PK is a 16-year-old female diagnosed with mild persistent asthma since age 12

SCENARIO 2

PK is a 16-year-old female diagnosed with mild persistent asthma since age 12. During her visit today, she reports having to use her albuterol MDI 3 days per week over the past 2 months. Over the past week she has been using albuterol at least once per day. She reports being awakened by a cough 5 nights during the last month. She also has a fluticasone MDI, which she uses “most days of the week.” Her current medications include: Flovent HFA 44 mcg two puffs BID, Proventil HFA two puffs Q 4-6 hr PRN shortness of breath, fexofenadine 180 mg po daily, diphenhydramine 50 mg qhs prn. What treatment plan would you implement for PK? What medication changes would you make? Include a complete medication order. How would you monitor the effectiveness of this plan, and what patient education would you provide? 
 

SOLVED – Scenario 1
: Prescription Error Identification & Correction – PK is a 16-year-old female diagnosed with mild persistent asthma since age 12

Prescription mistakes are a global public health issue, leading to severe medication responses and poor patient outcomes, especially among the elderly (Agustí et al., 2023). Adverse medication responses, inappropriate usage, interactions, inaccurate doses, and poor compliance are compounded by systemic inefficiencies such as prior authorization delays. To reduce these hazards, advanced practice nurses must grasp pharmaceutical categorization, MOA, and prescription formatting.

The prescription “linagliptin 5 mg PO daily #30 5 RF” has three significant errors, including the medicine name is misspelt (“linaglipton” should be “linagliptin”), the abbreviation “RF” should be “refills,” and the amount “#30” should be “30 tablets.”  This might cause dispensing errors and patient damage. The exact prescription is Linagliptin 5 mg tablet, one tablet daily. Give 30 pills and 5 refills for type 2 diabetes. Linagliptin inhibits DPP-4. Inhibiting the DPP-4 enzyme increases incretin hormones (GLP-1 and GIP), which enhance glucose-dependent insulin release and reduce glucagon production, decreasing blood glucose (Aroda et al., 2012).

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“Tresiba inject 10 units SC TID with meals #1 box of 5 pens 1 RF” is dangerously inaccurate. Tresiba (insulin degludec) is a once-daily basal insulin; “TID with meals” might lead to harmful buildup and severe hypoglycemia (Philis-Tsimikas et al., 2019). “Inject” is redundant, “SC” is better, and “#1 box of 5 pens” is unclear. Mixing strengths (100 vs 200 units/mL) or moving from pen to syringe can cause an overdose. Correct prescription: 100 units/mL insulin degludec (Tresiba) injection. Daily subcutaneous injection of 10 units. Dispense one refill and one 3mL pre-filled pen (300 units). For diabetes. Its long-lasting effect results from multi-hexamer synthesis upon injection (Philis-Tsimikas et al., 2019).

The prescription “tiotropium (Spiriva) 2.5 mcg PO BID #60 1 RF” contains route and frequency problems. Inoculation of tiotropium is once daily (“BID”), not twice (“PO”). The proper prescription is a tiotropium bromide (Spiriva Respimat) 1.25 mcg per actuation. Orally inhale 2 puffs (2.5 mcg) every day. One inhaler (60 puffs), one refill. To maintain COPD. Long-acting muscarinic antagonists (LAMAs) block M3 receptors, preventing bronchoconstriction (Agustí et al., 2023).

The prescription “Qulipta 60 mg PRN for migraine #30 1 RF” misuses “PRN”. Daily preventative medicine Qulipta (atogepant) is not used for acute attacks (Vernieri et al., 2025). The prescription is Atogepant (Qulipta) 60 mg tablet, taken once daily. 30 pills, 1 refill. For episodic migraine prevention. According to Vernieri et al. (2025), it selectively blocks the CGRP receptor, inhibiting the neurogenic inflammation and vasodilation implicated in migraine pathophysiology.

The life-threatening mistake in the levothyroxine prescription “levothyroxine 88 mg PO daily #30 5 RF” is milligrams instead of micrograms. 88 mg is 1000 times the usual amount. The exact prescription is one levothyroxine sodium 88 mcg tablet taken once a day on an empty stomach. Give 30 pills and 5 refills. The metabolic regulator levothyroxine is a synthetic T4 prohormone converted to active T3 for hypothyroidism.

References

Agustí, A., Celli, B. R., Criner, G. J., Halpin, D., Anzueto, A., Barnes, P., Bourbeau, J., Han, M. K., Martinez, F. J., De Oca, M. M., Mortimer, K., Papi, A., Pavord, I., Roche, N., Salvi, S., Sin, D. D., Singh, D., Stockley, R., Varela, M. V. L., . . . Vogelmeier, C. F. (2023). Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary.
American Journal of Respiratory and Critical Care Medicine
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(7), 819–837. https://doi.org/10.1164/rccm.202301-0106pp

Aroda, V. R., Henry, R. R., Han, J., Huang, W., DeYoung, M. B., Darsow, T., & Hoogwerf, B. J. (2012). Efficacy of GLP-1 receptor agonists and DPP-4 Inhibitors: Meta-Analysis and Systematic Review.
Clinical Therapeutics
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Philis‐Tsimikas, A., Billings, L. K., Busch, R., Portillo, C. M., Sahay, R., Halladin, N., Eggert, S., Begtrup, K., & Harris, S. (2019). Superior efficacy of insulin degludec/liraglutide versus insulin glargine U100 as add‐on to sodium‐glucose co‐transporter‐2 inhibitor therapy: A randomized clinical trial in people with uncontrolled type 2 diabetes.
Diabetes Obesity and Metabolism
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(6), 1399–1408. https://doi.org/10.1111/dom.13666