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
• Sara is a 45-year-old female presenting for her annual exam. Her
blood pressure today is 160/90 HR 84 RR 16. Her height is 64 inches and her
weight is 195. Her last visit to the clinic 3 months ago shows a BP of 156/92.
She
is currently taking ibuprofen 600 mg tid for back pain. She has no known
allergies. What is the goal for her blood pressure? What medication would you
prescribe to treat her blood pressure? What education would you prescribe?
scenario 2
• Monty is a 52-year-old male following up on his labs that were
drawn last week. He smokes 1 pack per day. He is currently on Lisinopril 20 mg
po daily. He is allergic to penicillin. Fasting lipid profile shows total
cholesterol
266, LDL cholesterol 180, HDL cholesterol 40, and Triglycerides 185. What
treatment plan would you implement for Monty’s lipid profile? What is the goal
Total Cholesterol (TC), HDL-C, and LDL-C level for Monty? How would you
monitor the effectiveness of your treatment plan? How many risk factors for
coronary artery disease does this patient have? Identify them specifically.
scenario 3
• Beatrice is a 17-year-old female diagnosed with mild persistent
asthma since age 7. During her visit today, she reports having to use her
albuterol MDI 3 to 4 days per week over the past 2 months. Over the past week
she has been using albuterol at least once per day. She reports being awakened
by a cough three nights during the last month. She is becoming more short of
breath with exercise. She also has a fluticasone MDI, which she uses “most days
of the week.” Her current medications include: Flovent HFA 44 mcg, two puffs
BID, Proventil HFA two puffs Q 4–6 H PRN shortness of breath, Yaz one PO
daily, Propranolol 80 mg PO BID. What treatment plan would you implement for
this patient? What medication changes would you make? How would you monitor
the effectiveness of this plan?
scenario 4
• Daute is a 56-year-old man seeking evaluation for increasing
shortness of breath. He noticed difficulty catching his breath about 3 years
ago.
Physical activity increases his symptoms. He avoids activity as much as
possible
to prevent any SOB. His previous physician had placed him on
salmeterol/fluticasone (Advair Diskus) one inhalation twice daily 2 years ago.
He
thinks his physician initiated the medication for the shortness of breath, but
he is
not entirely sure. He did not refill the prescription and has not been taking
it.
Pertinent history – Chronic bronchitis X 8 years with one exacerbation in last
12
months of treatment with oral antibiotics. He has a 40-pack-year smoking
history.
What treatment plan would you implement for this patient? What medication(s)
would you prescribe? How would you monitor the effectiveness of this plan?
