PHPR 875A EX VI 2007

PHPR 875A EX VI 2007 - PHFR STEP EWATIUN#6 THIS EXAM IS...

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Unformatted text preview: PHFR STEP: PHARMACDTPIERAPEUTICS EWATIUN #6 April 13, 2130'? THIS EXAM IS WORTH lflfl POINTS This exam is to be named in by 1pm {start afelasa} on Tuesday, April 24. Yet: can give or email it to me personally any time before. Note from the course syllabus the peme for late tum-ins. If you have anyr qumfl'ens, please feel free ta ask. PHARMACISTS PATIENT DATA BASE FORM Pharmacist: Patient Na me ILN. ' Location: Cancer Center Address. ‘ ' Date of Birth: '56 'o Heil'lt: 'i‘l inches 5‘1 1“ Wei t: 51k Date of ad missinnfinitial visit: 24 April 2m}? Occupation: Alle 'eszDRs PRIORITIZED MEDICAL PRGBLEM LIST MEDICATION FRflFlL-E : Nu Km“ Drug Mill-giggling; I] Chronic Pain {lower back, pelvic, abdominal} Roxicet 1-3 tabs qfihrs pm (takes Biday} X Not Itnownfinsdquate information dirt CA, metastasis, mali Itt [lrug Reaction Uknown 4hrs 111 {takes 3-4Ida : 2) Neuropathic Pain [slit metastasis} i ! numbness, tingling, “electric shock” Oxycontin 20mg bid pm (takes lfday} ‘ 3} Stae l‘vr Ovarian Adenocarcinoma with metastasis ! : i ' HPL PMH, FH. 51L etc- ' regular day tit diffuse pelvic pain {rates 4H ti}, lower back pain {rates Evil U} with Ull'raeet 1-2 tabs 1 burningftingling feeling in left leg, hasn’t had bowel movement in 5-6 days, nausea and poor Vioxx Sthn bid appetite, pruritis 3] Depression FH: father died of MI at T6 yo, mother died } 5 ovarian CA at +52 yo Lorazeam [him-I m hs rn slee 9 H n I hoshatemia PMH: Stage W ovarian adenoearcinolna DXXE _ Pheneran Iii-25 n1 - u ohrs rn nausea years ago with metastasis to peritoneal cavity, ;3 1E1] Anemia ofChronie Disease Low Fe, Low TIBC Chronic anemia coexists w! Fe deficient: Hx "debulkins" surges 3: TX wih Tam” — Carboplatin chemotherapy. Pt has recently 1 I] Malnourishedf' or diet Pantorazole 4|] m :1 been treated wt" monoclonal Ab product via i I !2 Ina ro riate theta Vim-1x, St. John’s I|Wort implanatabie intraperitoneal pump St. Johns 1|Mort 300m bid 5H: smokes Ippd til 2 years ago, no ETOHXZ 13] Inadequate Database: Use for 1iv'ioiot {this was taken off of market1 did pt have from before years, but drank heavily in younger years, 5: withdrawal monogamous with husband1 no hx illicit drug use Use of Pantorazole— GERD. Use of St. Johns Wort, ABGS, Urine osmolaii . Urine Na levels ABEL-idler ies, Differential was not conducted , Serum FolateNEl 2 levels {to PUD other anemia t l.- Vital ci i no, laborato data, die : noctic test results Wt 5245.. L — — = _em 31] ___ — — _— BPW 105% L — = — — P — =— — H Na 122 L — — CI ...,_ E-— = = Burt =— = =— crest Clear. 103 = ‘i_— — — —— ___ _ ___—__— ___—__— ___—___— ___—“___— ___—___— ___—___— ___—___-— ___—___— [___—__——_ ___—___— E_———————— ___—_— ___—___- ___—___- ———_—_——— NDTES: CT ofabdn’pelvis: large peritoneal fit pelvic masses wt tumor studding of omentum, multiple metastatic lesions of pelvic bones, MRI of spine shows lytic metastatic lesions at T12, L1—L2 with lower lumbar spine tenderness, no spinal cord compression. hepatotnegaly and abdominal distention adjusted for body weight is CrCl = [L35 [{l4D-AgeijWFSrCr x 22 = 0.35 {84) x 52 = 3212.3:r [0.5 it 22] = I133 er‘min {W111} Serum Osmolality: 2x SrNa + BLINJ‘2.8 + Glue;r i E = {2)(122) + 6123 +93f13 = 252 mflsm (Low) _ no = [Na)-{C1+HCD3] = 122- (99+24} = 122—123 = -1 + 2.5 (on low albumin} = 1.5 (Low) ituionl_H.N.F_ _ Phannaeist [.oetflm: Dal: DRUG THERAPY PROBLEM WURKSHEET VPE DF PROBLEM POSSIBLE CAUSES PR