Musculoskeletal System

Musculoskeletal System

Scenario 1

The assessment and treatment plan is as follows:

Sandra is a 52-year-old woman with past medical history of hypertension and GERD (gastroesophageal reflux) and at this time is feeling sad, anxious, and “empty.” She has added more cigarettes to deal with her symptoms. She has a presentation that is consistent with major depressive disorder with anxiety features, as well as nicotine dependence. If Sandra also smokes, however, she will benefit from quitting smoking assistance, so Bupropion is the proper medication choice. Bupropion can also be used to help quit smoking and to alleviate depressive symptoms. Sandra also says that she does not have a seizure history, as bupropion reduces the threshold for seizures.

Medication Order

Rx: Bupropion SR 150 mg Tablets: An Rx Drug. Rx: Bupropion SR 150 mg Tablets is an Rx Drug.

Sig: 1 tablet orally once a day for 3 days, then increased to 1 tablet orally twice a day.

Dispense: 60 tablets

Refills: 2

Dosage: 400-800 mg thrice a day, or 200 mg four times a day. Dosage form: capsule.

Continue current medications:

Following this treatment, patients receive:

• Hydrochlorothiazide (HCTZ) 50 mg oral 1 x daily

Patient Education

The patient needs to be informed that it may take weeks for the antidepressant effects of bupropion to be felt. She should not crush or chew the tablets. Smoking reduction should be considered, and a quit date should be established within 1–2 weeks of initiation of therapy for Sandra. Also, she should be warned about any side effects that can occur such as insomnia, dry mouth, headache, anxiety (Huecker et al., 2024). Drinking should be avoided because it can be a risk for seizures. If she gets depressed, suicidal, agitated or if her mood changes, she should go to medical help immediately. Lifestyle modifications including exercise, stress management, diet and smoking cessation counseling should also be discussed (Ngui et al., 2022).

Laboratory Tests and Monitoring

The following should be ordered and monitored:

• Completed blood count (CBC)
• Complete blood profile (CBC)
• Thyroid-stimulating immunoglobulin (TSI)
• Blood pressure monitoring
• All students complete a mental health assessment with the PHQ-9.
• Watch for signs of suicide and side effects from medication.

References

Huecker, M. R., Smiley, A., & Saadabadi, A. (2024, September 2). Bupropion. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470212/

Ngui, H. H. L., Kow, A. S. F., Lai, S., Tham, C. L., Ho, Y.-C., & Lee, M. T. (2022). Alcohol Withdrawal and the Associated Mood Disorders—A Review. International Journal of Molecular Sciences, 23(23), 14912. https://doi.org/10.3390/ijms232314912

‌Scenario 2

Working Diagnosis

The symptoms of JR – numbness, tingling, pain in the legs, balance disturbances, and fatigue – are associated with diabetic peripheral neuropathy and can be caused by long-term use of the drug metformin (Alvarez et al., 2025).

Treatment Plan

In addition, people who take metformin are also more likely to be vitamin B12-deficient, and vitamin B12 deficiency can lead to increased symptoms of neuropathy. Thus, the goals of evaluation and treatment should be a cure for diabetes, neuropathic pain, and correcting a vitamin B12 deficiency (Farooq et al., 2022).

Medication Orders

Gabapentin comes in a brand-name drug called Rx: Gabapentin 300 mg capsules.

Sig: Capsules – 1 capsule PO at bedtime for 3 days, then 1 capsule PO twice daily for 3 days followed by 1 capsule PO 3 times daily as tolerated for 3 days.

Dispense: 90 capsules

Refills: 2

Indication: Diabetic neuropathy

The intended use is to treat a deficiency in vitamin B12. It is used to treat vitamin B12 deficiency.

Sig: One tablet to be taken orally once a day.

Dispense: 30 tablets

Refills: 3

The dosage forms are Injection (IM, IV, SQ), and the dosage is 100 micrograms, 1000 micrograms, and 5000 micrograms (IM, IV, SQ).

