PHPR 875A EX V 2006

PHPR 875A EX V 2006 - MARIE COMBIVIR‘ HM IIIIIII(E9...

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Unformatted text preview: MARIE COMBIVIR‘ HM! IIIIIII (E9 KALETRfi {lupinavirfritunavirl tablets FHPR SEA PHARMACUTHERAPEUTICS EXAM #5 APRIL I I. 2006 THIS EXAM I5 WIGHT]! 20“ mm Hl'l Pl...isaleyearoldwomanwhoeomectotheciiniccioflthunswhenfland[have this cough“. She states it started to hurt when 511: initiated 2 days ago and mm [flittt‘i e- “'3 j 1mm to_ urinate all the time. She says this' Is just likmlmm infection. She Ijenies _f5:1il_'_IJg_ feverish or I'Iety_ing_ch_iils, flank pain, or _bl_t2ll_)t_ill In her urine. She does state that she has a I-tgissi‘ discharge that also am 915'. 3339. Regarding her pouthI'Iat staflcdyesterday Waco—ms tithe gettiiI—g worse. 311: states she had no pulmonary symptoms before yesterday. She has been “MES up yellow spimnn since this morning, but she denies hernofiysis. LMP 2 weeks ago and was normal aboardinfi to the patient. I-IInI HIV+, firstdctectedlyearsago. Shethinltssi'teaequireditfromyttmwith oneofhermalepaflnembutmealsohasapasthistoryofl‘yflhgoinuse. Sheflsohasa pastFEto—fgunonheaandgnttalhupeskeoendytestedforheflntisflmflcm syphilis, anti results were negatiye. At her last clinic visit, you note thatshehadaPPD applied,whichwasread2daysl_ater_ast_]mrn if”), m. --..-I its?” EW 5“ Pg rfifl is?" J .w-i..:_"._.' ‘v’J-IM- WorksforadeParhnetrtstoreduIingfltcdayandaneseortsewieeJntghtsperweek. Sh: isdiymceiandahestatestlutshelus “mothanafeuP’sexualpanners MEEWWY alwaysuseacorndorn. Simhasichildmmagea‘i'artdlfl,antllh:yarebothh:a1thy.Sit: smokes 1_ PPD cigarettes butshe says she stoppeddrinking lasiyear. Noillicit druglts: leears. Fl] Fallen. 56 years old with type 2 diabetes and CAD; n'Iotl'tcr age 52 is healthy. 2 younger siblings, both heaithy. Med: I” I Combiy'ir {AZT SODmyGTC lining) one biti K.a1e:trII{LP"tI'r 133.3!RTV 33.3} three hid Loestrin 21 1321} (cthinyl esb'adioli'norcthindrone} qday Acyclovir lflflmg III-n Methadone lflflmg qday Biaxintshestartedlakjngoldswplyfiirurimrysymmg] Scrtraline 511mg qday Zoipidem qhs p111 finder-r.- 73 Regarding her medications. the pao'ent states she has been on this antiretroviral regimen X 6 "190315 [she was not on ARTS prior to that} and she states she tries _heflst_to talte them but tl-ot' Is difficult She Is wondering it‘you have any suggestions to help herto take all of her HIV medications properlyr Physical Exam VS: BF mm, P T2, R 12. T 319, DE sat 93%; wt 62kg, Ht 5‘4" Geo: Well-developed. 1IIIrell-Itourisl'Ied woman who appears to be a little uncomfortable HEENT: normal exam lI'Jl'Iest: 'i' faint crackles at left base. otherwise normal Heart: ERR; no murmurs rubs or gallops Abd: sofl. nontender, no l'Iepatestilettor'rtegal}r Ext: no lesions, clubbing or edema Neuro: alert, OX3; GU: pelvic exam shows moderate 1ItIIItitenyelltlrvir discharge; no genital ulcers or other lesions. on pelvic masses on bimanual exam Rectal: Hernoccult negative CXR: small infiltrate In lefl lower lobe coo—sistent _tIri_tl_t_pneranooia; upper lobes appear normal; no evidence of pnetnuocystis, cocci Labs: his 139, K 4.1. Ci ltll , HCUB 24. HUN 9, clear as, glucose 96 CBC: WBC 1241-31! (6% hands}; Hill 13.4fm}. l, platelets 221(on AST 24, ALT to, all: phos 26. total bill 6.5 Lipid panel: total cholesterol I96, LDL 34, HDL 59, triglyceride as 11A: 346 WBCfl-IPF, l+ gram negative rodson gram stain Sputum: patient unable to provide sample Cooci scrologies negative PPD (fiom previous visit] 11mm GEM no (“as 92 prior to ART); viral load €50 {was 46.0w prior to ART) Cervical swab sent to lab for gone-rhea, HS'v'. o'ichonionas. PHARMACIST’S PATIENT DATA BASE DRUG THERAPY PROBLEM LIST PHARL’IACEUI'ICAL CARE PLAN In addition to the usual information you would provide for the case, film you address the patient’s request regarding helping her with ART adherence. Valli-do. not need to Gamma-ta this but ’ J “1/“ . .' 33".}! I! I“ I -. - '.: " I . . '1: m -_ r J: :23er If! .-. - :‘F'Z’ If: a I'm-I. ‘ -Ir 113' '.I.: "f" ‘ ,'_., -:-.r.r-,,-.-._-.a‘rrJ¢-,r;rr_ ,r'V.-_=-'z{ I J -' (rt-4 ‘ " (-- a ." 03133,}: “,1: "f'l :I‘.r::_."L _____,,F.|I ...... 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