Week 4 Case Scenarios – Drug Therapy Evaluation and Prescription Writing

WEEK 4 ASSIGNMENT (covers weeks 3-6)- Week 4 Case Scenarios – Drug Therapy Evaluation and Prescription Writing

Submit your Assignment by Day 7 of Week 4 (Sunday night, 11:59 pm ET).

Case studies are a useful way for you to apply your knowledge of pharmacokinetic and pharmacodynamic aspects of pharmacology to specific patient cases and health histories.

For your week 4 assignment, evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.

Directions: For each of the scenarios below, answer the questions using your required learning resources, Medscape, and clinical practice guidelines (ie AHA, ACC, ADA). 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 (if applicable). 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)?

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? Week 4 Case Scenarios – Drug Therapy Evaluation and Prescription Writing

 

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Week 4 Assignment: Drug Therapy Evaluation and Prescription Writing

 

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Week 4 Assignment: Drug Therapy Evaluation and Prescription Writing

Scenario 1 -Week 4 Case Scenarios – Drug Therapy Evaluation and Prescription Writing

Errors in Prescriptions (5 total) and Corrections

fluticasone/salmeterol (Advair) 115/21 mcg 1 inhalation BID #1 Diskus 3 RF

Error:
115/21 mcg is an Advair HFA strength, not available in Diskus form. Diskus strengths are 100/50, 250/50, and 500/50 mcg.

Corrected Prescription:

fluticasone/salmeterol (Advair) Diskus 100/50 mcg, 1 inhalation BID, Disp: 1 inhaler, Refills: 3

Classification:
Inhaled corticosteroid (ICS) + long-acting beta-2 agonist (LABA).

MOA:
Fluticasone decreases airway inflammation via glucocorticoid receptor agonism (Remien & Bowman, 2024); salmeterol stimulates beta-2 receptors, causing bronchodilation (Hsu & Bajaj, 2023).

albuterol 4 mg PO 15–30 min before exercise #30 2 RF

Error:
Oral albuterol tablets are rarely used and not first-line for exercise-induced bronchospasm (Johnson & Bounds, 2024). Inhaled form is recommended.

Corrected Prescription:

Albuterol HFA 90 mcg/actuation inhaler, inhale 2 puffs 15 minutes before exercise, Disp: 1 inhaler, Refills: 2

Classification:
Short-acting beta-2 agonist (SABA).

MOA:
Relaxes bronchial smooth muscle by activating beta-2 receptors (Johnson & Bounds, 2024).

budesonide/formoterol (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

Error:
Listed as “budesonide/fluticasone” instead of budesonide/formoterol.

Corrected Prescription:

budesonide/formoterol (Symbicort) 160/4.5 mcg, inhale 2 puffs BID and 1–2 puffs PRN asthma symptoms (max 12 inhalations in 24 hours), Disp: 1 inhaler, Refills: 2

Classification:
ICS + LABA.

MOA:
Budesonide decreases airway hyperresponsiveness by binding glucocorticoid receptors and suppressing pro-inflammatory cytokines, reducing edema, mucus, and chronic inflammation (Kalola & Ambati, 2023). Formoterol stimulates β2-adrenergic receptors in bronchial smooth muscle, increasing intracellular cAMP and causing rapid, sustained bronchodilation (Hsu & Bajaj, 2023).

tiatropium (Spiriva Respimat) 2.5 mcg/actuation inhaler; inhale 2 actuations PO once daily for COPD #1 inhaler/60 actuations 1 RF

Error:
“tiatropium” misspelled. Otherwise dosing and form are correct.

Corrected Prescription:

tiotropium (Spiriva Respimat) 2.5 mcg/actuation inhaler, inhale 2 actuations PO once daily, Disp: 1 inhaler (60 actuations), Refills: 1

Classification:
Long-acting muscarinic antagonist (LAMA).

MOA:
Blocks acetylcholine at muscarinic receptors in bronchial smooth muscle, leading to bronchodilation (Delgado & Bajaj, 2022).

lamotrigine (Keppra) 500 mg PO BID #60 2 RF

Error:
Lamotrigine and Keppra are two different drugs. Keppra = levetiracetam, not lamotrigine (Irelli et al., 2023).

Corrected Prescription:
Must clarify the intended drug. Assuming lamotrigine:

Lamotrigine 100 mg PO BID, Disp: 60 tablets, Refills: 2 (usual starting maintenance dose after titration).

Classification:
Antiepileptic drug.

MOA:
Inhibits voltage-sensitive sodium channels, stabilizing neuronal membranes (Betchel & Saadabadi, 2023).

Scenario 2 – Week 4 Case Scenarios – Drug Therapy Evaluation and Prescription Writing

AB is a 34-year-old female with a history of migraine without aura who presents with ongoing headaches despite the use of Ubrelvy (ubrogepant) as needed. She experiences three to four migraines per month, lasting up to 24 hours, and reports that her current acute treatment provides only partial and inconsistent relief. Given her migraine frequency and functional impairment, she is a candidate for preventive therapy in addition to optimizing acute treatment.

