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EX I 2007 - Na H20 K PHPR $15 EXAMINATIDN#1 January 31 see...

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Unformatted text preview: Na, H20, K! PHPR $15!. PHARMACUTHERAPEUTICS EXAMINATIDN #1 January 31], see? Name ID Numbefi *Nete: Grades in the newer: will he posted via e—mail in ID number erder. If fen Wish te use a 4 digit number ether than veer UA III , please cheese ene new. THIS EXAM IS WURTH Ill] PDINTS As you will see, this patient has several problems. You should create a complete, prioritized problem list, but fog}; your care plan on the acute, active problems {but don‘t forget to address the long-term solutions to those acute, active problemsl]. ] do not expect you to provide a specific therapeutic plan for the diseases not yet covered in therapeutics tie. her eating disorder}. If you feel there is missing information, make sure you note what information is missing and how you would obtain it. Make sure your therapeutic recommendations are specific. lfyou have questions, raise your hand and I will help you as best I can. THE CASE History of Present Illness {HPl} Id n MA. is ajfiyear old woman with a history of hygfidnsion and abl mda. About one week I'Nllr H E. 'r F him. ago, she began to feel nauseated and then increasingly fatiggg weak and digy, Four or 5 days ago, she began to have some diarrhea. She denies any nausea or vomiting, and she £1 E N. 1/ said she has been drinking lots of water. She states that abouufl days ago, she had a Hiheadachs. She thought that meant her blood pressmewas high, so she began taking m_o[_e sips: inf herhypefiensiohfledieation. She also was in Hogales at that time and bought some ,1“, T -Lasix since she heard that was good for hypertension. Her only other complaints are masingly frequent hot flages, and her menstrual periods have become sporadic in volume and frequency. I _ _. I] Eel: WI- _ Past Medical History (Para) j; iffgfgfll," 1,”, Hypertension X 4 years, asthma since childhood. Occasional headachs. q; H m .1: 4r W Family History (PH) s } an}: are no a“: M} Both parents alive, father has hypertension, mother has type 2 diabetes. Has 2 sisters, 5,; N .5: both alive and wet]. I HA Social History {SH} . . . _ _ . sass-mm Works as h1gh school science teacher; smokes cigarettes “once in a while“; dunks ”' “if alcohol on occasion. Denies use of illicit drugs. Married X3t} years, sexually active only with her husband 5,». ,5, fl.“ Medications (as prescribed) g ”1.. 5‘ HCTZ 25mg qd Albutero] MDI pm Fluticasone MDI ltflmcg hid Tylenol #3 1-2 tabs pm Lansoprazole 3flrng qd Ortho-Tricyclen Physical Exam 475. 