When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (ie diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.

Learning Resources: not limited to the lecturio resources and all required reading

Week 4 Assignment: Please use the following Case Studies to complete your Assignment

To Prepare:

Review the following case studies and answer ALL questions.
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 clinical practice guidelines in developing your answers. Please review all Required Learning Resources. Use the Medscape app or website and JNC 8 to complete assignment.
Include at least three references to support each scenario and cite them in APA format. Please include in-text citations. You do not need an introduction or conclusion paragraph.

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?

Struggling with where to start this assignment? Follow this guide to tackle your pharmacology case studies easily!

This assignment requires you to identify prescription errors, correct orders, classify medications, explain mechanisms of action, and create patient-centered treatment plans. Follow these steps for each scenario.

Step 1: Scenario 1 – Prescription Error Identification

Review each prescription for errors in:
- Dose, strength, or frequency
- Route of administration (oral vs inhaled)
- PRN vs scheduled dosing
- Maximum allowed daily dose
- Drug duplications or contraindications
Classify each medication: Include drug class and mechanism of action (MOA).
Rewrite prescriptions correctly using standard prescription format:
- Drug name
- Dose and strength
- Route
- Frequency
- Duration (# days supply)
- Refills
- Special instructions

Example Template:

Original: lamotrigine (Keppra) 500 mg po BID #60 2 RF
Corrected: Lamotrigine 25 mg PO daily for 2 weeks, then 50 mg PO BID, titrate as tolerated, #60, 2 refills
Drug class: Anticonvulsant
MOA: Inhibits voltage-sensitive sodium channels, stabilizing neuronal membranes and preventing excitatory neurotransmitter release

Step 2: Scenario 2 – Migraine Management

Assess patient history: AB has frequent migraines with partial response to acute therapy.
Treatment plan:
- Consider preventive therapy if >4 migraine days per month or inadequate response to acute therapy.
- Acute therapy adjustments: Try alternative or additional acute agents (e.g., triptans, antiemetics).
- Preventive therapy examples: Beta-blockers (propranolol), anticonvulsants (topiramate), CGRP monoclonal antibodies.
Medication order example:
- Topiramate 25 mg PO nightly × 1 week, then 25 mg PO BID, titrate as tolerated × 3 months, #60, 2 refills
Patient education:
- Track migraine frequency and triggers
- Take preventive medication consistently
- Use acute medications only as prescribed
- Recognize side effects and when to seek care
Monitoring effectiveness:
- Monthly headache diaries
- Reduction in migraine days and severity

Step 3: Scenario 3 – Early-Onset Alzheimer’s Disease

Medication choice: Cholinesterase inhibitors (e.g., donepezil) are first-line therapy.
Complete prescription example:
- Donepezil 5 mg PO once daily × 4 weeks, then titrate to 10 mg PO daily, #30, 1 refill
Monitoring:
- Cognitive function (MMSE or MoCA)
- Adverse effects: nausea, diarrhea, bradycardia
- Labs: baseline renal and hepatic function
Patient education:
- Take medication at the same time daily
- Report GI upset or dizziness
- Encourage caregiver support for adherence

Step 4: Scenario 4 – Type 2 Diabetes Optimization

Assess labs: BG 196 mg/dL, A1C 8.6%, eGFR 27 → avoid metformin due to low renal function; SGLT2 inhibitors not recommended.
Medication choice: GLP-1 receptor agonist (e.g., semaglutide) for glycemic control, cardiovascular benefit, and renal safety.
Prescription example:
- Semaglutide 0.25 mg SC once weekly × 4 weeks, then titrate to 0.5 mg SC weekly, #4 pens, 1 refill
MOA: GLP-1 receptor agonist increases glucose-dependent insulin secretion, decreases glucagon secretion, slows gastric emptying.
Patient education:
- Rotate injection sites
- Monitor for GI side effects
- Maintain diet and exercise
Monitoring:
- A1C every 3 months
- BG self-monitoring
- Renal function and weight
Goal A1C: 7% (per ADA guidelines for most adults)

Step 5: Writing Your Assignment

Organize by scenario (Scenario 1, Scenario 2, etc.)
Use tables for prescription corrections if helpful
Include rationale for each medication and monitoring plan
Use APA 7th edition for citations; at least 3 scholarly references per scenario
Sources: Medscape, JNC 8, clinical practice guidelines, UpToDate

Step 6: Writing Tips

Maintain professional, scholarly tone
Provide clear, concise medication orders
Ensure explanations include mechanism of action, classification, side effects, and monitoring
Proofread for grammar, spelling, and clinical accuracy

Optimizing Patient Care Through Prescription Accuracy and Pharmacologic Monitoring