PharmD case:HYPERTENSION

Pharmd Case:
A 65-year-old man presents to your hypertension clinic with a past medical history of type 2 diabetes and hypertension. Vital signs in clinic today are blood pressure 134/80 mm Hg, heart rate 78 bpm. Current medications include Metformin 1000 mg twice daily, Levemir 40 units daily, Novolog 10 units before each meal, lisinopril 40 mg daily, and simvastatin 40 mg daily. At the last visit, his lisinopril was increased due to BP of 140/85 mm Hg and his A1C was 7.2%. 

Case on Medication Error: Right Drug, Wrong Route

A 40-year-old female was brought into the ER for shortness of breath and rash following ingestion of seafood. On presentation, she was found to have edema of the throat with a mild stridor upon inspiration. Her temperature was 98.7°F

PharmD Case :MRSA Endocarditis

Case
JM is a 46-year-old man with a history of actively abusing cocaine intravenously who presented with methicillin-resistant Staphylococcus aureus (MRSA) endocarditis (vegetation on tricuspid valve per TEE). After 7 days of IV vancomycin therapy (with troughs in the 15 to 20 mcg/mL range), JM’s blood cultures remain positive for MRSA, and the microbiology laboratory reports a vancomycin minimum inhibitory concentration (MIC) of 2 mcg/mL. What treatment options are available for this patient?

Patient counseling: Chronic Pain Management ???

Case
ST is a 54-year-old woman with chronic neck pain related to severe cervical stenosis. Over the past several months, she has undergone unsuccessful trials with various long-acting opioids. Her pain clinic physician is now interested in pursuing a trial of methadone. What information should be ascertained prior to

[Answer] Alzheimer’s Disease case

JY is a 75-year-old man who was diagnosed with mild Alzheimer’s disease (AD) 1 week ago with a Mini Mental Status Exam (MMSE) score of 19. His wife, PY, comes to the pharmacy with her husband’s prescription for donepezil (Aricept), but she believes the doctor made a mistake. She recalls seeing an advertisement for a medication named memantine (Namenda) for use in the treatment of AD. PY asks the pharmacist why the doctor wrote a prescription for donepezil and not memantine.

How should the pharmacist respond to PY?

Answer: Case One The treatment of AD is based on a patient’s stage of cognitive decline. Various mental status examinations, such as the MMSE, are used in practice to diagnose and monitor a patient’s disease course. The MMSE is an 11-item test with a maximum score of 30 that quantifies a patient’s orientation, registration, attention, calculation, recall, and language. Mild cognitive decline is classified by an MMSE score of >18, moderate cognitive decline as a score of 10 to 18, and severe cognitive decline as a score of <10.

Medications used to treat the cognitive symptoms of AD include the cholinesterase inhibitors donepezil, rivastigmine (Exelon), and galantamine (Razadyne), and the N-methyl-D-aspartate receptor antagonist memantine. Donepezil is FDA-approved to treat all stages of AD, rivastigmine and galantamine are approved to treat mild to moderate stages, and memantine is approved to treat moderate to severe stages. Current treatment guidelines recommend that cholinesterase inhibitors be offered to patients with mild to moderate AD.

The pharmacist should reassure PY that donepezil is an appropriate medication considering her husband’s MMSE score, the drug’s approved indication, and AD treatment guidelines.

Pharm.D(Doctors) in GP surgeries reduce medication errors.

Revolution Pharmd suggests that there should be a Pharmacist in each GP surgery.Revolution Pharmd suggests that there should be a Pharmacist in each GP surgery. 5% of prescriptions written by GPs contain a mistake. Nowadays GPs are so busy that repeat prescribing is not one of their priorities (worrying, but true). Increasing pressures,the time that GPs have to review patients’ medicines and sign prescriptions is gradually being eroded. At the same time, patients are living longer — with an increasing number of long-term conditions and more complex pharmaceutical regimens.

what is the next Step in management ?

A 40-year-old male smoker presents with a history of chronic cough. Hehas had symptoms of an upper respiratory illness for a few months since
visiting family in Arizona. Physical exam

CARDIOLOGY MNEMONICS

Anti-arrythmics: for AV nodes
"Do Block AV":
Digoxin
B-blockers
Adenosine
Verapamil

Student, 5-day history of cough, low-grade fever, sore throat, and coryza

A 26-year-old female student presents with a 5-day history of cough, low-grade fever (temperature 37.6 C), sore throat, and coryza.
On exam, there is mild conjunctivitis and pharyngitis. Tympanic membranes are inflamed, and one bullous lesion is seen. Chest exam shows few basilar rales.

Laboratory findings are as follows:
Hct: 38
WBC: 12,000/μL
Lymphocytes: 50%
Mean corpuscular volume (MCV): 83 nL
Reticulocytes: 3% of red cells
CXR: bilateral patchy lower lobe infiltrates

The sputum Gram stain is likely to show

a. Gram-positive diplococci
b. Tiny gram-negative coccobacilli
c. White blood cells without organisms
d. Acid-fast bacilli

This patient is likely to have

a. High titers of adenovirus
b. High titers of IgM cold agglutinins
c. A positive silver methenamine stain
d. A positive blood culture for Streptococcus pneumoniae

Treatment of choice is

a. Erythromycin
b. Supportive therapy
c. Trimethoprim-sulfamethoxazole
d. Cefuroxime

A worried woman came to your office with mental disrepairs.

A worried woman 47 years old came to your office with mental disrepairs. There is no deficits on neurologic exam but she dont know where she is and what time is. Physical examination shows high temperature, respiration 27/min, pulse is 130, TA:100/65 mmHg. She has bronchial breath in auscultation. You confirm the diagnosis pneumonia from chest radiography.

Where do you put this patient status?

a. Bacteremia
b. SIRS
c. Sepsis
d. Shock
e. Hypotension due to sepsis