Brief Adult Patient History:
Mr. Jon Smith, a 50 year old African American male, has come to your clinic with a 15 year history of hypertension and type 2 diabetes. He drinks “a few beers” per week and confirms cigarette use of 1 ppd for the past 30 years. He tells you that he works a physical job in construction so is mostly on his feet and active. He eats what is available and tries to watch his diet when he can. Mr. Smith is taking Amlodipine 10 mg daily for hypertension and metformin 1,000mg BID for diabetes. His blood pressure has been hovering around 150/90 and Hemoglobin A1c has been 6.8. Also included in blood work is a total cholesterol of 243 mg/dL, LDL 170 mg/dL, HDL 36 mg/dL, Triglycerides 201 mg/dL. Additional findings include normal electrolytes, renal function and liver enzymes. You decide to enter these results in the ASCVD risk calculator to further learn his CAD risk.
Positive Review of Systems (otherwise you can assume negative):
Respiratory: No SOB, +non productive cough that he has had for “quite sometime”
Past Medical/Surgical History:
- Diabetes
- Hypertension
- Hyperlipidemia
- Tobacco use disorder
Social History:
- Smokes 1 PPD for the past 30 years
- A “few beers” per week
- Married with 2 teenage children
Medications:
Amlodipine 10 mg daily
Metformin 1000 mg BID
Naproxen 500mg PO daily PRN
Allergies: Penicillin (anaphylactic reaction)
PE: 50 year old African American Male in no acute distress. VS: Temp 98.0, BP 150/92, Pulse 86, R 18. Height 6’ 0”; weight 230 lbs. Exam unremarkable.
CASE ANALYSIS:
Illustrate your understanding of Pharmacotherapeutics in this patient’s care.
Complete an analysis for each medication and any medication you decide to prescribe including:
- Describe the mechanism of action, side effects, caution and/or contraindications, monitoring parameters and determine if the medication is the best option for this patient
- Common dosage, route and schedule for the medication
- Determine cost of each medication
- Is the medication being used reasonably in this situation (risk/benefit analysis)?
- Would you make any changes in the use of the drug if you were the provider?
Complete an analysis of the patient including:
- Evidence of drug effectiveness
- Indicate potential drug interactions (drug-drug, drug-food, drug-herb, etc.)
- Indications of possible adverse drug effects
- Factors affecting compliance/adherence
- What social factors must you considered for this patient?
- What education must you provide to the patient about these medications
- Are there special considerations for this patient population that must be considered? When would you want to see this patient again in a follow up visit?
- Include any nonpharmacologic interventions that you feel are appropriate.
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