You are managing a 72-year-old female who presents to your Emergency Department. Your assessment reveals that she is grieving after the recent loss of her husband, is anxious given her ability to cope, and is suffering from insomnia. She is currently in counseling. She does admit that she drinks two glasses of red wine every night but has never had withdrawal symptoms. She denies history of substance use. Denies history of anxiety or insomnia before her husband’s passing.
Medical history
No chronic history of anxiety. Asthma, not currently a concern. Hyperlipidemia
Medications
Lovastatin 20mg daily.
Vitals
HR 88; BP 130/78; RR 16; T 37; O2Sat 98%
NKA
Substance Abuse Decision Making
Clinical Decision-Making Questions
1. You would like to order something for anxiety. What medication would you order? Write out the order including the pharmaceutical agent, dose, route, and duration. Why have you selected this medication in this situation? Justify your selection over alternatives. What class/schedule of medication are you choosing and why? Explain why this medication and route was chosen over other options. Include the pharmacodynamic action of the medication you have chosen in comparison to the other options you mentioned. Include either a research article or evidence-based guideline that supports your decision-making and selection process. Give rationale and reference your information.
2. You would like to order something for insomnia. What medication would you order? Write out the order including the pharmaceutical agent, dose, route, and duration. Why have you selected this medication in this situation? Justify your selection over alternatives. What class of medication are you choosing and why? Explain why this medication and route was chosen over other options. Include the pharmacodynamic action of the medication you have chosen in comparison to the other options you mentioned. Include either a research article or evidence-based guideline that supports your decision-making and selection process. Give rationale and reference your information.
3. What are the potential side effects and/or adverse drug reactions and how should they be managed? Are there any reasons/indications that you would not give this medication? What would you expect that your patient might experience, and what are your worst-case scenarios? If these occur, what would you do?
4. What are potential drug interactions for this patient and what would your management be if you were concerned about a drug interaction? (Note: This answer may be none.) Don’t just copy and paste drug interactions into this area. What is applicable for this patient?
5. What is the cost of these medications? What reference was used to obtain this cost information? How does it compare to other options available for this patient? Is it your best option based on cost and effectiveness and indication for this patient?
6. How would you monitor the efficacy of these medications? Specifically, when would you expect these medications to work? Are there lab tests or other information that you would need to gather to see if these medications are efficacious? How do you know these medications are efficacious?
7. What are alternative treatment plans should this option fail? Specifically, address what medication, how and when you would use it.
8. How would this treatment change if the patient was a pregnant female? Specifically, what category in pregnancy is this medication? How would you approach this medication or alternative medications in this case scenario with a pregnant patient?
9. How would this treatment change if the patient was an adolescent 13-year-old boy?
