SCENARIO 1
What are the errors in the following prescriptions (5 total)? Rewrite each prescription correctly. What is each medication classification? What is the mechanism of action (MOA)?
- fluticasone/salmeterol (Advair) 115/21 mcg 1 inhalation BID #1 Diskus 3 RF
- albuterol 4 mg po 15-30 min before exercise #30 2 RF
- budesonide/fluticasone (Symbicort) 160/4.5 mcg, 2 puffs inhaled BID and 1-2 puffs prn asthma symptoms (max 12 inhalations in 24 hours) #1 inhaler 2 RF
- tiatropium (Spiriva Respimat) 2.5 mcg/actuation inhaler; inhale 2 actuations po once daily for COPD #1 inhaler/60 actuations 1 RF
- lamotrigine (Keppra) 500 mg po BID #60 2 RF
SCENARIO 2
AB is a 34-year-old female presenting to the clinic with ongoing migraine headaches. “I’m still getting migraines once a week, even though I take Ubrelvy when they start.” She reports experiencing 3 to 4 migraine attacks per month, typically associated with throbbing pain on one side, light sensitivity, and nausea. Migraines can last from 6-24 hours. AB has been taking Ubrelvy 50 mg po as needed at migraine onset for the past 3 months. She says it helps sometimes, but not consistently, and the pain often returns in a few hours. PMH: migraine without aura (diagnosed at age 27) Current medications: Ubrelvy 50 mg po PRN at onset of migraine, ondansetron 4 mg ODT dissolve on tongue PRN nausea, may repeat in 8 hours if needed. Vitals: BP 118/74, HR 78. What treatment plan would you implement for AB? What medication changes would you make? How would you monitor the effectiveness of this plan, and what patient education would you provide? Is a patient with migraines more likely to start on an acute or preventive agent? What are examples of each?
SCENARIO 3
RC is a 58-year-old female that presents to the clinic today with early-onset Alzheimer’s Disease. What would you prescribe? Consider her labs and provide a drug therapy plan. Include complete medication orders. How would you monitor therapy? Labs: TSH 3.4 mU/L, vitamin D 22 ng/mL, B12 501 pg/mL, Hgb 12.8 g/dL, BG 96 mg/dL, A1C 5.9%, BP 115/72, HR 76. Medications include: Tresiba 15 units SC once daily QHS, Novolog 5 units SC before each meal TID (adjusting based on carbohydrate intake and glucose monitoring), and lisinopril 10 mg po daily
SCENARIO 4
PL is a 63-year-old male with poorly controlled type 2 diabetes presenting for follow-up and treatment optimization. Current medications include dicyclomine 10 mg po QID prn abdominal pain, pantoprazole 40 mg po daily 30 minutes before breakfast, losartan 50 mg po daily, and probiotics daily. His lab work today includes: BG 196 mg/dL, A1C 8.6%, K⁺ 4.2, Cr 1.8, eGRF 27, BP 127/74. What treatment plan would you implement for PL (include complete medication order)? What is the classification and MOA of the drug you selected; why is it the best treatment option for PL? What education would you provide and how would you monitor the effectiveness of the treatment plan? What is his goal A1C?