Overview
Case studies are a useful way for you to apply your knowledge of pharmacokinetics and pharmacodynamic aspects of pharmacology to specific patient cases and health histories.
For this Assignment, you evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.
To Prepare:
- Review the case study posted in “Announcements” by your Instructor for this Assignment
- Review the information provided and answer questions posed in the case study
- When recommending a medication, write out a complete prescription for the medication
- Whenever possible, use clinical practice guidelines in developing your answers when possible
- Include at least three references to support your answer and cite them in APA format.
CASE STUDY
LM is an 89-year-old female resident of a long-term care facility who has been experiencing multiple falls, some resulting in injuries such as bruising and skin tears. Over the last 6 months, her ambulation status has declined from independent to wheelchair level. She complains of pain in her legs when walking more than short distances across the nursing unit. Past medical history includes HTN, Alzheimer’s disease, and diabetes. Her current medications include amlodipine 10 mg daily, donepezil 10 mg QHS, furosemide 40 mg QAM, glyburide 5 mg BID, ketorolac 10 mg daily, metformin 500 mg daily. Physical exam shows bilateral 2+ edema to lower extremities and vitals include blood pressure of 177/82. Labs show K+ 3.4, glucose 101, BUN 42, Cr 1.6 and eGFR 45 mL/min. What treatment plan would you implement for this patient? What medication(s) would you prescribe? How would you monitor the effectiveness of this plan?
PAST MEDICAL HISTORY
- HTN
- Alzheimer’s disease
- Diabetes
MEDICATIONS:
- amlodipine 10 mg daily
- donepezil 10 mg QHS
- furosemide 40 mg QAM
- glyburide 5 mg BID
- ketorolac 10 mg daily
- metformin 500 mg daily
Important things to consider:
Is step 1 in treating hypertension behavioral changes?
How is HTN treated per the JNC 8?
How does LM’s age, gender and ethnicity affect treatment?
Would you change the dosage and/or add medications to LM’s regimen?
Would you discontinue amlodipine, furosemide, glyburide, ketorolac and metformin? Why or why not?
Are glyburide and ketorolac on Beers List?
What medications can be given and/or should be avoided with LM’s eGFR of 45 ml/min?
Can amlodipine cause orthostatic hypotension and peripheral edema?
Could the patient have hypokalemia causing leg pain?
Can furosemide cause hypokalemia?
Is the patient dehydrated?
Would you change to a potassium-sparing diuretic (ie spironolactone)? An ACE inhibitor?
Would you replace metformin with a DPP-4 inhibitor (ie sitagliptin) which are safer in renal impairment?
What is causing LM’s falls- orthostatic hypotension, hypoglycemia, pain, confusion, dizziness, nocturia?
Any additional labs you would order (ie cholesterol)?
Are all of LM’s disease states addressed and adequately controlled?
UPDATED MEDICATIONS:
acetaminophen 500 mg 1-2 tablets prn (up to 4g/day)
donepezil 10 QHS
lisinopril 10 mg daily
metformin 500 mg BID
spironolactone 25 mg daily, follow up in 2 weeks may increase to 50 mg (OR reduce furosemide)
Monitor edema and pain level; recheck blood pressure and labs for improvement from current blood pressure of 177/82, K+ 3.3, glucose 101, BUN 42, Cr 1.6 and eGFR 45 mL/min
- Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier.
- Chapter 37, “Diuretics” (pp. 290–296)
- Chapter 38, “Drugs Acting on the Renin-Angiotensin-Aldosterone System” (pp. 297–307)
- Chapter 39, “Calcium Channel Blockers” (pp. 308–312)
- Chapter 40, “Vasodilators” (pp. 313–315)
- Chapter 41, “Drugs for Hypertension” (pp. 316–324)
- Chapter 42, “Drugs for Heart Failure” (pp. 325–336)
- Chapter 43, “Antidysrhythmic Drugs” (pp. 337–348)
- Chapter 45, “Drugs for Angina Pectoris” (pp. 364–371)
- Chapter 46, “Anticoagulant and Antiplatelet Drugs” (pp. 372–388)