ELEM LET NflTES {‘tn‘l'ttlatior‘i Iii-tum drug therapy range willimrt obvious mediea] Pantoprazole doing QD Hx GERD‘? Reason for use not clear and medical problems Medications unidentified Untreated medical eonditionis Need for additional drug dierapv New medical condition requiring new drug dierapv Fe deficient Pt needs Fe replacement TX at her discretion Chronic disorder requiring eomiriuod drug dies-aw Anemia of Chronic Disease Pt needs Fe replacement TX at her discretion Condilirm heat treated wilh combination drug therapy i Mav develop new niodieai condition urn-mar prophyioelie Chronic pain with need for continuous analgesia (lumbar, pelvic] I or preventative dierapyor preanedicaeion Neuropathic I Uni-recom- drug flierapy Medications with no valid indication St. Johns Wort, Pantoprazole Depression? GERD'? Condition ousted by accidental or intentional ingestion of toxin mount oi‘drugor elmnieai Medieal problems} seamed willr use oi‘or within-anal from aleohol, drug or inhaooo Corrditiron is better treated willt riorainrg “may Taking multiple drugs when single agent as effective Taking drug;{sJ to heat at: avoidable adverse reaction from anodicr medication Appropriate drug. seieetion L‘urrenl regimen not usually as effective as Ceiling effect vs." hydrocodone and codeine [Tylenol #4}; combination APAPFNSAID other choiees products cause ceiling effect ICurrent regimen not finally as safe as other choioes Therapy not individualized to potion Wrong drug Medial problem for which drug is not effective Patient has risk tutors Iliat eorIlraindieaIe use ofng Patient has infection with organisms resisturt todnig Patient refractoryI to cur'renl drug diet-app Taking oornbinalr'on produet when single agent mommiate Doe-age l'm'rn inqrpropriale Medication en'or Drug. Regimen Fan use not appropriate for ooridium oxyeontin. roxioel, viooproi‘en. oxveorlone lit, Tylenol #4, uin‘aeel Route ofadministmiolvdoisage romumir ofadrninislration these meds are best suited for ACUTE pain d: not ehronie pain not appropriate for fluent condition i Lmslh or oourse flrll‘fl'lp’f not writing Drug therapy altered 1iii-idler.“ adequate dierapeartie trial Dosflinterval flexibility not appropriate Dose too low Ddseffroqmnev loo low to produce desired response pain medication not meeting analgesic needs, pt pain level remains very high in Illis paflient Serum drug level below desired brownie range Timing of mlimicrobi-al proplrvlaxis not appropriate Mcdioation not stored properly.I Mediation error TY PE HF PROBLEM Dose too higJi Therapeutic duplication Drug allergy-fadyerse drug events lnlBt‘tlfliflrLs fdmg-drug drug- eiiscase, drug-nuh'ieni.‘ ell-ug- ial'mrumry tcsl} Failure to receive tlterapy ‘ Financial impact Patient knowledge ofdrug therapy POSSIBLE CAUSES [Jose-'th uency too high for this patient Serum drug level above the desired therapeutic range Dose escalated too quickly Doserintcrval thntibility not appropriate for this patient Medication error Receiving multiple agents without added benefit History of allergy or ADE to current [or chemically-related] Agean Allergyr'ADE history not in medical records Patient not using alert for severe allergyr'r'tDE Symptoms or medical problems that may he drug-induced Drug administered too rapidiy Medication error. actual or potential Etl'ecl of drug altered due to enzyme inductiontinhibition horn another drug patient is taking Efliecl of drug altered due to protein binding alteratirms from another drug patient: is taking Effect ot'drug altered due to phannacodynamie change from anodter drug patient is