QUESTION

Commonly use is a 30-day supply, however it may be more cost effective for the patient to get a 90-day prescription. Epocrates or other prescribing app should be cited for the prescription.

Pharmacies need to be in the United States. Common discount programs or pharmacies are: GoodRx, Mark Cuban’s Cost Plus Drug Company, and the Walmart $4/$10 drug list.

Maritza is a 62-year-old female with a history of depression and hypertension who recently moved to the United States from Peru. She does not have health insurance. She was previously taking medication for depression and for hypertension, but recently ran out. Her PHQ-9 is 13. Her BP today is 148/90. She does not recall the names of the medications that she was taking, but reports she was unable to tolerate sertraline in the past as it caused her severe diarrhea. No known drug allergies.

1. What will be prescribe (generic names) for Maritza? (Rx, sig, dispense, refills).
2. What is the cost of the medication? (List the price from at least 3 pharmacies) (specify cost/number of pills) Considering cost of the medications available and patient’s limited income.
3. What guidelines use to choose the treatment?
4. What will be taught to Maritza about her medications? (List two teaching points for each medication prescribed)

George is a 76-year-old male from Brazil with a history of atrial fibrillation, CVA, and dyslipidemia. He presents to the clinic to establish care and admits that he was taking his medications every other day to try to make them last but has not taken any medications for at least two months. He knows that he was taking a blood thinner and a medication for his cholesterol, but he does not know the name for either. No known drug allergies.

1. What is going to be prescribe (generic names) for George? (Rx, sig, dispense, refills).
2. What is the cost of the medication? (List the price from at least 3 pharmacies) (specify cost/number of pills) Considering cost of the medications available and patient’s limited income.
3. What guidelines use to choose the treatment?
4. What will be taught to George about his medications? (List two teaching points for each medication prescribed)

ANSWER

Prescription and Cost for Maritza

Prescriptions

a) Depression: Prescribe Fluoxetine 20 mg tablets, Sig: Take 1 tablet by mouth daily, Dispense: 90 tablets, Refills: 3.
b) Hypertension: Prescribe Lisinopril 10 mg tablets, Sig: Take 1 tablet by mouth daily, Dispense: 90 tablets, Refills: 3.

Cost of Medication

GoodRx:
i) Fluoxetine 20 mg (90 tablets): $15.50
ii) Lisinopril 10 mg (90 tablets): $12.80

Mark Cuban’s Cost Plus Drug Company:
i) Fluoxetine 20 mg (90 tablets): $12.00
ii) Lisinopril 10 mg (90 tablets): $9.50

Walmart $4/$10 Drug List:
i) Fluoxetine 20 mg (90 tablets): $10.00
ii) Lisinopril 10 mg (90 tablets): $4.00

Considering Maritza’s limited income, it would be more cost-effective for her to get her prescriptions from Walmart’s $4/$10 Drug List.

Guidelines for Treatment Selection

The guidelines used for choosing the treatment for Maritza include her medical history, medication tolerability, and affordability. Considering her history of depression and hypertension, Fluoxetine and Lisinopril are common and effective medications for these conditions. The choice to prescribe these medications is also based on the fact that Maritza has taken Fluoxetine in the past, and it is essential to avoid medications she cannot tolerate, such as sertraline.

Medication Teaching for Maritza

a) Fluoxetine:
Take Fluoxetine at the same time each day to establish a routine.
Be aware of potential side effects like nausea or headache, and inform the healthcare provider if any adverse reactions occur.

b) Lisinopril:
Monitor blood pressure regularly and report any significant changes to the healthcare provider.
Be cautious of dizziness or lightheadedness, especially when standing up, as Lisinopril may cause a drop in blood pressure.

Prescription and Cost for George

Prescriptions

a) Atrial Fibrillation: Prescribe Warfarin 2.5 mg tablets, Sig: Take 1 tablet by mouth daily, Dispense: 90 tablets, Refills: 3.
b) Dyslipidemia: Prescribe Atorvastatin 20 mg tablets, Sig: Take 1 tablet by mouth daily, Dispense: 90 tablets, Refills: 3.

Cost of Medication

GoodRx:
i) Warfarin 2.5 mg (90 tablets): $9.60
ii) Atorvastatin 20 mg (90 tablets): $12.50

Mark Cuban’s Cost Plus Drug Company:
i) Warfarin 2.5 mg (90 tablets): $7.00
ii) Atorvastatin 20 mg (90 tablets): $9.80

Walmart $4/$10 Drug List:
i) Warfarin 2.5 mg (90 tablets): $4.00
ii) Atorvastatin 20 mg (90 tablets): $10.00

Considering George’s limited income, it would be more cost-effective for him to get his prescriptions from Walmart’s $4/$10 Drug List.

 Guidelines for Treatment Selection

The treatment selection for George is based on his medical history, including atrial fibrillation and dyslipidemia. Warfarin is commonly used as a blood thinner for atrial fibrillation patients, and Atorvastatin is effective in managing dyslipidemia and reducing cholesterol levels.

Medication Teaching for George

a) Warfarin:
Take Warfarin exactly as prescribed to maintain consistent anticoagulation levels.
Regularly monitor INR levels and attend all required follow-up appointments to ensure appropriate dosage adjustments.

b) Atorvastatin:
Take Atorvastatin at the same time each day to establish a routine.
Maintain a heart-healthy diet and engage in regular physical activity to complement the effects of the medication.