Assignment

Directions: For each of the scenarios below, answer the questions below using your required learning resources, clinical practice guidelines, and medscape. 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

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)?

Lupron 3.75 mg Inject SC monthly for endometriosis up to 6 months #1 5RF
finasteride 1 mg PO daily for BPH #30 3RF (Note: women should not handle crushed/broken tablets- teratogenic to male fetus)
erythromycin 0.5% otic ointment Apply a ½ inch ribbon to the affected eye(s) every 4 hours x 5 days #1 tube (3.5g) 0RF
Augmentin (875 mg clavulanate/125 mg amoxicillin) PO every 12 hours x 10 days #20 0RF
rivoraxaban 20 mg PO daily with evening meal #30 0RF

SCENARIO 2

JL is a 65-year-old female seen in the clinic today. She presents with fatigue, brain fog, sore throat and temperature of 99.1. She reports that symptoms began three days ago with a sore throat and have progressively worsened. She also mentions loss of appetite. Oxygen sat 97%, respiratory rate 17, bp 122/73. Her rapid COVID-19 antigen test is positive. Chest x-ray is clear, no signs of pneumonia. Current medication includes atorvastatin 40 mg po daily. What treatment plan would you implement for JL (include complete medication order)? What patient education and monitoring would you provide?

SCENARIO 3

JS is a 23-year-old woman that presents with fatigue, poor concentration and heavy menstrual periods. Her labs today show TSH 20, MCV 76, MCHC 27, ferritin 11, TIBC 421, Hgb 11.8. Current medications include sumatriptan prn for migraine with aura and drospirenone 4mg one tablet po daily prescribed by her pharmacist, as well as kelp, chromium picolinate, turmeric and green tea supplements daily. What treatment plan would you implement for JS? What medication changes would you make? Include complete medication order(s). How would you monitor the effectiveness of this plan, and what patient education would you provide?

SCENARIO 4

A patient is prescribed gentamicin 5 mg/kg IV once daily for a 60 kg patient. The pharmacy stocks gentamicin in 80 mg/2 mL vials.

How much gentamicin (mg) should be administered per dose?
How many milliliters of gentamicin solution should be drawn up for each dose?
If the infusion rate is 10 mg/min, how long will it take to administer one dose?
A trough level is drawn 30 minutes before the next dose, and the result is 3 mcg/mL. Is the current dosing regimen appropriate based on the trough level? Would you increase, decrease, or leave the dose the same? Please include a complete medication order. What are risks associated with aminoglycoside therapy?
Why is gentamicin typically administered intravenously rather than orally? How does this relate to bioavailability?

Struggling with where to start this assignment? Follow this guide to tackle your medication scenarios easily!

This assignment requires you to identify prescription errors, correct orders, classify medications, explain mechanisms of action, and provide patient-centered treatment plans. Follow these steps to organize your responses.

Step 1: Scenario 1 – Prescription Error Correction

Identify errors: Look for mistakes in dose, route, frequency, duration, refills, or formulation.
Classify each medication: Include drug class and mechanism of action (MOA).
Rewrite prescriptions correctly using full format:
- Drug name
- Dose and strength
- Route
- Frequency
- Duration (# of days supply)
- Refills
- Special instructions (if applicable)

Example Template:

Original: Lupron 3.75 mg Inject SC monthly for endometriosis up to 6 months #1 5RF
Corrected: Leuprolide acetate (Lupron) 3.75 mg SC monthly × 6 months for endometriosis #1 vial, 0 refills
Drug class: GnRH agonist
MOA: Suppresses pituitary gonadotropins, reducing estrogen production

Step 2: Scenario 2 – Acute COVID-19 Management

Assess patient: Mild COVID-19, no pneumonia, comorbidities considered.
Determine treatment: Outpatient supportive care; consider antivirals or monoclonal antibodies if indicated based on guidelines (NIH/CDC).
Complete medication order example:
- Drug, dose, route, frequency, duration
- Include PRN medications if symptomatic treatment is needed (e.g., acetaminophen for fever)
Patient education: Symptom monitoring, isolation guidelines, when to seek care for worsening symptoms
Monitoring: Oxygen saturation, hydration, signs of secondary infection

Step 3: Scenario 3 – Hypothyroidism & Iron Deficiency

Assess labs: TSH 20 → hypothyroidism; MCV 76, ferritin 11 → iron-deficiency anemia
Treatment plan:
- Initiate levothyroxine for hypothyroidism (dose based on weight and comorbidities)
- Start oral iron supplementation (e.g., ferrous sulfate) for iron deficiency
Medication adjustments: Review supplements for potential interactions
Patient education: Proper administration of thyroid hormone and iron (separate timing), dietary considerations
Monitoring: TSH, free T4, hemoglobin, ferritin, symptoms

Step 4: Scenario 4 – Gentamicin Calculation & Monitoring

Dose calculation: mg/kg × patient weight (kg)
Volume calculation: Convert mg to mL based on vial concentration
Infusion time: mg ÷ infusion rate (mg/min) = minutes
Trough evaluation: Compare level to therapeutic range; adjust dose if needed
Complete order example: Include drug, dose, route, frequency, infusion instructions, # of vials, refills
Considerations:
- Risks: nephrotoxicity, ototoxicity
- IV route: poor oral bioavailability, ensures therapeutic plasma concentration

Step 5: Writing the Assignment

Use APA 7th edition for references (minimum 3 per scenario).
Include clinical practice guidelines (e.g., ACOG for Lupron, CDC/NIH for COVID-19, AACE for hypothyroidism).
Use evidence-based sources such as Medscape, UpToDate, or peer-reviewed journals.
Ensure clarity and precision in all medication orders.

Step 6: Tips for Submission

Organize by scenario (Scenario 1, Scenario 2, etc.).
Use tables for prescription corrections if it helps with readability.
Include rationale for each medication choice and monitoring plan.
Proofread for grammar, spelling, and clinical accuracy.

Correcting Prescriptions and Developing Evidence-Based Treatment Plans