5r 'F' H . WT”. T _ l} . l u VS: HP llflfl2 lying. amen sitting; P llt] lying: 1315 Slltlng; T 36, R fl,02sa196% Wt ookg. ht 5‘6" M53 Ila: General: Well-developed, wcll nourished middle-aged woman in no acute distress, but lying down because she says she feels ding. HEFNT: eyes, ears nl; mouth dry; jugular 1rennus pulse at lcm [2—5cn1 nl); thyroid not enlarged and without masses Chest: Normal breath sounds Hean: Regular rate and rhythm; rachyeardic; no murmurs, rubs or gallons Abdomen: Soft, non-tender. Ho henatoslzrulenon'iegal'},f Pelvic, rectal exams deferred Heuro: Awake, alert and oriented X3; cranial nerves ll-Xll intact; normal muscle strengt] reflexes Extremities: no skin lesion or edema; nonnal pedal pulses Labs (normal ranges in parentheses}: l J, t 1 Na 126 {135-145}, K 181135-55}, {318695405}, HCDH 34 (24-28] tBUN 3&(10-20), creatinine 1.0 (015-11), glucose 38 [ED-l 10} Ca 8.3 {Bi-IRS), P04 3.0 {2.5-5.5}, Mg 1.3 {I 15-15) Hemoglobinfldematoerit {HM} 14.3423 [13-14f39-43), WBC 8,6flfl {Sflflfl-lflflfl Semm albumin 3.3 {3.34.5}; urine pregnancyr test negative ass: pH ale, p02 95, oz sat 99%, poo: 44, Hcos an ECG: sinus tachycardia; flattened T waves and U wave present CXR: no acute disease PHARIIIIAL‘IST'S PATIENT DATA BASE DRUG THERAPY PRIDELEM WURKSHEET PHARMACEUTICAL CARE PLAN: Note that your plan should include immediate as well as longer-term recommendations. Hon‘t forget to be specific! Also. don’t forget to mention inadequate data in your problem list, (no make-sure you list those items somewhere. x. ‘\ for eaeh or the itlfelwtrolyte and aeilli'ltase problems. provide your tionale for your " line therapy (Le. tell me why you ehoae what you ehoal ther alternative J. I don’t care where you put this info. but make sure] ean Ind it easily. PHAR-MACIST’S PATIENT DATA BASE FORM Pharmacist Patient Name Add res; Fn .‘cian Pharrna -_= Na Known Drug NlargiaamDRn Nat knowntinadquata infarmaflan Patient ID Location Ram sex "4 aL Claw tian pa 12.5.: IN: f _‘ FRIORITIZED MEDICAL PROBLEM LIST MEDICATION PROFILE II If u. E II ‘ I1 I_._ I II .- I: :WW . u... a . HPI.PMH.FH,aH,etc. jim- , .a ., 1-... Far wan Exam, you do not need to complete this box 'I i: 1‘ {-1.3 .m- ffl. 'hm‘rfd l' HIM" v _ H .l . J- . 1 than I; I 4"} ERIN“ " etc: Miriam!” a: up “”qu 12-3.! W . - mm Lin - I _ .n, m ‘" 1" .11 tiff; gr 'II' fir?! r - i In}. :1.- 'I .ll 11' I: Wrfi'abm'wa s» 5 Ha: - .-.. a {J Exewég'wfl Hire. ;H a; aim? F Hag/J mmr}: .; dn'fihfi? accflztorflréf 7' 554:5» 9’13!” 445;»- 3 36 at“ Irrrggitfliji )3 “31125513 hi??? . EMS"?! #1 314301,? Vital a] 3 ns. Iahnratn data, din 3 nostic test result: m l-— Temp "'h- h .L i 7‘ a '5. i “:3 Ell C02 {HE-Ga} BUN Craat Clear. —fl_—— i i I i u: '1} NOTEflfififdfi’filfi'fi Mimic-Ir'fi S £5??an 5m _,-:,-fi':»;: '1 Eu? mum flryu/fl'rmr c: 5/15 mp arffiwfafit. kayak-mink, Hatfiyramfig .5 J r , . . . 55m: W933”; iii}; 3&3: 4‘?” $3.55! :5; $515?an mambmt‘ffl J, Hgflfim'cma j (BMW/Cr" 54;: -_- mafia/Lam ?x?m.~"'m dual. J ‘16 H53: :HJ'X 33m; 753.9%! rarer/5&3 é flaféwfl Tar/am": 1‘ M ways; pmm Fallen: M ’4' London TYPE OF PRO Plum-mien Dole flRUG THERAPY PROBLEM WURKSHEET IBLE CAUSES PROBLEM LIST Emelanon heaven: drug dump; and medial] problems Head for add-ill IJflB-l drug lhmmp'rr Umsaw drug fl'lmpy Appropriale 11mg aelen‘llon DrugRogimL-n [Jose to: lurw [Mugs wirhou: obvious meiioal indie-anions Mediealions unldentifiefl Una-filed medical couditlnns New medical medium reqlflringumv drug therapy {rum {j II ,J' o, F, Chronic disorder rewiring omninued drug lineup]: EC'F v? E £10 6 'IL } Condition best "rated with ombimtiom drug Ll'lcramr . r! ‘: May dfl'alop 13m- medical mama warm: mayhem ”’1 “L3 1W?” '5 fl JIM!