Sandra is a 52-year-old female with past medical history of hypertension and GERD. Current medications include pantoprazole 40 mg po daily 30 minutes before breakfast
Scenario 1 – Sandra
Sandra is a 52-year-old female with past medical history of hypertension and GERD. Current medications include pantoprazole 40 mg po daily 30 minutes before breakfast and HCTZ 50 mg daily. She smokes 1 pack per day and presents with persistent sadness, anxiety and “empty mood.” Her smoking habit has increased the past month as she says it “helps calm her nerves.” She denies any history of seizures. How would you treat Sandra? What medication would you prescribe (include complete medication order)? What education would you provide to the patient? What labs would you order?
Scenario 2 – JR
Patient JR is experiencing symptoms of pain, numbness and tingling in his legs. He states he sometimes has trouble keeping his balance and feels easily fatigued. He is currently on metformin 1000 mg po BID, Synjardy XR 5/1000mg po daily, Tresiba 20 units SC daily and rosuvastatin 10 mg po daily. What is your working diagnosis? How would you treat JR and improve his treatment? What would you monitor?
Scenario 3 – Zolpidem
Zolpidem has a half-life of 3 hours. If a patient takes 10 mg at 10 pm, what will the blood level be at 7 am? Do elderly patients need a smaller dosage of zolpidem? Name 3 antidepressants/antipsychotics you might prescribe for patients with co-existing depression and insomnia (include complete medication orders) and include patient monitoring.
Scenario 4 – David
A mother brings her 7-year-old son David into the clinic today stating that he is increasingly getting into trouble at school. He “fidgets and frequently leaves his seat, does not listen to his teacher, talks excessively and interrupts other classmates.” What would you prescribe for David? How common is it for a parent and child to both have ADHD? How are symptoms and treatment of ADHD different between children and adults? What would you prescribe for David’s 40-year-old mother with ADHD?
Expert Answer and Explanation
Muscle Case Study
Scenario 1
The Prescription of Medication
Sandra seems to be suffering from Major Depressive Disorder (MDD), as per the symptoms and given that she is a habitual smoker. The right medication for her would be Wellbutrin SR which is the brand name for bupropion. The drug belongs to the class of medications known as NDRIs which are effective against various conditions including comorbid disorders such as anxiety and depression (Karrouri et al., 2021).
This is the ideal choice of medication for Sandra because it improves symptoms of anxiety and MDD, and reduces cravings for nicotine, an addictive substance in cigarettes. The other aspect of this medication that makes it ideal for managing Sandra’s symptoms is that it is safe for patients with a history of GERD. This is unlike SSRIs like fluoxetine which exacerbate GERD symptoms.
The treatment will start with 150 mg of bupropion which Sandra will take once a day for the first one week. During the subsequent week, she will take 150 mg of the medication two times a week, which will also apply in the third and fourth weeks.
Patient Education
Patient education for Sandra will focus on providing her with information about the medications and lifestyle behaviors including their relationship with anxiety and depression. Part of the education would involve informing Sandra the importance of adhering to her medication, and the need for safe use of the medications, stressing the likelihood of developing seizures if she fails to adhere to the prescription information. This is necessary to prevent adverse health events linked to drug-to-drug interaction (Karrouri et al., 2021). The recommended medication causes nervousness and insomnia, and for this reason, letting her know about the side effects of the medication is crucial. This would psychologically prepare her to take the medications.
The Labs to Order
Urine screening to test for the traces of drugs is one of the important tests for this patient. This can help determine whether the symptoms are due to a substance use issue. It is equally important to screen for TSH which has similar manifestations like depression.
Scenario 2
Working Diagnosis
Considering the presented symptoms, JR appears to have Diabetic Peripheral Neuropathy (DNP), a condition that is prevalent in diabetic persons, and in which one’s legs tingle, become numb and painful. JR’s symptoms fit the profile of the DNP, which impairs motor function, and the body’s sense of action, position and locomotion. Tiredness, the other manifestation liked to diabetes, seems to occur because worsened diabetes interferes with the body’s metabolism which plays a vital role in generation of the energy in the body (Preston et al., 2023).
Treating JR and Improving his Treatment
The treatment of JR will involve applying various interventions including managing the neuropathy-based symptoms. Part of these interventions involves the use of duloxetine which is effective against DNP. To manage pain linked to DNP, Gabapentin is used, with the dosage increased or reduced depending on how the patient responds to therapy. The presence of the DNP is a possible indication of the diabetes that has worsened.
