Elizabeth: A Clinical Pharmacology Case Study Essay

The author read Mrs. X’s medical notes prior to their initial consultation to afford herself the knowledge she required should she need to prescribe for her when fully qualified. It was evident from reading her medical notes that there were a few considerations to take note of before commencing any treatment, such as her medical history, drug history and allergies. Her past medical history consisted of Type 2 diabetes mellitus, which was diet controlled, hypertension, hypercholesterolaemia, neuropathy, rheumatoid arthritis and raynauds syndrome.

This report is Part 1 of assignment for Marketing MBA 565-MBOL1 to Dr. Stephen Baglione

Her current prescription medications include a 225 mg tablet of Venlafaxine HCL once daily for anxiety related dizziness, and a 20 mg tablet of Atorvastatin for high cholesterol. She drinks alcohol socially, approximately two 12 ounce beers a day. She is a former smoker of one pack of cigarettes a day for nearly forty years. Her quite date was September, 2011. She denies the use of street drugs.

Erica Lindsay, PharmD, MBA, JD, is a health care attorney practicing in the greater Chicagoland area. She has worked in pharmacy management and compliance for more than 15 years. Dr. Lindsay consults clients through complex pharmacy regulations and guidelines, including 340B, Medicare and Medicaid billing, and HIPAA compliance. She is on faculty of PharmCon providing instruction on pharmacy legal and regulatory issues. Dr. Lindsay is active in various organizations including the American Bar Association where she is Vice of the Nursing and Allied Healthcare Professionals Task Force and members of the Health Care Compliance Association, Cook County Bar Association, and the Chicago Bar Association. She is a graduate of Florida A&M University

A (assessment): Ms. O’Reilly’s vital signs are temperature of 37.5 C, pulse of 112, blood pressure of 102/52, and respirations of 24. Her respirations are still deep but have a regular rhythm. She has a CBS of 8.1 and regular insulin running as per orders. The lab work shows uncompensated metabolic acidosis with no hypoxia. Ms. O’Reilly’s neurological status has improved with a GSC of 13. Her dehydration is being treated with NS containing 40mEQ KCL/L running at 200ml/hr and potassium levels maintained at 4.

and vomiting (N/V). She has also had coronary artery disease (CAD) for several years, and 2 years ago

The patient is a 76-year-old Hispanic gentleman brought to the ED by his wife because the patient has been anxious for 2 weeks and now unable to sleep much of the night. He denies any chest pain but has had on-and-off palpitations that seemed not to be related to activity or a particular time of day. He denies any shortness of breath, lightheadedness or loss of consciousness. He had two episodes of syncope three years ago. He was diagnosed with having an MI. He was at that time treated at St. Mary's Hospital in Passaic and underwent cardiac catheterization and he has had some stenting done to his coronary arteries. He saw his PMD approximately a week ago who prescribed some sleeping medicine and neurology consult which the patient has

Client continues to reports she suffers from, hypertension, Dyslipidemia, Psoriasis, H/O stroke, chest pain. She takes the following medications: Lisinopril 5mg, and Hydrocortisone Cream

The clinical features Mrs Lee now 83 is displaying changes to health and cognition noted in the last three to four months, with two transient ischaemic attacks but no significant medical issues. Although currently taking three medications for high blood pressure. Changes in word finding, getting words mixed up and confusing identifying words. Insisting everything is fine showing a lack of insight into her changes or difficulties. Short term memory Mrs Lees has difficulty retaining recent memories, however long term memory appears reasonable. Although Mrs Lees home is reasonably well maintained, she is emaciated and personal hygiene is poor. There is also evidence of emotionally Liable being frequently teary with no reason. History includes

I will override this DUR alert and dispense rasagiline (Azilect) to her. I will tell her that rasagiline is helpful in controlling her Parkinson's disease. The instruction is to take 1 tablet by mouth daily. If she needs to use the EpiPen, use it because it is lifesaving, although she might be experiencing severe and prolonged hypertension symptoms. Informing the medical assistance people that she takes rasagiline and Lisinopril daily, so they would know that they need to carefully monitor blood pressure for her. Rasagiline may cause drowsiness or sleepiness, advise her to avoid activities that requiring mental alertness or coordination such as driving. It may also cause hypotension, orthostatic hypotension, and hypertension. Watching

Ms. Castellanos reports she suffers from arthritis, dizziness, and headaches due to a head injury, hypertension, and cataract (both eyes). Client reports she underwent cataract surgery 10/8/15 in the left eye and 10/25/15 in the right eye. Client continues to reports she is currently taking the following medications: Meclizine 25mg, Simvastatin 40 mg, Gabapentin 300mg, Oyster Shell Calcium tab 500-200mg, Omega-3 Ethyl Esters 1mg, Losartan-HCI 100-12.5mgG, Amitiza 24 mg, and Sertraline. Client continues to report she is seen by Dr. Molinas Alveris tel3 718-4264747 located at 9319 Roosevelt Ave Fl 1, Jackson Heights, NY 11372.

Mrs. Wilson is seen in her room at Glenbridge Nursing Home on 02/28/2018. She had an episode last night of chest pain. She is so ebullient and distracted that it is hard to get a straight history, it came on when she was asleep but she may been sitting up. She was seen by a nurse, a sat was taken. I am not sure if there were other orders taken, but there is none on the chart. She says that she spent most of this morning in the bed and still feels tired, but she does not think she broke out in a sweat. She was more short of breath. She is calling it is a "stroke." I had tried to begin tapering her diazepam by discontinuing the morning dose and apparently all daytime clorazepate was discontinued by error and she gets it only at night.

Digoxin is being used to treat Mrs A's CCF. The dose of 250 micrograms daily far exceeds the regular maintenance dose for a patient of her age. It is thus almost certain that Mrs A is suffering from digoxin toxicity which is most likely being compounded by taking frusemide. Mrs A's symptoms of confusion, fatigue, irritability and visual disturbance are symptomatic of digoxin poisoning. Mylanta (also being taken by the patient) can suppress the effectiveness of digoxin however in this case the digoxin dose is so high that Mylanta would be having a minimal impact.

The medication that Mrs. A is on is Clozapine. The decision to use clozapine is not taken lightly because of the potentially life threatening side effect. An awareness of side effects is important to primary care practitioners because they have most contact with the patients.

This drug is used as an antidepressant. Anxiety, dizziness, blurred vision, dry mouth, diarrhea, and weight gain or loss are common effects of the medications and with aging. But serious effects such as fever; seizures, tremors, chest pain, hepatic necrosis, renal failure, abnormal bleeding, and infection should be cautioned. The dosage of this medication should not be prescribed more than 40 mg daily. Monitoring for mental changes when taking this medication is needed. It should be cautioned to watch for a change in behavior from depression into a mental illness. If this occurs medical attention is needed. Nurses should also assess elderly patients taking diuretics for signs of suggesting syndrome of inappropriate secretion of antidiuretic