The patient is a young adult with unspecified mental handicap who comes with mom. He has been on the following regimen for years:
clonidine 0.3mg per day
depakote DR 1000mg per day
geodon 200mg per day
valium 20mg per day
(Most of the above medications are split into two dosings a day.)
He has been on the regimen for years and is tolerating medications. Mother does not want to change the treatment. The above combination was from much trial and error and patient used to be much worse.
However, he has history of uncontrollable outbursts, even with optimized pharmacology. Since the last visit, he was hospitalized twice. Police was involved and had to restrain him. Inpatient treatment consists of increasing clonidine and depakote by a bit. Then he was discharged after a few days without prescriptions. Inpatient physician's rationale was that outpatient psychiatrist will manage medication.
Patient never remembers his outbursts. He cannot specific a trigger.
Since mom and patient wanted to keep the current medications, we agreed to add PRN medications for agitation. Mom is a nurse and know how to give injections.
1. What would be your PRN medication and why?
2. Would you have done something differently than prescribe PRN medication for agitation? If so, what would you have done?
clonidine 0.3mg per day
depakote DR 1000mg per day
geodon 200mg per day
valium 20mg per day
(Most of the above medications are split into two dosings a day.)
He has been on the regimen for years and is tolerating medications. Mother does not want to change the treatment. The above combination was from much trial and error and patient used to be much worse.
However, he has history of uncontrollable outbursts, even with optimized pharmacology. Since the last visit, he was hospitalized twice. Police was involved and had to restrain him. Inpatient treatment consists of increasing clonidine and depakote by a bit. Then he was discharged after a few days without prescriptions. Inpatient physician's rationale was that outpatient psychiatrist will manage medication.
Patient never remembers his outbursts. He cannot specific a trigger.
Since mom and patient wanted to keep the current medications, we agreed to add PRN medications for agitation. Mom is a nurse and know how to give injections.
1. What would be your PRN medication and why?
2. Would you have done something differently than prescribe PRN medication for agitation? If so, what would you have done?