Treatment Plan and Medication Changes

Continue Ubrelvy 50 mg po PRN at migraine onset, but consider increasing to 100 mg po once at onset (maximum 200 mg/24 hours), as higher doses have shown greater efficacy for some patients (Dighriri et al., 2023).

Add a preventive agent:

Propranolol 40 mg po BID, #60 tablets, 2 refills

Classification: Non-selective beta-blocker.

MOA: Decreases neuronal excitability and modulates vascular tone, reducing migraine frequency and severity (Shahrokhi & Gupta, 2023).

Provide an alternative acute option if Ubrelvy remains insufficient:

Sumatriptan 50 mg po at migraine onset; may repeat once in 2 hours, maximum 200 mg/24 hours, #9 tablets, 1 refill.

Monitoring Effectiveness

Ask patient to keep a headache diary documenting frequency, severity, duration, and response to medications.

Reassess in 8–12 weeks to evaluate preventive therapy effectiveness.

Monitor for propranolol side effects (e.g., bradycardia, hypotension, fatigue) (Shahrokhi & Gupta, 2023).

Track any medication overuse (risk of rebound headaches if acute agents are used for more than 10 days/month).

Patient Education

Explain that preventive medications take several weeks to show benefit.

Stress adherence to propranolol even if headaches are not daily.

Educate on avoiding migraine triggers (e.g., disrupted sleep, caffeine, alcohol, stress, certain foods).

Encourage lifestyle modifications such as hydration, stress management, and exercise.

Reinforce safe use of acute medications (do not exceed maximum doses).

Acute vs. Preventive Therapy

Most patients begin with acute therapy (e.g., triptans, NSAIDs, gepants like ubrogepant) for infrequent migraines. Patients with frequent or disabling migraines benefit from preventive therapy (e.g., propranolol, topiramate, amitriptyline, CGRP monoclonal antibodies) (Pellesi et al., 2024). In AB’s case, because of frequent attacks and incomplete control with acute treatment, adding preventive therapy is appropriate.

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

RC is a 58-year-old female presenting with early-onset Alzheimer’s disease. Her labs reveal a vitamin D deficiency (22 ng/mL), but otherwise stable thyroid, B12, hemoglobin, and glucose parameters. She is already on insulin therapy for diabetes and lisinopril for blood pressure. Management should focus on initiating therapy to slow cognitive decline while correcting nutritional deficiency.

Drug Therapy Plan

Donepezil 5 mg po once daily at bedtime, #30 tablets, 2 refills

Class
: Acetylcholinesterase inhibitor.

MOA
: Inhibits acetylcholinesterase in the CNS, increasing acetylcholine levels and enhancing cholinergic neurotransmission to slow cognitive decline (Kumar et al., 2023).

Cholecalciferol (Vitamin D3) 2000 IU po once daily, #30 capsules, 2 refills

Class
: Vitamin D supplement.

MOA
: Enhances calcium absorption and bone mineralization; correcting deficiency also supports cognitive and overall health (Al-Hashimi & Abraham, 2024).

Monitoring

Cognitive function using standardized tools (MMSE or MoCA) every 6–12 months (Wang et al., 2022).

Monitor for donepezil adverse effects (nausea, diarrhea, insomnia, bradycardia) (Kumar et al., 2023).

Recheck serum vitamin D in 3 months.

Continue monitoring BP, A1C, and renal function due to comorbid conditions.

Patient Education

Donepezil is not curative, but it may slow symptom progression.

Take at bedtime to minimize GI upset.

Encourage physical activity, cognitive stimulation, and good sleep hygiene.

Stress adherence to vitamin D supplementation.

Scenario 4: PL – Poorly Controlled Type 2 Diabetes – Week 4 Case Scenarios – Drug Therapy Evaluation and Prescription Writing

PL is a 63-year-old male with poorly controlled type 2 diabetes (A1C 8.6%) and stage 4 chronic kidney disease (eGFR 27). His current regimen does not include glucose-lowering therapy, and metformin and SGLT2 inhibitors are contraindicated due to renal impairment. An agent effective for glycemic control, cardiovascular protection, and renal safety is needed.

Drug Therapy Plan

Semaglutide (Ozempic) 0.25 mg SC once weekly × 4 weeks, then increase to 0.5 mg SC once weekly as tolerated, #1 pen, 1 refill

Class: GLP-1 receptor agonist.

MOA: Mimics glucagon-like peptide-1 to enhance glucose-dependent insulin secretion, suppress glucagon release, slow gastric emptying, and promote satiety, thereby lowering blood glucose and A1C (Kommu & Whitfield, 2024).