Continue:

• Metformin 2.5 gms Oral Twice a Day
• Synjardy XR 5/1000 mg PO daily
• Use Tresiba 20 units SC every day. Take Tresiba 20 units SC once a day.

This is a statin. This is a drug known as statins.

Patient Education

Diabetic foot care should be explained to the patient, including self-examination every day, wearing the proper shoes, and informing the physician of any cuts or infections as soon as they happen. Additionally, JR should be instructed about good blood glucose levels in terms of diet, exercise, and medication adherence (Song & Chambers, 2025). Gabapentin can cause dizziness or drowsiness; be careful when driving. Follow up on Vitamin B12 treatment as prescribed.

Monitoring

The following needs to be monitored:

Blood test of hemoglobin A1c (HbA1C) every three months

• Vitamin B12 levels
• Renal function tests
• Neuropathy symptom improvement
• Blood glucose logs
• Foot examinations

References

Alvarez, M., Prieto, A. E., Portilla, N., Moya, D., Rincon, O., & Guzman, I. (2025). Metformin-induced vitamin B12 deficiency: An underdiagnosed cause of diabetic neuropathy. World Journal of Diabetes, 16(7). https://doi.org/10.4239/wjd.v16.i7.107514

Farooq, M. D., Tak, F. A., Ara, F., Rashid, S., & Mir, I. A. (2022). Vitamin B12 Deficiency and Clinical Neuropathy with Metformin Use in Type 2 Diabetes. Journal of Xenobiotics, 12(2), 122–130. https://doi.org/10.3390/jox12020011

‌Song, K., & Chambers, A. R. (2025, September 15). Diabetic Foot Care. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK553110/

‌

Scenario 3

Zolpidem Half-Life Calculation

Zolpidem’s half-life is 3 hours. If a patient takes 10 mg at 10 PM, then the amount that will still be in the body at 7 AM is:

9 hours is the difference between 10 PM and 7 AM, or three half-lives (Bouchette et al., 2024).

After first half-life (1 AM): 10 mg → 5 mg

After second half-life (4 AM): 5 mg → 2.5 mg

After third half-life (7 AM): 2.5 mg → 1.25 mg

So, the concentration at 7 AM will be 1.25 mg.

genui{“math_block_widget_always_prefetch_v2”: {“content”:”10\left(\frac{1}{right) ^3 = 1.25\ \text{mg}”}}

Elderly Dosage Considerations

Elderly patients do need a lower dose of zolpidem as age-related factors such as lower hepatic metabolism and reduced drug clearance may result in a greater risk of falls, confusion, cognitive impairment, and hyper-sedation (Tavares et al., 2021).

Antidepressants/Antipsychotics for Depression and Insomnia:

Medication Order 1

Doxepin is the brand name for the drug. The brand name for the drug is Doxepin.

Sig: Take 1 tablet by mouth at bedtime as needed for insomnia

Dispense: 30 tablets

Refills: 2

Medication Order 2

Rx: Mirtazapine 15 mg, Tablets

Ban: Take one tablet orally at bedtime.

Dispense: 30 tablets

Refills: 2

Medication Order 3

A tablet of quetiapine 25 mg is a prescription-only medication.

One by mouth at bedtime (Sig)

Dispense: 30 tablets

Refills: 1

Patient Monitoring

Patients should be assessed for:

• Excessive sedation
• Orthostatic hypotension
• Weight gain
• Suicidal ideation
• Sleep quality improvement
• Daytime drowsiness
• Metabolic effects. Metabolic effects (with use of quetiapine).

