Consider these 2 case studies – you can answer either case study. Please follow
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Consider these 2 case studies – you can answer either case study. Please follow the grading rubric and make sure your responses are substantiated as needed. Use your Woo/Robinson textbook , APRN Prescribing Drug Therapy 2022, Prescribers letter or any reliable sources as you consider your answers:
Case study # 1
Complaint
“My migraine headaches will not go away.”
History
A 32-year-old female presents to the clinic with recurrent migraine. She reports that she has a
moderate to severe migraine once a week, on average. She uses SC Imitrex (sumatriptan), and
most of the time the headache resolves with one dose. She was told to return for a checkup if she
had to use the Imitrex more than two or three times a month.
Susan is married and has four children. She experienced her first migraine at age 18 and
has no other health problems. She was started on Imitrex and has had good results. She is
otherwise healthy. She reports a two to four cup a day intake of coffee; usually, one of those
“cups” is a double latte. She occasionally uses Excedrin Migraine for relief of mild headache—
she thinks only once or twice a week. She has never been hospitalized overnight for her
migraines but has gone to the emergency room for “pain medicine” before she was started on
Imitrex.
Assessment
Susan is afebrile, vital signs are all within normal limits (WNL), and her weight is 135 pounds
(body mass index [BMI] is 24), which is stable. The physical examination is completely WNL.
Her neurological examination is unremarkable.
What would be the initial management plan?
What would be the plan when the patient returns ?
What medications can prevent migraines?
Case Study # 2
Jack is a 54-year-old patient who has difficulty coming in for primary care visits. He sees
cardiology, pulmonary clinic, and endocrine clinic for his comorbid conditions of diabetes
mellitus, postcoronary artery bypass grafting (CABG) 2 years ago, and mild chronic obstructive
pulmonary disease issues from a 30 pack year history of smoking. His last visit with you was
over a year ago. Today, your registered nurse brings you a telephone triage call requesting a refill
of his Crestor prescriiption, which was ordered by cardiology soon after his CABG. Per the
electronic links to the cardiology service within your facility, the medication was due to be
renewed about 2 months ago. His last lipid labs were a year ago and his last complete metabolic
panel (CMP) was done at the same time. He was recently at the pulmonary clinic and his last
recorded HgA1C was 9.0 from a visit to endocrine 4 months ago.
Review of records include a prescriiption for his hypertension (Lisinopril 20 mg daily),
metformin 1,000 mg twice a day for his diabetes, and no known medications for his pulmonary
issues. The Crestor prescriiption appears to have multiple dosing levels over the past few refills.
His last vital signs were blood pressure (BP) 170/110 mm Hg, pulse 88, and respirations
22. His body mass index is 30 and he indicates a pain level of four out of five. His pulse
oximetry was 92% on room air.
How do you respond to this telephonic request?
What steps are required to get Jack’s therapeutic plan under control? If you change medications what will you choose and Why?
How can the provider in this scenario get Jack “back on track” and make sure they have the correct info form all providers?
You can choose to answer either case study, only answer 1, not both. Out textbook is: Woo, T. M. & Robinson, M. V. (2020) Pharmacotherapeutics for Advanced Practice
Nursing, 5th Ed. (ISBN-13: 978-0-8036-6926-0)
If you have any question, please ask. Thank you!