Rationale

Semaglutide is safe in renal impairment, reduces cardiovascular risk, aids weight loss, and is highly effective for lowering A1C (MacIsaac, 2025).

Avoid metformin (contraindicated with eGFR <30) and SGLT2 inhibitors (ineffective at low GFR) (Yau et al., 2022). Monitoring Recheck A1C every 3 months to assess response (goal <7.0%, individualized). Monitor renal function (Cr, eGFR). Watch for GI side effects (nausea, vomiting, diarrhea). Educate the patient to report symptoms of pancreatitis or severe abdominal pain. Patient Education Demonstrate proper injection technique. Stress consistent weekly dosing schedule. Discuss lifestyle: diet (carb moderation, portion control), physical activity, and weight management. Reinforce the importance of BP and glucose self-monitoring. Goal A1C 8.0-8.5% because the patient has significant comorbid conditions, and the aim is to avoid the risks of hypoglycemia from more aggressive blood sugar lowering (American Diabetes Association, 2018). Week 4 Case Scenarios – Drug Therapy Evaluation and Prescription Writing   References Al-Hashimi, N., & Abraham, S. (2024, January 10). Cholecalciferol . PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK549768/ American Diabetes Association. (2018). Glycemic targets: Standards of medical care in diabetes—2019. Diabetes Care , 42 (Supplement 1), S61–S70. https://doi.org/10.2337/dc19-s006 Betchel, N., & Saadabadi, A. (2023). Lamotrigine . PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470442/ Delgado, B. J., & Bajaj, T. (2022, February 15). Tiotropium . PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK541127/ Dighriri, I. M., Nazel, S., Alharthi, A. M., Altowairqi, N. A., Albariqi, A. M., Tohari, M. A., Alameer, A. A., Alsaran, A. K., ALshammari, F. R., AlMutairi, N. F., Alsubaie, F. M., & Alharbi, T. A. (2023). A comprehensive review of the mechanism, efficacy, safety, and tolerability of Ubrogepant in the treatment of migraine. Curēus . https://doi.org/10.7759/cureus.48160 Hsu, E., & Bajaj, T. (2023, June 20). Beta 2 agonists . National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK542249/ Irelli, E. C., Cocchi, E., Morano, A., Gesche, J., Caraballo, R., Lattanzi, S., Strigaro, G., Catania, C., Ferlazzo, E., Pascarella, A., Casciato, S., Quarato, P. P., Pizzanelli, C., Pulitano, P., Giuliano, L., Viola, V., Mostacci, B., Fortunato, F., Marini, C., & Gennaro, G. D. (2023). Levetiracetam vs lamotrigine as first-line antiseizure medication in female patients with idiopathic generalized epilepsy. JAMA Neurology . https://doi.org/10.1001/jamaneurol.2023.3400 Johnson, D. B., & Bounds, C. G. (2024, January 10). Albuterol . National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482272/ Kalola, U. K., & Ambati, S. (2023, August 28). Budesonide . PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK563201/ Kommu, S., & Whitfield, P. (2024, February 11). Semaglutide . PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK603723/ Kumar, A., Sharma, S., & Gupta, V. (2023). Donepezil . National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513257/ MacIsaac, R. J. (2025). Semaglutide: A key medication for managing cardiovascular-kidney-metabolic syndrome. Future Cardiology , 1–21. https://doi.org/10.1080/14796678.2025.2511412 Pellesi, L., Garcia-Azorin, D., Rubio-Beltrán, E., Ha, W.-S., Messina, R., Ornello, R., Petrusic, I., Raffaelli, B., Labastida-Ramirez, A., Ruscheweyh, R., Tana, C., Vuralli, D., Waliszewska-Prosół, M., Wang, W., & Wells-Gatnik, W. (2024). Combining treatments for migraine prophylaxis: The state-of-the-art. The Journal of Headache and Pain , 25 (1). https://doi.org/10.1186/s10194-024-01925-w Remien, K., & Bowman, A. (2024). Fluticasone . PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK542161/ Shahrokhi, M., & Gupta, V. (2023, May 1). Propranolol . PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557801/ Wang, G., Estrella, A., Hakim, O., Milazzo, P., Patel, S., Pintagro, C., Li, D., Zhao, R., Vance, D. E., & Li, W. (2022). Mini-mental state examination and Montreal cognitive assessment as tools for following cognitive changes in Alzheimer’s disease neuroimaging initiative participants. Journal of Alzheimer’s Disease , 90 (1), 263–270. https://doi.org/10.3233/jad-220397 Yau, K., Dharia, A., Alrowiyti, I., & Cherney, D. Z. I. (2022). Prescribing SGLT2 inhibitors in patients with CKD: Expanding indications and practical considerations. Kidney International Reports , 0 (0). https://doi.org/10.1016/j.ekir.2022.04.094   Week 4 Case Scenarios – Drug Therapy Evaluation and Prescription Writing