Musculoskeletal Assignment

Directions: For each of the scenarios below, answer the questions below using clinical practice guideline where applicable. Explain the problem and explain how you would address the problem. If prescribing a new drug, write out a complete medication order just as you would if you were completing a prescription. 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)?

• allopurinol 1.2 mg PO initially, followed by 0.6 mg one hour later for acute gout flare #3 0 RF

• dextromethorphan/bupropion (Vraylar) 45 mg/105 mg extended-release tablet Take 1 tablet PO QAM for 3 days, then 1 tablet PO BID #60 0RF

• trazadone 50 mg po qhs #30 1 RF

• lithium carbonate 300 mg po TID #90 for goal therapeutic range of 1-2 mEq/L

• fentanyl transdermal patch 25 mcg/hr Apply 1 patch topically every 72 hours. Rotate application site. #10 patches 1RF

 

SCENARIO 2

Buspirone has a half-life of 3 hours. If a patient takes 15 mg at 20:00, what will the blood level (mg) be at 8 am? Name 3 medications you might prescribe for a patient with anxiety. Include complete medication orders, MOA and common side effects for each of the 3 medications.

 

SCENARIO 3

LB is an 8-year-old male brought in by his mother due to concerns about behavior and school performance. His teacher reports that LB is frequently out of his seat, talks excessively, blurts out answers, and has difficulty completing tasks or following multi-step directions. At home, he often loses toys and homework, seems forgetful, and struggles to stay focused on activities like reading. He has no significant medical history. Growth and development are age-appropriate. He sleeps about 9 hours per night but still wakes up feeling tired. His diet is average for a child his age. There are no signs of anxiety, depression, or other mood disorders. What is the most likely diagnosis? What is an appropriate first-line medication (include complete medication order)? What monitoring parameters should be considered during treatment?

 

 

 

SCENARIO 4

ST is a 51-year-old male presenting for medication refills. He has no recent lab work, but reports fatigue and occasional dizziness. Current meds: metformin 1000 mg PO daily, Jentadueto 2.5 mg/1000 mg PO BID, fluoxetine 20 mg po daily, amitriptyline 50 mg PO qhs, valacyclovir 1 gram PO TID x 7 days, gabapentin 300 mg PO TID. He is unsure of his A1c or blood pressure. How would you assess and improve his regimen? What monitoring is needed? List 5 possible disease states based on his medications.

Struggling with where to start this assignment? Follow this guide to tackle your musculoskeletal and pharmacology scenarios easily!

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

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Step 1: Scenario 1 – Prescription Error Identification

1. Review each prescription for errors in:

   • Dose

   • Frequency

   • Route

   • Duration

   • Refills

   • Drug interactions or contraindications

2. Classify each medication: Provide the drug class and mechanism of action (MOA).

3. Rewrite each prescription correctly using standard prescription format:

   • Drug name

   • Dose and strength

   • Route

   • Frequency

   • Duration (# days supply)

   • Refills

   • Special instructions (if applicable)

Example Template:

• Original: allopurinol 1.2 mg PO initially, followed by 0.6 mg one hour later for acute gout flare #3 0 RF

• Corrected: Allopurinol 100 mg PO once daily, titrate as needed to prevent gout flares × 30 days, 0 refills

• Drug class: Xanthine oxidase inhibitor

• MOA: Inhibits xanthine oxidase, decreasing uric acid production

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Step 2: Scenario 2 – Buspirone Pharmacokinetics & Anxiety Medications

1. Half-life calculation: Use exponential decay formula:

   Ct=C0×(12)tt1/2C_t = C_0 times left(frac{1}{2}right)^{frac{t}{t_{1/2}}}Ct​=C0​×(21​)t1/2​t​

   • Identify the remaining blood level at 12 hours post-dose (from 20:00 to 8:00).

2. Anxiety medication selection: Choose three evidence-based options, e.g.:

   • Buspirone: 5–10 mg PO TID

     • MOA: Partial 5-HT1A receptor agonist

     • Common side effects: dizziness, nausea, headache

   • Sertraline: 25–50 mg PO daily

     • MOA: SSRI, inhibits serotonin reuptake

     • Common side effects: GI upset, insomnia, sexual dysfunction

   • Alprazolam: 0.25–0.5 mg PO TID PRN anxiety

     • MOA: Benzodiazepine, enhances GABAergic transmission

     • Common side effects: sedation, dependence, dizziness

3. Provide complete medication orders for each, including dose, route, frequency, duration, and refills.

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Step 3: Scenario 3 – Pediatric ADHD

1. Diagnosis: Likely ADHD, combined presentation (per DSM-5 criteria: hyperactivity, impulsivity, inattention).

2. First-line medication: Typically a stimulant such as methylphenidate or amphetamine derivatives.

   • Example prescription:

     • Methylphenidate ER 18 mg PO once daily in the morning × 30 days, 2 refills

3. Monitoring parameters:

   • Vital signs (BP, HR)

   • Growth (height, weight)

   • Symptom improvement (inattention, hyperactivity)

   • Adverse effects (insomnia, appetite suppression)

4. Provide patient/caregiver education on medication timing, adherence, and monitoring.

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Step 4: Scenario 4 – Polypharmacy Assessment

1. Assess current medications: Identify possible drug duplications, interactions, and unnecessary agents.

2. Monitoring needs:

   • A1c, fasting glucose, renal function, liver function

   • Blood pressure

   • Electrolytes, especially if on multiple medications with metabolic effects

3. Potential disease states based on medications:

   • Type 2 Diabetes Mellitus (metformin, Jentadueto)

   • Depression (fluoxetine, amitriptyline)

   • Neuropathy or chronic pain (gabapentin)

   • Viral infection (valacyclovir)

   • Possible anxiety or insomnia (amitriptyline for off-label use)

4. Optimization plan:

   • Consider deprescribing unnecessary medications

   • Adjust doses based on labs, age, renal function

   • Provide patient education regarding adherence, monitoring, and lifestyle measures

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Step 5: Writing Your Assignment

• Organize by scenario (Scenario 1, Scenario 2, etc.)

• Use tables for prescription corrections if helpful for clarity

• Include rationale for each medication choice and monitoring plan

• Use APA 7th edition for citations; at least 3 scholarly references per scenario

• Sources: clinical practice guidelines (ACR for musculoskeletal disorders, AAP for pediatric ADHD, ADA for diabetes, NIH/Medscape)

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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 accuracy

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