Pharmacotherapeutic Case Study

M. W. is a 70-year-old Caucasian with a medical history of hypertension, osteoarthritis, atrial fibrillation, and total hysterectomy who lives by herself in a two-story row home. She visits the primary care clinic with her daughter, who is concerned because M. W. has bounced a few checks and can no longer pay her bills without assistance. M. W. admits that she has been forgetful and appears anxious as she describes an incident in which she went shopping and could not remember where she parked her car. Her daughter states that her mother’s memory has progressively worsened over the past year.


  • Fosinopril 20 mg PO daily
  • Metoprolol Succinate ER 50 mg PO daily
  • Warfarin 5 mg PO daily
  • Vitamin D 1,000 IU PO daily
  • Acetaminophen 325 mg 2 tablets (650 mg) PO tid

A careful evaluation and workup was ordered.

Diagnosis: Mild AD with an MMSE score of 22

  1. List specific goals of treatment for M. W.
  2. What drug therapy would you prescribe for M. W.? Why?
  3. What are the parameters for monitoring success of therapy?
  4. Discuss specific patient education based on the prescribed therapy.
  5. List one or two adverse reactions for the selected agent that would cause you to change therapy.
  6. Would there be any over-the-counter and/or alternative agents appropriate for M. W.?
  7. What lifestyle changes would you recommend to M. W.?
  8. Describe one or two drug-drug or drug-food interactions for the selected agent.


  1. Craft a Therapeutic Plan.
  2. Using Beers Criteria and rational drug prescribing, review the medications and diagnoses listed for M. W. What three prioritized changes would you make to the medication regimen? Include a detailed and evidence-based rationale for all changes, including, but not limited to, monitoring, drug-drug interactions, drug-disease interactions, pharmacokinetics/pharmacodynamics, age, gender, and culture.
  3. What would be your pharmacological-related patient education?
  4. Would you order any laboratory testing? Provide rationale for all decisions.
  5. Describe a follow-up plan of care with rationale.


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