This necessitates making changes to the dosages (Preston et al., 2023). Supplementation of the vitamin B12 would be necessary in this case considering that this vitamin may become deficient with prolonged use of the metformin. It is also important to add Liraglutide, a GLP-1 receptor to the Tresiba. This would help optimize the glycemic control. JR can also benefit from physiotherapy in which they receive training on how to maintain balance.
What to Monitor
As the treatment of the patient progresses, it is important to monitor JR for the progression of the neuropathy. This would require examining if JR’s legs are numb or tingling. Monitoring glycemic control is equally crucial because it helps inform whether to adjust medications.
Scenario 3
The Prescription of Antidepressants
If Zolpidem’s half-life is 3 hours, and the patient takes 10 mg of the drug at 10 pm, the concentration of the drug on their system at 7 am will be:
The time difference between 10 pm and 7 am is 9 hours.
This means that the number of half-lives = 9 hours/ 3 hours
= 3 half-lives.
For the first half-life, the concentration will be 10 mg/2= 5 mg
For the second half-live, the amount of drug in his system will be 5 mg/2=2.5 mg
Concentration of Zolpidem in the patient’s system at the third half-life is 2.5/2=1. 25 mg
The safe prescription of the Zolpidem requires considering the patient’s age. Low dosage is recommended for an elderly patient due to the slow rate of metabolism in elderly population. Using 10mg or more for this population exposes the patient to the risk of experiencing dizziness and other side effects because slow metabolism results in the accumulation of the medication into their systems (Edinoff et al., 2021). According to the Food and Drug Administration, 5mg is the ideal dosage for an elderly patient.
The Antidepressants
The management of the insomnia and depression that co-occur involves the use of quetiapine which is taken as a 50 mg of oral medication once a day during bedtime.
The second option is 15 mg of oral mirtazapine which is increased depending on how the patient responds to treatment. The same applies to the Trazodone which starts with 50 mg dosage and is taken orally once a day.
Patient Monitoring
When monitoring the patient, a provider assesses the patient’s moods, and examines their sleep patterns. They also examine the signs that may indicate the patient’s suicide risk.
Scenario 4
Prescription for David
Given David’s age, the medication that needs to be prescribed is Ritalin, a methylphenidate-based stimulant which starts with a 10 mg dose. This particular medication increases dopamine and norepinephrine’s activities, allowing the patient to maintain focus and have a better control of impulses.
The Likelihood of a Child and a Parent Having ADHD
While personal factors and influences within one’s environment can expose them to the risk of ADHD, a child can inherit the disorder from their parents. The common genome characteristics in parents and their children mean that a child’s risk of developing the condition is high if their parent suffers from the disorder (Eiland & Gildon, 2024).
Difference in ADHD Management in Children and in Adults
While the ADHD symptoms in adults and children are generally similar, hyperactivity manifests differently between the two groups. In adults, this symptom is less pronounced while in children, it is clearly noticeable (Eiland & Gildon, 2024). Due to this difference and the variation in metabolism between the two groups, a lower dose of medication is used for a child while in adult, the dosage is higher.
Prescribing for the David’s Mother
When treating ADHD in David’s mother, the Vyanse would be the appropriate treatment. However, 20 mg of Ritalin taken at bedtime every day would still be the right drug in this case. These two represent first-line medications because of their fewer side effects, and potency in managing the symptoms.
References
Edinoff, A. N., Wu, N., Ghaffar, Y. T., Prejean, R., Gremillion, R., Cogburn, M., Chami, A. A., Kaye, A. M., & Kaye, A. D. (2021). Zolpidem: Efficacy and Side Effects for Insomnia. Health psychology research, 9(1), 24927. https://doi.org/10.52965/001c.24927.
Eiland, L. S., & Gildon, B. L. (2024). Diagnosis and Treatment of ADHD in the Pediatric Population. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 29(2), 107–118. https://doi.org/10.5863/1551-6776-29.2.107.
Karrouri, R., Hammani, Z., Benjelloun, R., & Otheman, Y. (2021). Major depressive disorder: Validated treatments and future challenges. World journal of clinical cases, 9(31), 9350–9367. https://doi.org/10.12998/wjcc.v9.i31.9350.
Preston, F. G., Riley, D. R., Azmi, S., & Alam, U. (2023). Painful Diabetic Peripheral Neuropathy: Practical Guidance and Challenges for Clinical Management. Diabetes, metabolic syndrome and obesity : targets and therapy, 16, 1595–1612. https://doi.org/10.2147/DMSO.S370050.
Place your order now for a similar assignment and get fast, cheap and best quality work written by our expert level assignment writers.
Limited Offer: NEW30 to Get 30% OFF Your First Order