References

Bouchette, D., Akhondi, H., Patel, P., & Quick, J. (2024, February 29). Zolpidem. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK442008/

Tavares, G., Kelmann, G., Tustumi, F., Tundisi, C. N., Silveira, B. R. B., Barbosa, B. M. A. C., Winther, D. B., Boutros, E. C., Villar, G. dos S., Brunocilla, G., Lourenção, G. R. C., Ferreira, J. G. A., & Bernardo, W. M. (2021). Cognitive and balance dysfunctions due to the use of zolpidem in older people: a systematic review. Dementia & Neuropsychologia, 15(3), 396–404. https://doi.org/10.1590/1980-57642021dn15-030013

‌

Scenario 4

Assessment and Diagnosis

David’s symptoms are Fidgeting, talking excessively, changing positions frequently, interrupting others, and not listening when spoken to, as it fits the criteria for the diagnosis of attention-deficit/hyperactivity disorder (ADHD), predominantly hyperactive/impulsive presentation (Yacoub et al., 2025).

The Medicine Medallion for David.

Case study: Qualitative and quantitative ingredients and ingredients in parenteral medicines – methylphenidate ER (Concerta) tablets.

Dosage: 1 tablet, orally, in the morning.

Dispense: 30 tablets

Refills: 0

Parent/Child ADHD Relationship

There is a strong genetic component to ADHD. Research suggests that approximately 25% – 50% of the parents of children with ADHD are also ADHD (Uchida et al., 2022).

The differences between ADHD in children and adults. The difference between the ADHD of children and that of adults.

Children with ADHD are hyperactive, impulsive, and talkative, and have classroom behavior problems. Inattention, poor organizational skills, forgetfulness, restlessness, and problems with handling responsibilities are more common in adults. Behavioral therapy and stimulant medications can be used for children. Stimulants, psychotherapy, coaching, and/or organizational support could be helpful for adults (Elmaghraby & Garayalde, 2022).

Order for Meds for Mom’s David

Apis cerana F. Tablets of bee-stings.Crataegus oxycoccus: Hawthorn berry.

Indications: As a dietary supplement for general health support. Suggested Dosage: 1 capsule, orally, daily.

Dispense: 30 capsules

Refills: 0

Engaging patient education and monitoring.

Patients should be warned of the side effects of stimulants, such as insomnia, loss of appetite, elevated heart rate, and elevated blood pressure. Taking medication in the morning will reduce disturbances in sleep.

The following needs to be monitored:

These are monitored:

• Weight and appetite
• School/work performance
• Mood changes
• Sleep patterns
• Risk of abuse/dependency:

References

Elmaghraby, R., & Garayalde, S. (2022). What is ADHD? American Psychiatric Association. https://www.psychiatry.org/patients-families/adhd/what-is-adhd

Uchida, M., DiSalvo, M., Walsh, D., & Biederman, J. (2022). The Heritability of ADHD in Children of ADHD Parents: A Post-hoc Analysis of Longitudinal Data. Journal of Attention Disorders, 27(3), 250–257. https://doi.org/10.1177/10870547221136251

Yacoub, M. W., Smith, S. R., Abbas, B., Iqbal, F., Jazieh, C. M. O., Al Shaer, N. S. H., Luk, C. C.-F., & Syed, N. I. (2025). Attention-Deficit Hyperactivity Disorder (ADHD): A Comprehensive Overview of the Mechanistic Insights from Human Studies to Animal Models. Cells, 14(17), 1367. https://doi.org/10.3390/cells14171367

‌

 

CLICK HERE TO ORDER A CUSTOMISED-FREE PAPER

Week 7: Musculoskeletal System

Discussion Topic: WEEK 7: Musculoskeletal System WEEK 7: Musculoskeletal System
Class,

Welcome to week 7! This week we will apply pharmacology concepts to musculoskeletal system disorders. We will cover the topics of NSAIDs, DMARDs, opioids, and muscles relaxants in relation to the treatment of arthritis, RA, gout, and addiction.

When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.

ASSIGNMENT

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

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

For your week 7 assignment, evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.

