Question

CC: I have had a fever for the past day and it’s not going down.

HPI: CL is a 35 year-old-female who reports to the outpatient pharmacy looking for OTC recommendations for her fever (she has not tried using any medication yet). She complains it started yesterday and she has only tried a sponge bath but would like medication recommendations. CL also mentions her ongoing issue with a dry eye disease that is slightly controlled with artificial tears but is not providing her the full benefit she hopes for. Finally, CL mentions her ongoing concern with smoking but she is not ready to quit just yet.

PMH: Hypertension, Hyperlipidemia, Fever (for the past day), Dry Eye disease.

Labs:

            Blood Glucose today: 78 mg/dL (goal is <130 mg/dL)

            Total Cholesterol today: 79 mg/dL (goal is <100 mg/dL)

Vitals:

            Blood Pressure: 122/72 mmHg (goal is <130/80 mmHg); HR is 81 bpm; Temp is 38.3 C

Social History: Smokes ½ pack per day

Medications:

- Lisinopril (Prinivil®) 40 mg PO daily

- Atorvastatin (Lipitor®) 10 mg PO daily

- Carboxymethylcellulose 0.5% solution (Refresh Optive®) 1 gtt OU four times daily

Allergies: Naproxen (severe diarrhea)

Questions:

1. Based on the case above, what are current drug-related problems that are going on?

2. Based on your answers to number 1, for each drug-related problem, identify which of the 8 categories the problem falls under (i.e. needs additional therapy, unnecessary therapy, adverse drug reaction, dose too low, more effective therapy available, dost too high, nonadherence, needs monitoring).

3. Now prioritize one problem as the primary problem and the other problems as either secondary or tertiary problems.

4. Next, for each problem identified describe the problem with a specific characterization (i.e. uncontrolled, worsening, improving etc.). Then, discuss what each problem needs to fix each problem.

Answer 1

1. Please find the current drug-related problems.

A.Lisinopril (Prinivil®) 40 mg PO daily--Prinivil (lisinopril) is an ACE inhibitor. ACE stands for angiotensin converting enzyme. Prinivil is used to treat high blood pressure (hypertension) in adults and children who are at least 6 years old. Prinivil is also used to treat congestive heart failure in adults, or to improve survival after a heart attack.

B.-Atorvastatin (Lipitor®) 10 mg PO daily--Atorvastatin, sold under the brand name Lipitor among others, is a statin medication used to prevent Hyperlipidemia in those at high risk and treat abnormal lipid levels.

C.Carboxymethylcellulose0.5% solution-Carboxymethylcellulose is a lubricant. It works similar to natural tears and provides temporary relief from burning and discomfort due to dryness of the eye.

2 A. Primary- Hypertension.( Unnecessary Therapy, neeeds monitoring as patient has an history of Hypertension.)

B. Secondary- Hyperlipidemia.( adverse drug reaction,Dose High, as it should be given once daily.)

C. Tertiary- Dry Eyes.(Needs monitoring).

Based on your answers to number 1, for each drug-related problem, identify which of the 8 categories the problem falls under (i.e. needs additional therapy, unnecessary therapy, adverse drug reaction, dose too low, more effective therapy available, dost too high, nonadherence, needs monitoring).

B.Lisinopril may rarely cause serious (possibly fatal) liver problems. Get medical help right away if you have any symptoms of liver damage, such as: nausea/vomiting that doesn't stop, loss of appetite, stomach/abdominal pain, yellowing eyes/skin, dark urine. A very serious allergic reaction to this drug is rare.

C. A very small number of people taking atorvastatin may have mild memory problems or confusion. If these rare effects occur, talk to your doctor. This drug may infrequently cause muscle problems (which can rarely lead to very serious conditions called rhabdomyolysis and autoimmune myopathy).

3.Now prioritize one problem as the primary problem and the other problems as either secondary or tertiary problems:

A. Primary- Hypertension

B. Secondary- Hyperlipidemia

C. Tertiary- Dry Eyes.

4. Next, for each problem identified describe the problem with a specific characterization (i.e. uncontrolled, worsening, improving etc.). Then, discuss what each problem needs to fix each problem.

A . Symptoms can include: Chest pain, chest tightness, chest pressure and chest discomfort (angina) Shortness of breath. Pain, numbness, weakness or coldness in your legs or arms if the blood vessels in those parts of your body are narrowed.

B.High blood pressure often has no symptoms. Over time, if untreated, it can cause health conditions, such as heart disease and stroke.

C. Dry eyes: The eye may become dry, red and inflamed. The main symptoms are discomfort and sensitivity to light.