Two months ago, you saw Josie, a 34-year-old nurse, to whom you prescribed escitalopram 10 mg daily and
alprazolam 0.5 mg, three times a day as needed for anxiety.
Today, Josie, her mom, and her boyfriend, Robs, present for a follow up visit. Josie reports, “My anxiety isn’t
really any better. I haven’t been able to come in to work for the past three days. I ran out of my alprazolam and
I cannot even think about going to work without it. Tell her, Robs, what it’s like.”
“Yesterday,” Robs says, “Josie couldn’t get through the day, so um, yeah, she took some of my mom’s
alprazolam yesterda--.”
Josie’s mom interrupts to ask, “But why did you even give her that drug? With her history of alcohol addiction!
She’s been alcoholic since she was in her early 20s. And did she tell you her dad also had problems with
addiction?”
“Addiction?” Robs asks Josie’s mom. “Are you worried about addiction to this drug?”
He turns to you, agitated. “Did you know Josie’s sometimes taking up to seven pills a day? At least that I know
of. Is that overusing or addiction?”
Josie starts crying. “But I can't function without alprazolam. Robs, you know how hard nursing has been ever
since orientation ended. I love my job but I just want to feel normal. And the alprazolam makes me feel that
way. Please…." she pleads.
Questions
Based on the initial letter of your last name, from your perspective as Josie’s psychiatric nurse practitioner,
address the following in your initial post. Question 5 should be answered by everyone.
A–F: What course of treatment would you recommend for Josie? Would you admit her into the hospital? Why
would you make this choice? If you stop prescribing alprazolam, what symptoms of alprazolam detox would
you expect Josie to have?
Sample Solution