SCENARIO 1 What are the errors in the following prescriptions (1 per prescription)? Rewrite each prescription correctly. What is each medication’s classification and mechanism of action (MOA)? Repatha 140 mg IV every 2 weeks #1 1 RF Hyzaar (losartan/hydrochlorothiazide) 50/25 mg PO daily #30 3 RF digoxin 1.25 mg PO daily #30 1 RF hydralazine/isosorbide mononitrate (BiDil) 37.5 mg/20 mg PO every 8 hours #90 1 RF clonidine 0.3 mg patch PO once weekly #4 1 RF
SCENARIO 2 A patient with stable angina is prescribed nitroglycerin. The provider avoids oral tablets and instead chooses a sublingual or transdermal formulation. Why is oral nitroglycerin not clinically useful? Discuss how first-pass metabolism affects nitroglycerin’s bioavailability and define both terms. Identify the route of administration with 100% bioavailability and explain how alternative routes overcome the first pass effect. Include a sample prescription for nitroglycerin.
SCENARIO 3 Where are the majority of cytochrome P450 (CYP) enzymes located? Using the Drugs.com pill identifier, enter the following characteristics to identify the medication AND strength. What CYP enzyme metabolizes this medication? How can this information be applied to medication therapy management? Write a sample prescription for the identified medication and strength. Imprint (E 137) Shape (Round) Color (Pink) Form (Tablet) Scoring (None)
SCENARIO 4 KU is a 47-year-old male following up on his labs that were drawn last week. He smokes 1 pack per day. He is currently on lisinopril 40 mg po daily, liraglutide (Victoza) 0.6 mg subcutaneously once daily and St. John’s Wort. Fasting lipid profile shows total cholesterol 260 mg/dL, LDL 180 mg/dL, HDL 43 mg/dL, and TG 185 mg/dL. He is 5’9” and weighs 204 lbs. What treatment plan would you implement for KU? What are GOAL Total Cholesterol (TC), HDL, LDL, and Triglyceride levels for KU? What is his BMI per Medscape calculator? What patient monitoring and education would you provide? How many risk factors for coronary artery disease does this patient have? Identify them specifically.
