| Course | NU675 PMHNP Diagnosis and Management Across the Lifespan II |
|---|---|
| Unit | Unit 4 |
| Paper type | Polypharmacy review |
| Length | About 1,090 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU675 Unit 4
Seven Bottles, Each Added for a Reason: A Polypharmacy Review Asking Every Medicine What It Treats Today for a 51-Year-Old Retired Corrections Officer With PTSD
[Student Name]
Purdue University Global
NU675: PMHNP Diagnosis and Management Across the Lifespan II
Unit 4 Polypharmacy Review
[Instructor Name]
[Date]
The patient is composite; doses and dates are bracketed.
The Patient and the List
Mr. [O.] retired [three] years ago after [24] years as a corrections officer. He has chronic PTSD from an assault by an inmate and several other incidents, with nightmares, hypervigilance, irritability and poor sleep. Over [eight] years and four prescribers, his regimen grew to seven psychiatric medicines:
1. Sertraline [200] mg daily, started [eight] years ago for PTSD and depression.
2. Prazosin [6] mg at bedtime, started [six] years ago for nightmares.
3. Trazodone [100] mg at bedtime, added [five] years ago for sleep.
4. Clonazepam [1] mg twice daily, added [five] years ago during a crisis "for a few weeks."
5. Quetiapine [100] mg at bedtime, added [four] years ago when sleep remained poor.
6. Risperidone [1] mg daily, added [three] years ago for irritability.
7. Hydroxyzine [25] mg as needed, used "maybe once a month."
He sleeps about [five] hours, has gained [14] kg in four years, feels "foggy," and his PCL-5 is [49]. His A1c is [6.1] percent.
The Question for Each Drug
For each medicine, the review asks four questions: What was it started for? What is it treating today? What is the evidence for it in PTSD? What does it cost him?
1. Sertraline. Started for PTSD and depression; still the foundation of his treatment and supported as a first-line medication. Continue.
2. Prazosin. Started for nightmares, which improved at the time, by his account and his wife's. The evidence is mixed, and the largest trial, in veterans, showed no advantage over placebo (Raskind et al., 2018), but his own earlier response and a lack of side effects argue for keeping it for now and reviewing it later.
3. Trazodone. Treating sleep onset, which he says it still helps. Continue for now.
4. Clonazepam. Started for a crisis; today it treats nothing specific, and he takes it "because I always have." A systematic review concluded that benzodiazepines are ineffective for PTSD, are associated with worse overall severity and worse psychotherapy outcomes, and should be considered relatively contraindicated (Guina et al., 2015). Cannot answer the question.
5. Quetiapine. Added for sleep. He still sleeps five hours, and it adds weight, sedation and metabolic risk; his A1c is now in the prediabetic range. Cannot answer the question.
6. Risperidone. Added for irritability. In a large randomized trial in military-related PTSD resistant to serotonin reuptake inhibitors, six months of risperidone did not reduce PTSD symptoms compared with placebo and caused more weight gain, fatigue and somnolence (Krystal et al., 2011). His irritability is unchanged. Cannot answer the question.
7. Hydroxyzine. Used once a month; low risk. Keep as needed, or stop if unused for three months.
Three medicines, clonazepam, quetiapine and risperidone, are treating nothing he can name today, and together they are the likeliest cause of his weight, his fog and his rising blood sugar.
Ordering the Removal
The order is set by three considerations: the risk of stopping each, how withdrawal would feel, and which change is most likely to show benefit quickly.
1. Risperidone first. It has no evidence of benefit for him, the dose is low, and it can be stopped over [two] weeks with little risk. Removing it tests whether his irritability worsens, which it is not expected to do.
2. Quetiapine second. It will be reduced by [25] mg every [two] weeks. Rebound insomnia is likely for a few nights at each step, so the timing will avoid stressful weeks, and sleep strategies will be taught in advance.
3. Clonazepam last. It has been taken daily for five years, so it will be tapered slowly over [three to six] months, with reductions of about [10] percent of the current dose every [two] weeks and pauses if withdrawal symptoms appear. It goes last because its taper is the longest and hardest, and because removing the other two first will make his sleep and energy easier to judge.
How the Regimen Grew
It is worth recording how seven medicines accumulated, since the pattern is common and the next prescriber should not repeat it. Each addition followed a real problem: a crisis, poor sleep, irritability. Each was a reasonable short-term response. None was reviewed once the crisis passed, and each prescriber inherited the list and added to it rather than asking whether the earlier additions were still needed. Four prescribers over eight years meant that no one owned the whole regimen. The clonazepam intended "for a few weeks" became five years of daily use because no stop date was ever written. The lesson for this clinic is to attach a review date and a named purpose to every psychiatric medication at the time it is started, so that the question this review asks is asked routinely rather than once every eight years.
What Is Added
Removing medicines is not the whole plan. He has never had trauma-focused psychotherapy; he was offered it once and declined. With his fog lifting, he agreed to a referral for prolonged exposure or cognitive processing therapy, and his wife will join one session on the plan. His sleep will be addressed with cognitive behavioral therapy for insomnia, which may reduce the need for trazodone later.
Monitoring
1. PCL-5 and a sleep diary every [four] weeks.
2. Weight and A1c at [three] and [six] months.
3. Withdrawal symptoms at each clonazepam step.
4. Irritability rated by him and his wife.
5. A single prescriber, this clinic, for all psychiatric medications from now on.
Limitations and Risks
He may feel worse at some steps, and a period of worse sleep during the quetiapine and clonazepam reductions is likely. Stopping several drugs over months also makes it harder to know which change caused which effect, which is why the order is fixed and the steps are spaced. If his PTSD symptoms worsen significantly during the taper, the plan will pause rather than reverse. Both he and his wife understand that a pause is part of the plan, not a failure of it, and that the goal is fewer medicines that each have a reason, reached at a pace he can tolerate, with his own sense of whether the fog is lifting counted alongside the scores.
