PHPR 875A EX VI - PI-IPR SEA PHARMACOTHERAPEUI‘ICS...

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Unformatted text preview: PI-IPR SEA PHARMACOTHERAPEUI‘ICS Exam #6 Ma}r 10, Zflflfi Group Name Grazing Members Siflature THIS EXAM IS WORTH 200 POINTS Case DC: “I can’t stand this pain. Ijust want to go to sleep and never wake up.” HP]: L.H. is a 445 year old woman diagnosed 6 months ago with breast cancer. At the time of diagnosis, she underwent simple mastectomy with axillary node dissection. 3f12 nodes were positive for tumor, but she had no evidence at the time of metastatic disease. Her tumor was hormone receptor negative, and she “we offered chemotherapy. She elected to delay chemotherapy, but then am to begin therapy 2 months ago. After her first round of doxombicinicyclophosphamide, she developed severe back pain, which was found to be metastatic disease to her spine. Workfiup at that time revealed vertebral metastases at Till-12 an Lt , as well as local spread of the tumor to her chest wall. Since that time, she has complained :1 increasing pain and has seen multiple physicians. She was diagnosed with a UTI a few days tag: and she was given an antibiotic. She describes her pain as “Ell out of It)“, and is a constant throbbing in her back that is not relieved by anything, not by medications or by changing her position She thinks one of the pair medications she is taking helps, but it makes her nguseated. She says sometimes the pain shoots down her left leg “like an electric shock“. She also states that she can't sleep, though sometimes she will fall asleep But then wake up around 2am can she can’t fall back asleep. Her appetite is very poor, and she feels very anxious. She states that she would like to have a Warm some time before she dies. She tells you that she feels like the pain will never get better, and sh is thinking of an easy way to kill herself She feels guilty that she is putting her family through this, and she thinks they would he better off without her. She has stopped taking all of her medications Incept for her pain medications — ' fi“_ ——“ ~———._,_\_ Pher: Breast cancer as above. Hx bipolar disorder, first diagnosed at age 22. She has been hospitalized twice for manic em'sodes, but not for the past It} years. She has had several episode of mmion, including one episode of post-partwn depression that also resulted in psychiatric hospitalization She is prerneuopausal, and had normal periods until she got sick SH: works as public defense attorney, on medical leave since breast cancer diagnosis; married 2 it] years, 2 children ages lit and 12; Drinks 1-2 shorts oflfl every mght to try to get to sleep, bu she says she is not usually a drinker. Smoked marijuana in college, but no recent illicit drug use- FH: Matemal grandmother died of breast cancer ale at 56; father has hypertension Medications prescribed (average #pillsiday): 2 a. "'5 ‘5'”ch ‘3 Vicodin 1-2 tablets q4-fih_pr_n_fl4fday}fl ? VPercooet 1-2 tablets qfihfliyday) £st '5" Morphine immediate release 24mg qflhflljfi Xflmgiday] Wntin 2i}mg qd (lidsy) 9,; .5 Tylenol Extra-Strength 1-2 q4h_pg_{4iday) Ibuprofen 200mg q4h pip (4iday) Ranitidine 15cmg qua Divalproex 500mg qllh Sertraline somg qasr [precepam 1mg th Tcrnacharn 15mg qhs prn Calcium carbonate Sflflmg qllh Ciprofloxaoin Sflilmg qlEh ' 5'5? Exam VS: P 92, BP uses, R 1s, T 36.8, 02 sat 96% on room air, wt 58kg, ht 5"?“ Gen: chronically-ill appearing woman who appears to be in mild distress, but she asks you to kill her. Her physical exam is essentially normal except for severe tenderness of her thoracic and lumbar spine, and the surgical sear post-mastectomy. Imaging studies show the metastatic lesions previously described. Head MR] shows no brain metastases, and abdominal CT scan shows no liver metastases. Labs: Na126, K 4.], Cl 9!, H003 24, BUN 5, crest 11.5, giuc 94 Hill 13.5i41.l, WEB 4501] with 76% neutrophils', platelets 225nm AST 26, ALT 18, alk phos 1,5611, Thili {1.4, 11is 1.1 Ca 8.4, P04 3.2, Mg 2.1, albumin 