taking Bioat'ailability of drug altered due to interaction 1with another drug or food Effect of drug altered due to substance in food Patient’s lahoraraay test altered due to interference from a drug use patient is taking Patient did not adhere with the drug regituen Drug not given due to medication error Patient did not take due to high drug eosttiaclt: ofinsutancc Patient unable to trait: oral medication Paticnl has no [‘v' access For W medication Drug Imprint not available The cement regimen is notthe most costreffectiirc Patient unable to purchase medicationstno insurance Patient does not understand the purpose. directions or potential side eli'eets of the drug regimen Current regimen not consistent with the patient‘s health beliefs PRDB LEM LIST NOTES continuous APAP level is very high but does not exceed 4gr’day, but still concerned with daily regimen roxicet, oxycodone IR, 3; oxycontin all have oxycodone metabolites by CYPEDE Hydrocodone from Vicoprofen also rnajor subs for CYP EDIE ask pt about allergies. MS [Iontin and AFAP are minor subs for C‘fl" ans Codeine in 2 products: Tylenol #4 ti: Viooprofen [hydroccdone] Unknown ADRr’AIIcrgies pruritis, constipation, nausea From narcotics a CA regimen lorazepiam1 phenergan: increased CNS depression with St John‘s Wort Decreased levels of codeine with St. John’s 1ti'ttort All oxycodone containing products metabolized by same CYP resulting in competition with same enzyme. yicxx inducer of CYPtfi ill. increase clearance of panoprazole Imkrtown insurance and financial situation. High cost load til’t medical treahnem regimen pruritis and constipation from narcotic use; risks wr' stopping chemotherapy. Pt is allowed and encouraged to decide upon Fe, Hyponatremia, l-Iypophosphaternia. Goal is to maintain quality oflife without a negative impact with a near end of life pt. Emphasis is on general well-being. Patient hi hi. _V MEDICAL PRUBIEM LIST ijChronic Pain tart ca metastasis} It} Number CURRENT DRUG REGIMEN Roxicet 1—3 tabs :1 Ethrs prn Oxycodonc IR 5mg BID Oxycontin Ethng BID prn MS Cumin 30mg till) Tylenol #4 2 tabs each 445mm pm Ultracet Iv2 tabs each tihrs pm 1|slice-profen 1-2 Phlrmeeisl_ T Location PHARMACEUTICAL CARE PLAN DRUG THERAPY PROBLEMS pain egirnen is mainly pm with multiple drugs to treat past. a needs better. continuous analgesia for chronic pain therapyI and also limit one analgesic for break through pain to simplify therapy for pt. Ceiling effect with medications containing codeine 3r. with combination T'l-IERAPELTIC RECOMMENDATIONS [it'll all current pain medications. Assure pt that pain will get better. Morphine sulfate tilt] mg SR capsule Pl) BIEII as a calculated therapeutic alternative to current analgesic regimen of IR and SR analgesia. Purpose of this recommendation is to provide sustained release of morphine sulfate to get ho pain under control and relieve the pill load she is currently using. the goal is to reduce pain to ill on a scale oft] through tilt 1with illI being the worst pain. Reissues: closing after 24 hours for adequate pain control. if inadequate add previous days MEIR to MSSR. this will equal new daily MESH. dose and continue with MEIR for break through pain ol'5rlt't mg each has prn. Continue with this pain regimen through discharge from hospital and ceassess upon RTE! in 2 weeks or sooner if needed by patient then monitor each month to assess pain relief and need for adjusrnienL Adjust MSSR and MSIR as stated above upon RTG ifttcodcd. GOA LSJ'DESIRED ENDPDINTS The goal is to reduce pain to It or at least to a level that the