Directions: For each of the scenarios below, answer the questions below using clinical
practice guideline where applicable. Explain the problem and explain how you would
address the problem. If prescribing a new drug, write out a complete medication order
just as you would if you were completing a prescription. Use at least 3 sources for each
scenario and cite sources using APA format.
1. Jamie is a 38-year-old homeless bipolar patient that is diagnosed with an acute
psychotic episode. He tells you that he has been on lithium for years and was
recently started on amitriptyline (Elavil) 25mg po TID by someone at a free clinic.
What treatment plan would you develop to Jamie? Would you discontinue any
medications? What medications would you add?
2. A 68-year-old woman has a history of rheumatoid arthritis and has been taking
nabumetone (Relafen) 1000 mg po qd 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 would be appropriate additional therapy for this
patient? What monitoring would be appropriate to monitor this medication? What
monitoring would be appropriate to monitor this medication?
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?
4. Xavi is a 44-year-old man with complaints of low back pain following a motor
vehicle accident. The accident occurred 7 days ago. He rates his pain 8 out of
10. He was prescribed Lortab 5 / 325 in the ER last week. 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 medications would you
prescribe and how would you monitor them? What education would you provide
regarding his treatment plan?
