Pharmacology Case Studies
Scenario 1
Diagnosis: Sandra is likely experiencing Major Depressive Disorder (MDD) with coexisting anxiety, given her symptoms of persistent sadness, anxiety, and an empty mood (Walter et al., 2023). Her increased smoking indicates a need to manage both her mood and nicotine dependence.
Treatment:
Antidepressant: First-line treatment would involve initiating a selective serotonin reuptake inhibitor (SSRI), which can treat both depression and anxiety.
Medication: Sertraline 50 mg PO daily
Route: Oral
Frequency: Once daily
Special Instructions: Take in the morning to avoid insomnia
# Dispensed: 30 tablets (30-day supply)
Refills: 1
Tapering: Start at 50 mg. Depending on the response, it may be titrated up to 100 mg after 4-6 weeks (Srensen et al., 2022).
Smoking Cessation: Recommend smoking cessation to address both health concerns and to improve her mental health (White et al., 2023).
Medication: Nicotine replacement therapy (NRT) via a patch
Order: Nicotine transdermal patch 21 mg/24 hours
Route: Transdermal
Frequency: Change every 24 hours
Special Instructions: Rotate application sites; discontinue smoking upon starting therapy
# Dispensed: 30-day supply
Refills: 1
Current Medications:
Pantoprazole: Continue for GERD.
HCTZ: Review her blood pressure and consider switching or adjusting HCTZ to control her hypertension more effectively since SSRIs can increase BP.
Education: Educate Sandra on:
SSRI side effects, such as nausea, dizziness, and sexual dysfunction.
Importance of smoking cessation for cardiovascular and mental health.
Importance of adherence to medication and follow-up visits.
Labs:
Baseline liver function tests (LFTs) to monitor for potential hepatotoxicity with sertraline.
Comprehensive Metabolic Panel (CMP) for HCTZ and BP management.
References
Srensen, A., Juhl Jrgensen, K., & Munkholm, K. (2022). Clinical practice guideline recommendations on tapering and discontinuing antidepressants for depression: a systematic review. Therapeutic advances in psychopharmacology, 12, 20451253211067656.
Walter, H. J., Abright, A. R., Bukstein, O. G., Diamond, J., Keable, H., Ripperger-Suhler, J., & Rockhill, C. (2023). Clinical practice guideline for the assessment and treatment of children and adolescents with major and persistent depressive disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 62(5), 479-502.
White, S. A., Stone, E., Murphy, K. A., Daumit, G. L., & McGinty, E. E. (2023). Smoking cessation medication prescribing for smokers with and without mental illness. Psychiatric Services, 74(4), 332-340.
Scenario 2
Diagnosis: Based on JRs symptoms of pain, numbness, tingling, and balance issues, the working diagnosis is Diabetic Peripheral Neuropathy (DPN), commonly associated with diabetes (American Diabetes Association, 2022).
Treatment:
Neuropathic Pain Management:
Medication: Pregabalin (Lyrica) 75 mg PO BID (Khdour, 2020)
Route: Oral
Frequency: Twice daily
Special Instructions: Start at 75 mg, may increase to 150 mg BID after one week if tolerated
# Dispensed: 60 tablets (30-day...
…randomized, triple-blind, placebo-controlled trial. Neuropsychopharmacology, 47(2), 570-579.
Scenario 4
Diagnosis: David presents with classic signs of Attention Deficit Hyperactivity Disorder (ADHD), characterized by hyperactivity, impulsiveness, and difficulty focusing (Walter et al., 2020). ADHD is common in children, and it is not unusual for it to run in families, meaning both parent and child can have the disorder.
Treatment for David:
Medication: Methylphenidate (Ritalin) 5 mg PO BID
Route: Oral
Frequency: Twice daily (before breakfast and lunch)
Special Instructions: Adjust dose weekly based on response, up to 20 mg/day
Dispensed: 60 tablets (30-day supply)
Refills: 1
Monitoring: Monitor height, weight, blood pressure, and heart rate regularly to check for side effects of stimulants (Coghill et al., 2021).
ADHD in Parents: It is not uncommon for both parents and children to be diagnosed with ADHD. While the core symptoms (inattention, impulsivity) are similar, adults often present more with organizational difficulties, time management problems, and work-related issues rather than hyperactivity seen in children (Weibel et al., 2020).
Treatment for Davids Mother:
Medication: Atomoxetine (Strattera) 40 mg PO daily
Route: Oral
Frequency: Once daily
Special Instructions: May increase to 80 mg after four weeks
Dispensed: 30 tablets
Refills: 1
Differences in Treatment: In children, ADHD is often treated with stimulant medications, but in adults, non-stimulant medications like Atomoxetine or behavioral therapy may be…
