SCENARIO 1 Jamie is a 38-year-old homeless bipolar patient that presents with an acute psychotic episode. He tells you that he has been on lithium for years and was recently started on imipramine 75 mg daily by someone at a free clinic. What treatment plan would you develop for Jamie? How would you monitor therapy? SCENARIO 2 A 68-year-old woman AH has a history of rheumatoid arthritis and has been taking meloxicam 15 mg po daily for 2 years. Other pertinent past medical history includes: occasional incontinence, Crohn’s disease with frequent exacerbations, and well-controlled diabetes type 2. Recently, her arthritis pain has been much worse and she is requesting additional medication for her rheumatoid arthritis. What treatment plan would you develop for AH? How would you monitor therapy? SCENARIO 3 Sheila is a 26-year-old with history of head injury and tonic clonic seizures. She is seen today with complaints of “funny” eye movements, feeling uncoordinated, blurred vision, and feeling lethargic. Her current medications include Ritalin 10 mg po BID, Dilantin 300 mg po BID, Paxil 20 mg po daily, Lasix 20 po daily Lab Values from today Dilantin level of 11 Albumin 2 WBC 9.9 Plt 177 Na 141 K 4.2 Hg 13.2. What do you think is causing the patient’s symptoms? What lab values and calculated corrected medication level support your diagnosis? What is your treatment plan for this patient? SCENARIO 4 Xavi is a 44-year-old man with complaints of low back pain following a motor vehicle accident. The accident occurred 10 days ago. He rates his pain 8 out of 10. He was prescribed Lortab 5 / 325 in the ER. He is requesting a refill of the Lortab today and indicates it just barely makes him comfortable. What treatment plan would you implement for Xavi? What days supply would you prescribe?
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