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CASE STUDY: Parkyr Litchfield Parkyr Litchfield Transcript Hiya doc. I’m Parkyr—with a y. So my old doc … well, he’s not all that old, but he was my doctor since I was born, he can’t see me anymore because he’s only a pediatrician. And I’m 22 and an adult. And I need a refill on my ADHD meds, so I got a referral to you. What I need is Vyvnase. I’ve had to ration them because I couldn’t get the refill right away. So I saved my pills for test days. I’m at the tech school—I’ve got most of my core courses done, and now I’m focusing on the pipefitting courses. I’m going to get my associate’s degree. If I can make it through the classes, which has been tough without the med. I was diagnosed back in grade school. I think I was about 9. Mom says it made all the difference knowing what was going on with me. They tried a bunch of different meds. They’d work for a while, then not so much. So Mom kept saying I needed higher doses. I don’t remember all the different meds, but Vyvanse seems to work the best. I’ve been on it for years, at least since I was a senior in high school. I’ve tried both stimulants and non-stimulants. The stimulants always worked better. I think that covers it. How about that refill now? Vitals BP: 129/86, P: 92, R: 18, T: 97.4, height 5′ 11, weight: 183, multiracial Medical History Childhood asthma Allergies: Ragweed HPI SI: None Mood swings: None Psychosis: None Sleep: “Does okay falling asleep and staying asleep.” Anxiety: “I’m worried about this med and how I’m doing at school, but otherwise, no.” Depression: “Not really a lot of depression.” Appetite: “Not much.” Medications Vyvanse, 80 mg in the morning, 30 mg at noon Albuterol inhaler as needed Personal History Had problems with drugs after high school graduation; sober for two years after nearly flunking out of first year of college. Social History Starting second year at technical school; getting an associate’s degree and pipefitting certificate. When he takes his meds, does really well. When he didn’t take the meds for a few weeks, his grades dropped. “I had to ration them because I couldn’t get a refill right away. So I saved my pills for test days.” Lives at home and works part time as an Uber and InstaCart driver. Family History “I think maybe my mom was depressed.” 1. Medication Parkyr is taking Vyvanse 80 mg in the morning, 30 mg at noon. What concerns, if any, do you have about this medication and/or dose for him? Parkyr responds with surprise: Wow! I had no idea this was a “high” dose. It works great, however! So I can keep taking it, right? 2. Pick one of the following questions (30 points): If you practice in a collaborative state, address whether you can prescribe this medication. What information would you give to your collaborating physician regarding Parkyr? If you practice in an independent practice state, what are your state’s rules and regulations regarding your prescriptive authority to prescribe Vyvanse? 3. Refill or Alternatives Would you refill Vyvanse at the same dose? If so, why? If not, what are two viable alternatives for Parkyr? Explain why, as well as the starting dose, indications, and possible side effects. (30 points) 4. Screening: What screening tests or referrals, if any, would you like to do to get an accurate diagnosis of ADHD? 5. Referral to a clinical psychologist is appropriate. Find one in your area (Maryland, zipcode 20772) who does ADHD diagnostic testing to whom you can refer Parkyr. Include their name, credentials, website if available, and specific information about services they provide related to ADHD and adults. (10 points) 6. What tests and/or lab work would you order for Parkyr? Why? Include at least one supporting reference. (20 points) 7. Explain your treatment plan to Parkyr, including your medication recommendation. If you don’t prescribe Vyvanse, also explain to Parkyr what Vyvanse is and how it works. (10 points) 8. Patient Education: What are your recommendations for patient education? (10 points)

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