10 Jan Musculoskeletal System

SCENARIO 1

Buspirone has a half-life of approximately 2 hours. If a patient takes 15 mg at 8 am, what will the blood level be at 2 pm? Can buspirone be given as an adjunct to antidepressant therapy? Name 3 antidepressants you might prescribe for patients with co-existing depression and anxiety (include complete medication orders) and include patient monitoring.

SCENARIO 2

What are the errors (6 total) in the following prescriptions? Rewrite each prescription correctly.

methylphenidate (Concerta) 5 mg BID before breakfast and lunch #60 1 refill

pegloticase (Krystexxa) 8 mg IV infusion once per month #1 0 refill

Ubrelvy 200 mg po prn onset of migraine #12 1 refill

alprazolam (Valium) 0.5 mg po TID #90 0 refill

zolpidem 10 mg qhs #30 6 refills

SCENARIO 3

Patient TL is experiencing symptoms of daily leg muscle weakness and feet cramping at night. He is currently on metformin 1000 mg po BID, Invokamet 50/500 mg BID with meals, atorvastatin 40 mg po daily and atomoxetine 40 mg po daily. Blood pressure is 118/78 and labs include: BG 90 mg/dL A1c 4.5% sCr 0.9 mg/dL eGFR 101 mL/min/1.73 m² total cholesterol 181 mg/dL LDL 95 mg/dL HDL 57 mg/dL TG 146 mg/dL B12 150 pg/mL CK 505 U/L What is your working diagnosis? What would you prescribe for TL and how would you improve his treatment? What would you monitor?

SCENARIO 4

When a person uses nicotine, it causes temporary feelings of relaxation and well-being. Nicotine binds to nicotinic receptors in the brain, augmenting the release of numerous neurotransmitters. Name at least three of these neurotransmitters. Patients may self-medicate ADHD, anxiety and depression by smoking. Is there a medication that could treat ADHD, anxiety, depression and provide smoking cessation? Write a complete medication order for this medication. Does the patient need to quit smoking before starting treatment?

Grading Criteria

Applicable to all Scenarios:

· Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

· Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

· Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

· References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.