patient is comfortable with THERAPEUTIC ALTERNATIVES FCA pump morphine 2 mg IV with llfi mg W bolus each s mus pm for breakthrough pain and the PEA lockout set at b minutes When pl discharge from hospital. chronic pain management is based on TDD conversion from IV to PEI dosing. ETD after 2 'energies to assess pain control and adjust as stated in therapeutic recommendations Date MONITORING VS assessmnt each 2 hrs for the first 4 hours after initial dose of morphine and afler every change in morphine dosing while in hospital. lfpatiertt VS stable alter dosing change monitoring parameters then monitor each E hours it 24 hrs until pl DC. All ‘lt'Ss are important when monitoring but pay particular atlerrLion to sedation with each VS assessment. Patient RTO afler DC ftom hospital each week it 4 weeks to ensure pain needs are met on current dosing. If pain therapy unchanged then RTE) each month to monitor pain relief and need for analgesia adjusu'nent PATIENT EDUCA'ITDN Maire sure pr understands the importance of pain control. If using Alternative Therapy tl’Cat} then instruct family diat only pt will administer PEA pain control and that no others are allowed to touch it to provide pain control for family member. DNL‘I' the pt is allowed to use PCA. Speak with pt about any Fears, bowel fitnctlon, adverse drug reactions. etc. Assure the pt at the beginning oftit that her pain needs will be met. and she will get good pain relief IDNnraher Pharmacile ' Patient_ E. N. Location PHAWCEUTICAL CARE PLAN CURRENT DRUG DRUG THERAPY THERAPEUTIC MEDICAL PROBLEM LIST REGIMEN PROHI.HMS RECDMMENDATIGNS lb} Pelt'ie Pain NONI-i Pt not receiving Adjtmctiee therapy with "EU {metastatic lesions on continuous analgesia dill] mg, PD QID harem with etch narcotic pain assessment. ifpain needs are not met adjust dose to bill] mg P0 QII]. Continue therapy while in hospital and after DC. See til for monitoring For pain relief. Di; Floss. bone} The rationale is to provide an adjunctitre antinflamrnatory with morphine sulfate Nonriptyline 15mg qhs reassess pain and readjust dose after 24 hours to 50mg qhs if neuropad'lie pain is not II] or pain needs are not met {scheduled dosing, not prn since want to present pain. not treat.) See ii I for continuous treatment and monitoring. This medication also has less antieholinergie effects Pt net receiving correctiadequtate or for this type of pain problem 2} Neuropathie Pain The rationale for using nortryptyline is this it is a tertiary amine which has less anti‘eitolinergic efl'eets ll'lan seeondary arninea. Also useful to or pt’s depression Once pain, nausea, constipation and depression are relieved pt may begin eating again, which is expected to correct malnutrition, electrolyte, albumin imbalances. This will most liker require longer than 2 days to notice any changes and will be monitored with are 1risits for pain monitoring or earlier as needed to adjust dosing Poor appetite secondary to nausea, depression. chemotherapy, constipation 3) Stage W Ovarian Adenocarcinoma with metastasis Chemotherapy CflhlfiiflEf-illlfifi ENDPDI'N'IE Seefll Correct electrolyte imbalance, return albumin to normal and regain nutritional status THERAPEUTIC ALTERNATIVES Diclofimm .51] mg PC! Tit} Gahapenlin 301} mg Pt) TID arid titrate slowly to a maximum dose of 3601] mg. Maintain dosing on regular schedule and not prn bit; the goal is to prevent pain. See it I for continuous TX d: monitoring Refer to dietician for help by a specialist Dat:_____ MONITDRWG Assess pt's pain and SEE every 4 hrs while in hospital Have pt continue