1. Jamie is a 38-year-old homeless bipolar patient that is diagnosed with an acute psychotic episode. He tells you that he has been on lithium for years and was recently started on amitriptyline (Elavil) 25mg po TID by someone at a free clinic. What treatment plan would you develop to Jamie? Would you discontinue any medications? What medications would you add?
2. A 68-year-old woman has a history of rheumatoid arthritis and has been taking nabumetone (Relafen) 1000 mg po qd 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 would be appropriate additional therapy for this patient? What monitoring would be appropriate to monitor this medication? What monitoring would be appropriate to monitor this medication?
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? 4. Xavi is a 44-year-old man with complaints of low back pain following a motor vehicle accident. The accident occurred 7 days ago. He rates his pain 8 out of 10. He was prescribed Lortab 5 / 325 in the ER last week. 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 medications would you prescribe and how would you monitor them? What education would you provide regarding his treatment plan?
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