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Written Assignment
In this Assignment, you will write a 5- to 6-page paper (it will likely be longer based on the depth of
the questions asked below) on considerations you have for how you might de-prescribe in the 4
patient case scenarios provided in the classroom. Your paper needs to cover all 4 patients. Support
your answers with five (5) evidence-based, peer-reviewed scholarly literature resources outside
of Required Learning Resources in this course.
Answer the following questions using the patient examples described in the classroom.
Patient 1
Patient 1: A 36-year-old male presents to
your office being prescribed by his primary care physician (PCP) for the
past 3 years an opioid analgesic medication for a work accident. He has
chronic pain and is attending a pain clinic. It is determined the best
course of treatment for pain is to remain on opioid medication. The
patient is also being prescribed clonazepam 1mg BID for “relaxation” and
panic attacks .
What are the concerns of the patient remaining on the opioid medication and
clonazepam?
How might you educate the patient about these risks and concerns?
The patient agrees that he should not continue both medications in combination. He
would like to “get off” the clonazepam but worries about “bad withdrawals” that he’s
heard about from stopping clonazepam “cold turkey” and is concerned about re-occurring
panic attacks. How might you respond to the following:
How would you instruct the patient to taper off clonazepam?
What other medication would you recommend for the patient for the
treatment of his panic attacks? Keep in mind, he will continue the opioid
medication for pain relief.
How would you start the new recommended psychotropic medication for the
patient?
Discuss one legal, ethical, or social consideration with the treatment plan.
Patient 2
Patient 2: A 42-year-old female on
alprazolam 1mg BID for panic attacks. Panic attacks have been in
remission and the patient wants to taper off the medication. But, every
time she has attempted to do so in the past, she experienced withdrawal
effects. She is wondering how to safely taper off the benzodiazepine
medication without having withdrawal effects.
The patient reports withdrawal symptoms when previously tapering off the
alprazolam. What symptoms are common withdrawal symptoms from this
medication?
Provide the patient education of withdrawal symptoms that range from
common and less serious to withdrawal symptoms that are a cause for concern
and that should prompt patient should seek medical attention.
Given the patient’s history of having withdrawal effects from attempting to
taper off alprazolam, what longer-acting benzodiazepine would you choose to
convert the patient to?
What is the dose you would prescribe and how would you taper off the
medication?
Patient 3
Patient 3: A 24-year-old female prescribed
lorazepam 1mg TID for generalized anxiety disorder. She recently found
out she is pregnant (9 weeks gestation). She was referred to you by her
OB-GYN to discuss this medication for her current situation. The patient
is wondering if she can stay on the lorazepam through her pregnancy and
postpartum, as it is an effective medication for anxiety symptoms. She
plans to exclusively breastfeed for the first 6 months postpartum. She
has not had any other trials of medication to treat anxiety as lorazepam
has been effective.
Review the potential risks, benefits, and side effects of continuing lorazepam
throughout the pregnancy and postpartum for both the patient and fetus.
Review other alternative medications to treat generalized anxiety disorder.
Include risks, benefits, and potential side effects to both the patient and the
developing fetus. Keep in mind, the patient is looking to breast feed for 6
months postpartum.
The patient agrees that it would be safest for her pregnancy and fetus to
discontinue the lorazepam. How would you recommend she discontinue
lorazepam? Provide education on potential side effects from tapering off the
medication, including common side effects to more serious side effects and
when to seek medical attention.
The patient would like to forgo medications at this time, given she is early in her
pregnancy and is concerned about “damage” to the fetus if she were to continue
medications. Provide education to the patient about the risks of untreated
anxiety symptoms during pregnancy for both the patient and the fetus.
Patient 4
Patient 4: A 71-year-old-male who comes to
see you at the insistence of his daughter. His daughter expresses
concern of memory loss and is wondering if he has the beginning stages
of dementia. He is forgetful and seems to be tripping on things or
walking into walls, although he has lived in the same home for the past
35 years. The patient does not agree with his daughter but does admit he
has had a “few stumbles and falls” lately. Medication reconciliation
shows the following medications: metoprolol ER 50mg q day, omeprazole
20mg q day, clonazepam 1mg TID, levothyroxine 75mcg q am. His daughter
is wondering if he should be started on a “dementia medication.”
Review potential side effects for elderly on benzodiazepines providing
education to both the patient and the patient’s daughter. What are the risks of
continuing the benzodiazepine for this patient?
How would you evaluate the patient for these side effects?
The patient and daughter agree he will need to taper off the clonazepam given
the risks of continuing this medication. How would you recommend tapering off
this medication?
Review with the patient and daughter potential side effects of tapering off the
medication. Review with them common side effects to more serious side effects
and when to seek medical attention.
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