“ ' i, 3, . J mpmrmlauwlhmpympnmbdmalmn JflllfPfi'hfiar’rfih-H'al hdfflfiflfifflm‘gr hf-jzfjflfii'lg E}:- f!.-';" Medieale with no valid indie-align Goodman oauae-d by accidental or inremional Ingesljon oflume mount ofdrug or chancel Medical prablmntej Hammad with use ot'm' withdraw-fa! from alcohol, drug. or [chasm Cundjljon is better neared wilh naming Iherapy Taking mulfipledmga when single aganr as effective Taking drug's) to treat unavoidable adverse reaefion from enema: medication Current mgimnn not Luuflj' a: offender: as other choices. Current ream not usually as safe as dher charcoal 'l'herapy no! individualized ll} panenr mic-a1 problem for which drug is no: efl‘eetiue _ - Pabmrhfiriskflflmflnalmxfl'aindiuatuyiffl T1“ 3.! D £3501fo J if? :51?- r r Patient refiadoq' h:- eumem drug Ibempj' P0 3a} ~ 3h £36163] {0 Taking. comthllian product when single agent appropriate lineage form inappmpriale Medic-lion error cu Kw (mm) H of PRN use not Appropriate for emfiiflon Route of ahiniatratimm’doaage fom’mode of admiaiauafion ml. appropriate fur current condition Length or course of dream no! appropriale Drag amm- allered “amour adequate Iherapeurie 111'31 Doaefmtenral flexibiliq- not appropriate Doser'l'mqumrey tau law to produce drained rcspuuss L11 this puljeu'l Serum drug level below desired therapeutic range 'l'imhrg ot‘antinfiwabia] prophylaxis n01 approprme Llocliealjm nal stored papal}: Modieau'un error m JI- P FPROBLEM Dueleehigh Therapetflic tittplteetimt Drug afletgt'fadtmemtg nuns Interactions tdtug-dmg. drug- Jtseaee. dt'ttg-nulrimt. [51115. lab-mum teet} Failure to merit: temp]. P'mlneial impact Patient knowledge aiding thee-e133. POSSIBLE CfiUSES MEL-equality tune high fest-this patient WMEVH ehut-ethedeeiredmempetliemge Dose escalated tee qttzieltiy Dewlnufvei flexibility net Imt'lfllt ['et lititt petiettt Medication firm" Reeeitit'tg multiple Igettte uit‘emtteddetl benefit Histog- afflict” ctr ADE to current {at aluminum-tainted} egeets AllergyMDE history net tame-dice] reeotds Patient not using alert for severe ellerfiMDE Manama-GM Drug administered mnpidly Mediation en'ut. Iettul Drp-DIfiJIilI Etfeel el'tit'ugaiteted due to enzyme induetiettt'ittht'bition Front meeherdntg patient is whim Ell'eet aiding altered due to Fatein binding. altertllim: I‘m whet- drttg patient is taken; Efl'eet efdrug altered due to phermeeulynemie change than another drug peliet'tt is taking Eioat'eiiehilitt' artful eltete-idtte to intemiett with 1|:th drug or feed Et’t'eet et'drugeltetedduetesuhe‘tmeeinflmd Patiml‘e lab-amt} test Iltet'ed due to httetferenee l'mm l tirughptltienttltakiflg Patient did nun. Idhet'e tat-id: the chug mgimm Drug nut gtvett due