on analgesic adjunctis'e ts once 11C. Assess pl‘s pain and Sis q 4 hrs while hospitalized. Have pt continue on analgesic adjunetive ta once DC. Monitor pt for adverse affects to medication Electrolytes, albumin every 2 weeks liar first two weeks and then montth as suggested in number I after patient DC. FaTiENT EDUCATION 'i'eaei'l pt to watch for SIS of bleeding disorders that may occur with NSAIDS and to eat before taking NSAIDs Possible sedation, dizziness, postural hypo'l'N, dry mouth, and urinary retention Teach patient to monitor for adverse affects Teach patient importance of nutrition to help with well-being, ADL, to help non'nalize lab values to assist with treatment. Have patient aware of optimal eating times when she foals better or when her mood is elevated or her energi- level is elevated throughout the day. Hospice referrai Patient ill. __ _ MEDICAL PROBLEM LIST 4} Constipation The rationale is to provide oral therapy since other treannents were W. Pi is also receiving aItti-emetie,, ' which should I.“ decrease the nausea. ,' _ Osmotic agent and ‘ -- mild stimulant drugsi of ehoioe for I ! constipation in ca. tNH pts receiving narcotic.\ I I. This regimen is less -' costly and very effective when compared with outer medication regimens and is a good 0? regimen 5]: Itehinessfpi‘tlt‘itis NM. The rationale is tn provide a cheap and effective alternative to promehaizine for CURRENT DRUG REGIMEN NONE ID Number PharmacisL Int-calao-n' PHARMACEUTICAL CARE PLAN DRUG TI-I'ERfiP‘I" PROBLEMS Narcotics."pain medications. Pt is not receiving adequate eonslipalien prophylactic TX Premediaaine: may not be adequate or alone to treat itchiness since pt was taking before and she was THERAPEUTIC RECUMMENDATIDNS MUM 15 ml. Pill BID while in the hospitai. Assess daily ritualittr and quantity of st no improvement d Senna BID to help treat non ‘ until DC. Increase fluid and better nutrition and ad more fiber to diet. Upon DC. continue MUM 15 niL PD BID iii: Senna Pt] BID. Reasses upon RTD with pain management {see #1} Lotatidine 5 mg Pt] QD prn reassess llir aflcr loratidine administration if pt complains of pruritis then increase dose to 10mg PD l{lll'lptn andreassess THERAPY GUMESIREU ENDFDiHTS To resolve pt’s current constipation and prevent further eonstipation problem: Prevention is I very important. Goal is in also prevent obstruction (to. Wren r and avoid surgical removal To resolve the patient’s itehinesstpniritis and to prevent fiirtl‘iet eecun'ence TElERr‘tPEUTEC ALTERNATIVES Laerulose I5 ml. PO lilD for constipation; if no relief from constipation after 2 clays increase iaetuiosetd 30 ml. - PG ETD Hydroxvzine 15 mg each IIShIs pm for itchiness-‘pmritis MDNH'CIRING Monitor pt’s 33 q l1 hours while in hospital and then at 2 day follow-up Continue with pruritis monitoring with each follow up visit for pain monitoring Monitor pt‘s SIS every 3 hrs and then at. 2 day FLI. Continue with pruritis monitoring PATIENT EDUCATION Make sure pt knows to avoid bulk laxatives like Metamucil, which may cause a ohsthotion Never admin Docusate {Coleen} bare it is ineffective Teach pt the importance to take on scheduled regimen to treat current constipation and orouhvlactieallg,r present EECUHBHCB Inform pt that itchiness is coming from narootie use. and that it‘s not a pnnitts, An still suffering. Pt also in lhr. Reassess 1 hr after eaeh with each fallflw TRUE allergy. Be alternative H1 taking increased dose loratidine dose to ensure up fisfl for pain sure pt liner-'3 to blocker such as of morphine onoe DC alleviation ofpi pnnitis. mommg