Optimizing Medications for Bob Barkley: A Case Study on Patient Variables in Advanced Pharmacology
Place your order now for a similar assignment and have exceptional work written by our team of experts, At affordable rates
For This or a Similar Paper Click To Order Now
ASSIGNMENT INSTRUCTIONS:
GNUR 570 Advanced Pharmacology
Case Study #3- Patient Variables
Spring Semester
Bob Barkley is a 92 y.o. Caucasian male with PMH of HTN, diastolic heart failure, Type 2 Diabetes, Constipation, Hypothyroidism, asthma, chronic kidney disease (CKD) IV, benign prostatic hypertrophy with urinary retention, hyperlipidemia, insomnia, eczema, and depression.
He is widowed and lives on his own, with minimal assistance from adult children who live next door.
In the past year, he has been hospitalized for a UTI and once for a broken hip requiring surgical repair.
VS: T 98.4, HR 94, BP 129/76. SpO2 94%. His weight is 176 lbs. Height = 64 inches.
Lab values are:
Complete Blood Count: WBC 7.6, Hgb 13.5, HCT 42, Plt 290,
Comprehensive Metabolic Profile: Na 141, K 4.0, Cl 95, CO2 31, UN 30, Cr 1.8, Glu 101, Ca 8.4, TP 6.4, Alb 4.0, AST 22, AP 44, ALT 16, Tbili 0.5, Mg 1.3, GFR (calculated) 25ml/minute
Lipid panel: Chol 164, TG 148, LDL 66, HDL 48,
TSH: 2 Hemoglobin A1C: 6%
He denies sore throat, fevers, chills, chest pain, dizziness, nausea, dysuria, or fatigue.
Your exam shows:
General: A&O x 3, appears comfortable.
Resp: respirations slightly labored. Lungs have expiratory wheezes bilateral that clear with cough
CV: no jugular venous distention, S1S2 regular.
Abd- soft, NT, ND, +BS x 4.
Ext-trace edema.
Skin: eczematic patches flexure surfaces of elbows.
He is concerned about the number of medications he takes and about his ability to afford them. He can afford 70 dollars per month. His prescriptions are filled at Walmart Pharmacy, as they have a discount program. (See the price list in BB). Any other meds (whether OTC or Rx) cost copays $10. RXs may only be written for a 30-day supply, with refills as appropriate
** No medication substitutions allowed. You may order a combo tablet when available to save money**
This is a list of his medications:
Docusate sodium (Colace)
Lisinopril (Zestril)
Metoprolol
Budesonide / Formoterol (Symbicort)
Furosemide (Lasix)
Aspirin
Tiotropium (Spiriva)
Albuterol
Alendronate (Fosamax)
Tamsulosin (Flomax)
Calcium/ Vitamin D3
Hydrocortisone topical
Fluoxetine
Atorvastatin
Metformin
Levothyroxine
Diphenhydramine
20 points: Review his listed medications. Given his chronic conditions, kidney function, age/ Beer’s criteria, and cost choose the meds that you are going to renew. Remember, he cannot afford more than $70 per month.
Provide a rationale for keeping the meds you are prescribing.
Provide a rationale for why you decided to discontinue other meds.
Medication to Rx Rationale Medication to stop Rationale
40 points- Write the remainder of the medications at starting doses Write each medication on a prescription blank. Be sure to include all elements for a valid prescription. Be sure to include the indication/ rationale for each medication you are writing for. Use the history in the case study to help you. Include 3 brief patient teaching points for each medication.
Special instructions
– Tamsulosin and Colace are both at the max dose.
– Albuterol is a needed (PRN) medication
– Atorvastatin is a moderate-intensity dosed
– Levothyroxine at 1.6mcg/kg daily
10 points- Provide a medication list for Bob to take home to his family and hang on the refrigerator. Make sure it is in patient-friendly language.
Medication/ dose Indication Price
Total monthly cost:
30 points – pick three medications that you have written, report the pharmacokinetics, pharmacodynamics, and ADR profile **SPECIFIC TO THIS PATIENT**, any monitoring (for the patient/family or APRN), and any teaching for the patient and/or family. You may write each in a brief paragraph. Citation of references must be included.
HOW TO WORK ON THIS ASSIGNMENT (EXAMPLE ESSAY / DRAFT)
A challenging case for drug management is presented by Bob Barkley, a 92-year-old man with various chronic illnesses, kidney failure, and financial restraints. Taking into account his age, kidney function, and Beer’s criteria, we will analyze his present drug list in this essay and offer suggestions for renewing and stopping medications. Following that, we will give Bob and his family patient-friendly medication information along with prescription instructions. Finally, we’ll talk about three of the prescription medications’ pharmacokinetics, pharmacodynamics, ADR profile, and monitoring.
Renewed medication: Zestril (lisinopril)
Lisinopril is an ACE inhibitor used to treat heart failure and hypertension, two serious comorbidities for Bob. The Beers Criteria state that ACE inhibitors are often safe for usage in older persons, and Walmart pharmacy offers Lisinopril at a reasonable price.
Drug discontinued: Colace (docusate sodium)
Justification: Docusate sodium is a stool softener used to treat Bob’s severe constipation. The Beers Criteria advises against using it in elderly people due to possible side effects such as electrolyte imbalances and dehydration. Docusate sodium is also rather pricey and not necessary for Bob’s medical care.
Rx to medication: 500 mg of metformin PO BID Indication: Bob has Type 2 Diabetes, which is one of his chronic diseases. The first-line treatment for this ailment is metformin. It costs less at Walmart Pharmacy and has a low risk of adverse drug reactions.
Patient Instruction:
To prevent GI distress, use Metformin with meals.
While using Metformin, consume enough water to avoid becoming dehydrated.
Regularly check your blood sugar levels and let your doctor know if anything seems off.
Rx to medication: Tamsulosin (Flomax) 0.4 mg PO daily
Indication: Flomax is an alpha-blocker used to treat Bob’s chronic disease, benign prostatic hypertrophy (BPH). It costs less at Walmart Pharmacy and has a low risk of adverse drug reactions.
Patient Instruction:
To keep a stable medication level in the body, take Flomax at the same time each day.
Any dizziness or lightheadedness you experience as a result of taking Flomax should be reported.
If while taking Flomax your BPH symptoms persist or worsen, let your doctor know right once.
Rx to medication: Levothyroxine 50 mcg orally each day
One of Bob’s chronic illnesses is hypothyroidism, which is treated with the thyroid hormone replacement levothyroxine. Thyroid function tests are used to alter the dose, and Walmart pharmacy offers initial doses at reasonable prices.
Patient Instruction:
To keep a steady level of medication in the body, take Levothyroxine at the same time each day.
Levothyroxine should not be taken with iron or calcium supplements since they may lessen its effectiveness.
Any hyperthyroidism symptoms, such as sweating, palpitations, or weight loss, should be reported as these may be signs of overmedication.
Medication, dosage, indication, and price in the prescription list
Lisinopril 20 mg PO once daily: $4 for heart failure and hypertension
Type 2 Diabetes: $4 for Metformin 500mg PO BID; BPH: $4 for Flomax (Tamsulosin) 0.4mg PO daily
Place your order now for a similar assignment and have exceptional work written by our team of experts, At affordable rates