3.4 The patient’s attending oncologist states that comfort measures will be the main intervention as this point. Once she is improved, she adll discuss chemotherapy options with the patient. The goal of the patient‘s family is to have her come home as soon as possible. PHARMACIST'S PATIENT DATA BASE DRUG THERAPY PROBLEM WURKSHEET PHARMACEUTICAL CARE PLAN—In your care plan, MAKE SURE you provide a complete rationale for your management of her pain and her psychiatric condition PHARMACIST’S PATIENT DATA BASE FORIII Patism‘t Mama Paflarrt ID Fha Data a! Biflh Rana [HIE-I. t WEI ' ht Data of admiaaianflnilial visfl Dmpaflan Alla ! “FADE: PRIORH'IZED HEDIGAL PROBLEII LIST D Mu Known Drug AlhrniaflAD-fia El Hat Imawnlhm mulnfamflan chars-ca, max Rfilc‘lifll‘l 1. z -I'....-- zth—g, ‘hflc 5-..1. J-aJa— -/ Vida HFI. FMH, FHJI 5H. ate. 7 1 awn}, You do not need to complete this box Phannaciat Lac-411m Sax MEDICATION PROFILE Vitalslflna laboratu data. dial-nestle test results 3 D w... m m :m CC an. :m refit Cheer. Date Temp F'Iatahat HDTEE Pulilmt Lunatim PE 0 DBIEM melmim Bdrm drug mung; utdmndiml pruhlmns deforuddiflmaldmgflmamr 12.1mm drug flauramr Alumni]: dmgsutunfion Phnlmncisl Data DRUG THERAPY PROBLEM WDRKSHEET BIBLE CAD Dmgs wilhmn nbviam mafia] ‘mdjnafim Medications midmjfied Nuw madiml ounfljmraquh-ingnmdmglhu-up} May dnvcklpmw Ina-dicta] umdiiiunwimuut prophylactic orpl‘wmtafiwthuapyorpunndimfim Wm Mlhnnwh'dimiuatim Condiu'm “mudhymidwulwinmmimm ofwficmmnfdmgorahwfiml Wlpmblamfs) undateduithmanforufilhdmwal fi'omalwhul.dnlgottabam Condiu'mh: human-531w wilh nmw Takimmuhipla drugs when singlcagmt :5 Effective Takingdmfls} In Heat mavaidahlu ndwm: reunion Emmanodwrmadinlfim Emmmmaumwu flinchDims mmnmmmflyumu Mailman 'I'hurapymiudhriduulizadmpmim Mndicalm'blnnforwhjnhdmgisnmafleaflw Pafiuflhaadskfictmthatomajndimmeardmg Patimthasinfectimwithfl'ganimrefiammwdmg Pnfififlrnfi'mmytoummdmgt‘ufimpy Taking unm'birlatimpn‘odmlwhmsh'glaagmuppmpml: Dosaggflumhmmfiae Madiuafimm PRN use mappmprial: for mnditim Rum: ofadminimfimfimaga fflmfmnde ofmdnfinimflm mt appuw'ma for nun-em audition Langth or course ofdmamrmappmpfim Drug thmamr allfladwifmut aduqnatelhuapmniu: trial Dmafinmwl flnibilitjr ml approprim Dowfi'eqmnytmlmlnpmdmdmirdmpme inthispafiem Smdmglnflbflmdfiimddimpmm'nmnge Timing nfanliminmba'nl pmphfiafism appruprinte Wmmtammipmpefly Mona-rot PROBLEM LIST N'D'I'E E OF LEM Dwmffigh mawmmm [mar-minus [fig-drug, drug— disease, WWI. drug— labmm test} Ffihflem rueiwthflapy F'mmfill impact Patina: Immludga ut'drug lineup} Sflmdnghwlabwemduiredflwmpwfiuma Doumhtadimqflddf WI flm‘bility uni. Ippmpfiam for this patina-n Wm” Emaiving mulfiplgaflmlaudlhmuaddedhmfil FEM nl'allwgy at ADE loam-run {at Mum-1mm; agents WE‘RE history Im‘t in madlual ”curds Patina: nut uingalerl formuflwmfhm Symptomsarnflml pubhmllulmbum— Mun-cl Il'lmgadminimadmonpifly . Lia-imflmmMJmInlurp-mmflfl Effwl offing flmadmmtuumymhflnafimfifldbiflm fiulnamflmdmgpaflemiauflng Emwmmmmmmmm Mummhmfinfl Efi'nnlofdmg al'bunddustu pharmacodwmfip chlngafi'mn mdhwfimpuflmtishkiru Mmhbilily afdmgaltumd dull In Man will] Inufl'lar drugorfmd Effectofth'ugaltundduatowhmmfmd Mm'Ihbmmwllmnddmtahmfamfi'MI drugdflpatimtiltukiug Pulimtdidnutadwewilhmadnmngimm Dlugnutgiu-mdmlomadimfianm Mmdidmuhafiumhdghdmgmflmkufimwmu Wmmmmwm Mmhumethndic-fim Dugpmduntmlmihbh 'I'hcwrmfl maimm imam III: mull oust-effuuliw Putin-It numb}: topln'dua: mnqiiufiamfm tum-mo: mmnmwmaflma polmfiflsifiuffwuufflwmqnfimm MWMMimmflnwfim's hullh baliufs Palinm ID Number MEDICAL PRDBLEM CURRENT BRIE} LIST REBHHEN PHARMACEUTICAL CARE PIAN THERAPY mmfismfin 'I'HERAPEIH'IC MONITORING PATIENT WHITE ALTERNATE-E3 EDUCATIflh Patiiml 1]]th Humanist PHARMACEUTICAL CARE PLAN MEDICAL PROBLEM CURRENT DRUG DRUG THERAPY WT WIRED THERAPEUTIC WEEK} PATIEI‘IT LIST PROBIEMS RECEMJENDATICNS ENDPDINTS ALTERNATIVES EDUCATE!“ Patient ID Number Hmat 1.0mfim______— PHARMACEUTICAL CARE PM MEDIC A] PRGBLEM LIST ...
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