updated drug therapy plan. Include complete medication orders. How would you monitor drug therapy? Labs: TSH 5 mU/L, vitamin D 29 ng/mL, B12 350 pg/mL, Hb 12.1 g/dL, HgA1C = 5.5% Meds: donepezil 5mg po qhs, zolpidem 10mg po qhs.