as sin-firs eep m Hydroxgrzine from hospital Reassess with every 3 hours listed with pain ant:-l silagne recommended bt'c [it with VS assessment as 1atoll t monitoring on an rad taking increased until or DC. Continue widi each i prurith epls es doses of morphine FU RTE! for pain management oomparnd to previous listed under all regimen. THERAPEUTIC MONITORING PATIENT THERAPEUTIC Tl lElUtPY GDALSEDESIRED MEDICAL CURRENT DRUG DRUG ']'l IERAPY PROBLEM LIS'I' REGIMEN PROBLEMS i RECOMMENDATIONS ENDPUWT-‘S ALTERNATIVES 1 EDUCfiTlflN ti] Nausea; the Phenergan 12.5-25 I’t has nausea dain i Continue current therapy of TD Wb'fli't'fi PEI-15w! flfld I Realm 5mg 5 SEE o it Help pattern to rationflig is m pmvidc mg PD mph 5111.5 hm without pumping phi:an but at [1.5 mg pg improve pt 5 equalingr ofl1t'c ever}r tints pm lor hours. _i Itrate dose understand PD med For nausea a pm nausea Is pt compliant with et'ery 4-5 hours pm for nausea. am} inertia“ Pam"? “WSW- Chance “1 murdlflg 1“ Wilma: 0F avoid unnecessm' current medication i if nausea not reiiet'ed upon WflEh'E m “UTmal WflE-hi W IT'S 3V”? ffimmmdfifl WHERE “WSW dissolution with a . next assessment at 4 hours and per he'sht fihn are Ifnaum raise according to to Improve :tupptrsitor}r for pt. 1 patient is compliant then “‘31 rei'EVE‘d “1 i-"m Si'mpmms- x WEI" rmmended In 513}. increase dim to 25 mg pg current dose and Monitor for ADhs hemp, Hate pt with Phcnflgan pm ,: Wm 44*, hours reassess ape]. 4 patient is compliant of medication aware to always or In bfc it works as 5 hours then after next shift or s have a supple 01“ an anti-emetic 8: Hi .1 hours, whichet'er comes first Phfllflfi'gflfl blmker Ital-high ma}.- ! availabch for LISEi help Tit the pruritis ' 32;: mm nmmm eil'ects from narcotic use and chemtherapp Monitor electrolytes &i HIH eaeh Ehrs until DC men with each If pt decides on treatment then fluid restrict to 1500mli'day Allow patient to decide goals with byponah‘emia, improve and Allow patient to maintain nonnniies'. if treatment is decided then identifi' and ML GEUSBc retum Malnourished dit Do not treat problem with loop nausea caused by diuretics or fluid restriction {lit chemotherapy at end stage cancer and first goal oat-cries is to restore mental well being 1'} hypotonie hyponatt'eluia and “dug: pain mun-‘31. M10“.- elecirolyt: imbalance to Demecleeycline RTCI under pain restore ppm-531 p; m decide treatment and tap normal 300mg PD BID management for #l diet as tolerated tier of side eEl‘ects prior to PCP Will tbs-cuss treatment end of life imues Teach pt to recognize SIS of depremion. Refer to counseling. Teach pt about ADEs See therapeutic alternative for number #2 under therapeutic recommendations and alternate recommendations Assess pt‘s symptoms after 4 melts and once pain is under control. Refer for a psychological malaation. Monitor for ADEs St. John’s Wort DEC Lorazepam and St Johns 1"“ mm“: P“ depress“: cause-.5 increased ens Wort. See #2 IfNorh‘iptyline can decrease 5?. and? I depression when be used for depression} 1mme P1 5 ill-15]“? ‘3'“le combined wi1l'l Monitor patients pain control. Lorazepam or Good pain control will help Pircnergan alleviate or reduce depression. Good control of depression will also help tt'id'l pain control. St. Johns Wort Lorazeparn 3} Depression DD mm m Pmbkm {m cm Alton- patient to maintain Resnict dietary Monitor Mlun‘ Pt I“ h h h t . NONE cancer and first Ba; ism normalicy. Iftreatlnent is phosphate to less electrolytesn Hill decide goals w! _ 91' WP “5P 3 mm“ fire mum we“ hing and rimmed 111m identity and than