lumedieetinn emu Faliflt'l did not take due to high drug metfleelt eE' iueunnee Patient tmlble 1t: take ctr-l medieetien Patient has m N meets for W medieatim Drug product not amilable The cement regime'- ie net the meat unst—uffecliiu Patient tenable te pum'use metiieetiensFm immune Pefient dm mt! undetmttd the ptttpttee. diteetieus nu- patentiel side effects affine drug reg'mm Current regimen nut eminent with the patients health beliefs I’R ELEM LIST Hem! embed 15 Pl" ‘I'I.3L1;l'1,15..IIT=#‘3 .J I fidvttg the? iofxcerci Jinn/grid a/fzf: Her: new fez-eh 1* Merle 3w.- H; Mfltfi, Mei rift?» our! NM 3.5in Neil fl tam-1,4,»? i ff; leclir Jfflf/hrfffflip’éflfl"fl : {(55 if/Iij'i’é'ia My? DRUG WY PROBLEMS HGTZJE Lihix -dut.. MEDICAL PRflELEM LIST I} ELF Valumb .nsmhwfir PHARMACEUTICAL CARE PIAN PATIENT . _ Emmanu- “ ID wdzvlqinjrewr gfimmm I pa Maimiww A HEN? 311d TA} WWW-'95 hqpn-‘mwjiow “59”“ in Wit?” 5 dlufliim IL achls'rH:1-1.']'han H- wuL a”? Emefm hawfia’tflV-cdé mink plawh WWI HE.- FWV 30 _ I”? SKEW-t WthVamfl pm. 5. win ’m TEwEuE . W $memx‘l- a f : ELF volume daplfihm Haw qJfi x4. IDtawa E 1')? +ar+has¥¢¥£n find pmwflr TEmrrawcc hqpalmhaion Yeti-55555 {FIN Improvcmzn ' n“ | a v’ 1mm Janna M5 v: ann{ hqpapcfirsén 3:: mm flue Jame rem” d‘orfiam dawfgfl rcpm’r rF Ha improwm- $511951 wfi’f'flmfi-‘HHLEJ Jismj/hr N5 mm P+ :1 Mafia firm! pt *0 {might-LE PG hqfifaJ-‘M @l'lwré E gal-avast 19w“ H511 MM. +5} gang/fail mt! Lmhm Bflm‘ifibl‘awf 5H. 155 fier/HT PHARMACEUTICAL CARE PLAN Tl-IERAPEUTIC RECW’I‘ICHS 54c ”I Km “fig/it'd! 4m E}. J9 H: “.4: Zvfi-ELTWI hair a”; £3»;ng Fa Lo?u§dr Yififldufhfffl {5 F jflk435+ 9a} rah-IVE: rgdmfmh.’ K 7353;? {aw-.55 fling; TX {gr-5km 3.ng buffifikfll'lflwfi A!" m; drag-hm +52%" mum: Du Hart AIS-mm 5W! .unli Kira-5‘ DC! Lefiif I +HCTE 1'9 33-5 Wfl {950 filing r” c Ha fig hf. ante: {was 5 x a Errsdafpflad Q’s-JAM; lg‘hfflg... 5156594155, +175 Narnafflfia 3}Mcm’mhc New: fir Ilia lc-sra hllufitvalh‘fl‘l Ilflwcdgfilfl sz ”ma/Gt. Lear): time? 1141 ma‘l H 3 Fir.) mm THERAPY mm ”111+ him :10 @H‘r'tma, 1'5 Wiwlizci HIWILva I {CM-[LC]- Wdaf r. 4' “3" wars; Mm LUL JP HTTU 5; {“4me WW5 fifl-fitfim Ham , mmfir KW: abovt.» (Iii) Mug; +17! H UP Wanfior k+ Mar-I TXrE-‘dr Sheriff! {1% prawn-1 EEWVM' 4dwFpPHcfi +9 madam" mum? flfiuw’rnl Laaix arWflflHLb HL-pu trauma rcwk'iwf “"4"" jinx? an [‘F 139 y-Hojqa dimmer, rlmlgfhwh/' 51'."me Willi.) 'rakziwé/‘f'fifi '4' mm: hr ébpfimqfikn “ii darn Warmm figfhh’d had I'fir CW flcl'rr'jr: in Harp 5mm: (Hr; PHARMACEUTICAL CARE PLAN (WHEN-'1'“ Jill? bum mp: mafia 1%”chch Hamel MM ‘4” W's-vole}. ELI-EH): 'HJ rt NHL-LE. E cumw* HLIJ {Newt}; hfflh'. I. :kVIJ I F1141 M! r: W}; EUR!!! £0163!» mtg/Maw 1; } .1 Pmiunt m #4. ID Humbu' Humanist human Dal: PHARMACEUTICAL CARE PLfiN MEDICAL 99.0an THERAPY GUALSJDESIRED THERAPEUTIC MONII'DRING PATIENT LIST EDUCATIDN Java-Jr; ar' J0 a r' 94’ r“ “ rrfifgmmg‘ni" _r .- 33me M93 wag; fie} fiflip Lfitflifiifififi'roffi R FIT/WT. ...
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