Citations are required to enhance the discussion. 

You are the psychiatric nurse practitioner working in an outpatient community mental health clinic. You are scheduled to see a new patient for a psychiatric evaluation. The patient is a 43-year-old female who recently moved to the area from another state and would like to establish care. Per her new patient paperwork, she carries a diagnosis of generalized anxiety disorder. She has no history of inpatient psychiatric hospitalizations, no history of substance use treatment, and has no history of suicide attempts. Her medical history includes a recent diagnosis of fibromyalgia. Family history is positive for alcohol use disorder on her paternal side of the family. During your evaluation, she discloses that she has a history of sexual abuse from ages 2 years to 10 years of age by an adult close family friend. She never disclosed the abuse and no longer has contact with the perpetrator of the abuse. She does complain of having nightmares several times a week with themes of fear and loss of control. Despite having some symptoms of a mood disorder including poor motivation and initial and middle insomnia, the patient does not meet criteria for a depressive disorder or bipolar disorder. Her current medications include lorazepam 1 mg po BID and trazodone 50 mg po q hs. She is requesting to have the lorazepam refilled and an alternative plan for the sleep/nightmares.

1. You check the prescription monitoring program database and find that the patient has obtained benzodiazepines from 2-3 different providers during the same period multiple times in the past. How do you interpret this finding?
2. How do you address the findings in #1 with the patient and what kind of teaching would you provide?
3. What is your pharmacologic plan for the lorazepam and why (please include how you would write the prescription in an outpatient setting: dose, frequency, route, dosage form, quantity prescribed)?
4. What is your pharmacologic plan to treat the insomnia/nightmares and why (please include how you would write the prescription in an outpatient setting: dose, frequency, route, dosage form, quantity prescribed)?
5. What is your pharmacologic plan to treat the generalized anxiety disorder and why (please include how you would write the prescription in an outpatient setting: dose, frequency, route, dosage form, quantity prescribed)?

Citations are required to enhance the discussion. 

You are the psychiatric nurse practitioner working in an outpatient community mental health clinic. You are scheduled to see a new patient for a psychiatric evaluation. The patient is a 43-year-old female who recently moved to the area from another state and would like to establish care. Per her new patient paperwork, she carries a diagnosis of generalized anxiety disorder. She has no history of inpatient psychiatric hospitalizations, no history of substance use treatment, and has no history of suicide attempts. Her medical history includes a recent diagnosis of fibromyalgia. Family history is positive for alcohol use disorder on her paternal side of the family. During your evaluation, she discloses that she has a history of sexual abuse from ages 2 years to 10 years of age by an adult close family friend. She never disclosed the abuse and no longer has contact with the perpetrator of the abuse. She does complain of having nightmares several times a week with themes of fear and loss of control. Despite having some symptoms of a mood disorder including poor motivation and initial and middle insomnia, the patient does not meet criteria for a depressive disorder or bipolar disorder. Her current medications include lorazepam 1 mg po BID and trazodone 50 mg po q hs. She is requesting to have the lorazepam refilled and an alternative plan for the sleep/nightmares.

1. You check the prescription monitoring program database and find that the patient has obtained benzodiazepines from 2-3 different providers during the same period multiple times in the past. How do you interpret this finding?
2. How do you address the findings in #1 with the patient and what kind of teaching would you provide?
3. What is your pharmacologic plan for the lorazepam and why (please include how you would write the prescription in an outpatient setting: dose, frequency, route, dosage form, quantity prescribed)?
4. What is your pharmacologic plan to treat the insomnia/nightmares and why (please include how you would write the prescription in an outpatient setting: dose, frequency, route, dosage form, quantity prescribed)?
5. What is your pharmacologic plan to treat the generalized anxiety disorder and why (please include how you would write the prescription in an outpatient setting: dose, frequency, route, dosage form, quantity prescribed)?