Tflflmgi‘day. each Bhrs until DC hypophospltate'm a. improve & restore normal diet as tolerated. [i' screlamer is admin watch for ADEs-oonstipatio n, Nausea upset stomach then with each RTE) under pain management for #1 Ifsevclamer is administered watch for ADE: Admin 2 caps Sevelamet PO wfeach meal, iiltelg,r to bind with other drugs, separate doshtg 1 hr before or 2 hrs after reduce pain (same reasons as "53‘ “met “3mm aria-r winging-cm] electrolye imbalance to I normal Pattent B. N ID Number ___ _ Pharmacist [motion [Into _ PWCEUI‘ICAL CARE PLAN MEDICM. CURRENT DRUG DRUG THERAPY THERAPEUTIC 11-IEFULPY GDMSIDESIRED THERAPEUTIC MONITORING PATIENT PRDBLHM LIST REGIMEN PROBLEMS RECUMM HNIJATI‘DNS ENDWENTS ALTERNATWES EDUCA'HU‘N 1mmcmia Bf NONE NONE N0 mama-[t Im "w and of To increase pt‘s I-Ii'H. to Ferrous Furnurete Assess pts’ Fe llat'e pt eat. more chronic mam hm [if]; and maimed pint.th increase iron stores. and to 200mg PU TJD a let-eta after 1". food and include Dgficicmy Anna-“in win-I mmipmim and Mum. increase serum Fe levels lifetime (tii't months and then more high protein The mu is to maintain and underyling chronic after 4 months to foods. Avoid ‘ jmpmye “gum and condition} 351353 pt‘s taking iron wit \ miwiam 1 mm is progress with RTE! milk or whole H ‘Illl I? I dwim upon tin] about r I 1 For inonthl}r Tirisit grain foods that i; noes. admin FEB _ 325 P0 5 'i, E. _ For pain may bind the I i I. | I no a lifetime {an I'll'l raring - = ' '- mansecmmt fmneral 50 that [t ‘31 i: chronic maximum _- ix Memoir for ADEs is not absorbed "'1 “u ' '- tl'Fe is given the (ii I ]} malnourished l2} inappropriate herbal dierapy 13-} inadequate Database ' i \ Add a half an ensure with each meal and increase to one fiiil can with each meal Increase caloric intake as tolerated to increase weight and improve well being increase caloric intake as tolerated to nicrease weight and improve well Moritth weights with CBC, albumin, LFTs, RF, dietitian Nausea d-"l chemotl'ierap} and narcotics Enoourage a well balanced diet with a minimum calorie goal as directed through a. referral to a dietieian. Continue therapy while in hospital and continue as tolcratcd to records being. Encourage some regimen may discharge, increase calorie patient to pick PU with RTG to monitor inm- foods that she weight gain every month. enjoys and also Speak with dietieian about have her help goals being met. Encourage pt plan outlier diet to choose foods she enjoys. Plan St. John's Wort si John‘s Wort has See depression treatment as See depression mm #3 Sec deemsiun See depression Teach pafimt hummus drug drug treatment #3 treatment #8 about potential interactions harmfel interactions with herbal therapies and other DTCs. Consult with a physician before adding amir over the counter items to therapyr Use of St. John's Wort, Need ass. I} bili. scan T0 idsntifi’ and “'33! Ste main?“ Ste misiml Est mistrial pmnapmmn, at View is discontinued analysis, urine osrnolality, emblems dementia I flwraIJimtic therapeutic John‘s Wort. Victor and no longer urine Na levels. ADRs, “Emudfliflns Nmmndattflns mtmmndfltion recommended as allergies, differential, serum fur # 13 ffll' if E’- store! 13 NSAJD therapyr folate. El 2 levels ...
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This note was uploaded on 04/05/2008 for the course PHPR 875A taught by Professor Katz during the Spring '08 term at Arizona.

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PHPR 875A EX VI 2007 - PHFR STEP EWATIUN#6 THIS EXAM IS...

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