To Prepare:

Review assignment rubric and case studies. Be sure to thoroughly answer ALL questions.
Explain the problem and discuss how you would address the problem.
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.
Answer questions using your required learning resources, clinical practice guidelines, Medscape and JNC 8.
Include at least three references to support each scenario and cite them in APA format. Please include in-text citations. You do not need an introduction or conclusion paragraph.

WEEK 7 ASSIGNMENT

SCENARIO 1

Sandra is a 52-year-old female with past medical history of hypertension and GERD. Current medications include pantoprazole 40 mg po daily 30 minutes before breakfast and HCTZ 50 mg daily. She smokes 1 pack per day and presents with persistent sadness, anxiety and “empty mood.” Her smoking habit has increased the past month as she says it “helps calm her nerves.” She denies any history of seizures. How would you treat Sandra? What medication would you prescribe (include complete medication order)? What education would you provide to the patient? What labs would you order?

SCENARIO 2

Patient JR is experiencing symptoms of pain, numbness and tingling in his legs. He states he sometimes has trouble keeping his balance and feels easily fatigued. He is currently on metformin 1000 mg po BID, Synjardy XR 5/1000mg po daily, Tresiba 20 units SC daily and rosuvastatin 10 mg po daily. What is your working diagnosis? How would you treat JR and improve his treatment? What would you monitor?

SCENARIO 3

Zolpidem has a half-life of 3 hours. If a patient takes 10 mg at 10 pm, what will the blood level be at 7 am? Do elderly patients need a smaller dosage of zolpidem? Name 3 antidepressants/antipsychotics you might prescribe for patients with co-existing depression and insomnia (include complete medication orders) and include patient monitoring.

SCENARIO 4

A mother brings her 7-year-old son David into the clinic today stating that he is increasingly getting into trouble at school. He “fidgets and frequently leaves his seat, does not listen to his teacher, talks excessively and interrupts other classmates.” What would you prescribe for David? How common is it for a parent and child to both have ADHD? How are symptoms and treatment of ADHD different between children and adults? What would you prescribe for David’s 40-year-old mother with ADHD?

Note on Assignment Attempts

Students are expected to review their work and submissions of work carefully prior to due dates. Unless otherwise approved by the faculty, students are allowed one submission of graded work per assignment. While the classroom allows for multiple submissions, once an assignment is graded, submissions will no longer be accepted unless approved by the faculty. If an assignment is submitted prior to the assignment deadline and has not yet been graded, then students may submit a revised assignment prior to the assignment deadline. Once the deadline has passed, resubmission is not permitted.

Late Assignment Policy

Students are expected to submit assignments by the due dates noted in the course and welcome announcement. In extenuating circumstances, such as illness, the student must contact the instructor as soon as possible to discuss the situation. In those circumstances, faculty will determine the appropriate course of action for the student. Depending on the situation, these actions may include recommendations to drop the course (if within the university drop/withdrawal period), acceptance of some or all of the overdue assignments with or without penalties, or failure to accept assignments.

Assignments submitted late without the prior agreement of the instructor, outside of an emergency absence, or in violation of agreements for late submission, will receive a grade reduction for the assignment amounting up to 20%. Each day late will result in a 4% point deduction up to day 5. After 5 days, the assignment will be graded a zero.

Wishing you much succesS.

EXTRA LEARNING

The following is an interactive case study on Complex Regional Pain Disorder:

http://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_07/index.html

The following is a great quiz on controlled substances:

https://denalirx.com/controlled-substance-quiz/ Links to an external site.

1. Which medication does not have anticholinergic side effects?

Acetirizine

Bdiphenhydramine

Cdicyclomine

Dbenztropine

Ecyclobenzaprine

2. All of the following medications treat gout except

Asulfinpyrazone

Bmesalamine

Ccolchicine

Dallopurinol

Eprobenecid

3. Which of the following is a non-narcotic pain medication?

Atramadol

Bfentanyl

Ctoradol

Dmeperidine

Ecodeine