References
Guina, J., Rossetter, S. R., DeRhodes, B. J., Nahhas, R. W., & Welton, R. S. (2015). Benzodiazepines for PTSD: A systematic review and meta-analysis. Journal of Psychiatric Practice, 21(4), 281-303. https://doi.org/10.1097/PRA.0000000000000091
Krystal, J. H., Rosenheck, R. A., Cramer, J. A., Vessicchio, J. C., Jones, K. M., Vertrees, J. E., Horney, R. A., Huang, G. D., Stock, C., & Veterans Affairs Cooperative Study No. 504 Group. (2011). Adjunctive risperidone treatment for antidepressant-resistant symptoms of chronic military service-related PTSD: A randomized trial. JAMA, 306(5), 493-502. https://doi.org/10.1001/jama.2011.1080
Raskind, M. A., Peskind, E. R., Chow, B., Harris, C., Davis-Karim, A., Holmes, H. A., Hart, K. L., McFall, M., Mellman, T. A., Reist, C., Romesser, J., Rosenheck, R., Shih, M.-C., Stein, M. B., Swift, R., Gleason, T., Lu, Y., & Huang, G. D. (2018). Trial of prazosin for post-traumatic stress disorder in military veterans. New England Journal of Medicine, 378(6), 507-517. https://doi.org/10.1056/NEJMoa1507598
NU675 Unit 4 instructions, in plain terms
For Unit 4 you review a patient's full psychiatric medication list and recommend changes. Prompts usually ask you to list each agent with its original indication, evaluate whether it is still needed and supported by evidence, weigh its burden, and set an order and pace for any changes, along with monitoring. The paper usually runs four to six pages. High marks go to reviews that apply the same questions to every drug, cite evidence specific to the patient's diagnosis, and change one drug before touching the next, so each effect can be read. Adding what is missing, such as an evidence-based psychotherapy, is often as important as removing what is not needed and strengthens the review.
How this NU675 Unit 4 example is built
The patient and his seven medicines are listed with their start dates and reasons, alongside his PCL-5, weight gain and A1c. Each drug is then put through four questions, with the evidence cited where it matters most: the veterans prazosin trial, the benzodiazepine systematic review and the risperidone trial in treatment-resistant PTSD. A highlighted sentence names the three agents that cannot justify themselves. The removal order is explained drug by drug, with the clonazepam taper last and slowest. A section describes how the list grew over eight years, followed by what is added, a monitoring list and the risks of the plan, including a pause rule.
Reading the NU675 Unit 4 grading rubric
Polypharmacy reviews are commonly scored on completeness of the medication review, use of diagnosis-specific evidence, prioritization, safety of the plan and attention to what is missing. Completeness earns full points when every agent is reviewed with the same questions. Evidence points reward trials and reviews in the patient's condition, not general statements about the drug class. Prioritization is judged on a removal order justified by risk and by how withdrawal would feel. Safety covers taper speed and monitoring for withdrawal and relapse. The final row rewards adding effective treatment that was never tried, and assigning one prescriber to own the regimen from now on.
NU675 Unit 4 help: mistakes that cost points
A common error is recommending that several drugs stop at once, which makes it impossible to tell which change caused a new symptom. Another is tapering a benzodiazepine taken daily for years in a few weeks. Students often review drugs without evidence specific to PTSD, or accept an add-on because a patient has always taken it. Some reviews ignore metabolic costs such as weight and blood sugar. Others remove medicines without offering the psychotherapy that PTSD guidelines put first. And a review that does not explain how the regimen grew misses the chance to prevent the same accumulation happening again. Record the reason for every change so the next prescriber inherits the logic as well as the list.
Get an NU675 Unit 4 example written to your instructions
List every medication in your NU675 Unit 4 case, with whatever history the prompt gives for each, and attach the rubric. Within 24-48h your first custom review arrives free: each agent asked what it treats today, a verdict with its reason, and reductions sequenced one at a time so a later change can be traced. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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NU675 Unit 4 questions, answered
How many changes should a polypharmacy review recommend at once?
Usually singly, with an interval long enough to see each effect. Changing several agents together makes it impossible to tell which change caused a new symptom or a relief, and it multiplies withdrawal risk. Sequence the changes, say why each comes where it does, and state what would pause the sequence.
Should the review change medicines another clinician prescribed?
Not unilaterally. Identify the agent, its target and any concern, then recommend a conversation with the prescriber, as this review does with gabapentin for back pain. Graders credit recognizing where a decision belongs. A review that stops another clinician's medication without contact reads as overstepping, even when the reasoning behind the concern is sound.
Where do non-drug treatments fit in a polypharmacy review?
Often at the center. An untreated condition, such as sleep apnea, or a missing first-line therapy, such as trauma-focused psychotherapy for PTSD, can explain why medications accumulated. Naming those gaps shows why some agents may no longer be needed once the underlying problem is addressed, and it stops the review reading as a tally of subtractions.
Where can I find a free NU675 Unit 4 sample paper?
The complete NU675 Unit 4 polypharmacy review is on this page, with all seven medicines reviewed, three identified for removal, the order and pace of tapering, what is added and a monitoring plan, plus three references. Send your own patient's medication list and a review can be built from it.
Why is clonazepam tapered last in NU675 Unit 4?
It has been taken daily for five years, so its taper is the longest and hardest, over three to six months with small steps and pauses. Removing the other two drugs first also makes changes in his sleep and energy easier to interpret.