Moderate Depression in a 70-Year-Old Man with Recent Hip Fracture: Prescribing an Antidepressant
Write a prescription for moderate depressive episode and have every line marked: drug choice, dose, route, frequency and duration, checked against the patient's allergies, current medicines, renal function and the interaction database, with each error explained.
medium8 scoring rulesrenal impairment
- Patient
- 70 years, male, 75 kg
- Diagnosis
- Moderate depressive episode
- Renal function
- eGFR 55 mL/min/1.73m²
- Allergies
- None known
The scenario
Patient B-217 is a 70-year-old man, 75 kg, admitted to a rehabilitation ward three weeks after a dynamic hip screw for a right intertrochanteric fracture. He is normally independent, but now feels low in mood, tearful, and has lost interest in activities. He reports poor sleep and reduced appetite. On mental state examination he appears withdrawn, but makes good eye contact; speech is normal in rate and content. He denies suicidal ideation, psychotic symptoms, and manic symptoms. He has no cognitive impairment. PHQ-9 score is 18.
He takes aspirin 75 mg once daily for previous myocardial infarction and tramadol 50 mg twice daily for fracture pain. He has no known allergies. He does not smoke and drinks minimal alcohol.
Blood pressure 138/78 mmHg, pulse 72 bpm, temperature 36.8°C. Blood tests: serum creatinine 1.3 mg/dL, eGFR 55 mL/min/1.73m², ALT 28 U/L, bilirubin 12 µmol/L, haemoglobin 12.8 g/dL, TSH 2.1 mIU/L, vitamin B12 and folate normal.
Diagnosis: moderate depressive episode. He is asking for help with his low mood. Write a prescription for an antidepressant, including any co-prescribing you consider necessary, and specify the review interval.
What gets marked
- Whether you chose an indicated drug, and whether you avoided the contraindicated ones.
- Dose, route, frequency and duration against the range for this patient.
- Renal and hepatic dose adjustment where this patient's numbers demand it.
- Allergy cross-reactivity and interactions with the medicines already on the chart.
- The instructions and monitoring you write, not only the drug you pick.
8 scoring rules apply to this scenario. A single critical error fails the attempt whatever the score.
Log in to prescribe for "Moderate Depression in a 70-Year-Old Man with Recent Hip Fracture: Prescribing an Antidepressant"
A free account opens the prescription pad: search the formulary, write the chart, and have it marked line by line by the safety engine.
Taught in
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Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.