Pharmacy Case Studies

Pharmacy Case Studies
Guidelines:
1) Support your responses with scholarly academic references using APA style format.
2) Make sure the references are accurate, complete and APA style. Triple check your work.
3) Part A, B, and C each should have separate citation and attach separately.

A
Discussion Question 1 (2 pages)
Mike is a 46-year-old who presents with a complaint of "heartburn" for 3 months.
He describes the pain as burning and it is located in the epigastric area. The pain improves after he takes an antacid or drinks milk. He has been taking either over- the-counter (OTC) famotidine or ranitidine off and on for the past 2 months and he still has recurring epigastric pain. He has lost 6 lbs since his last visit.

Pharmacy Case Studies
Assessment
His examination is unremarkable. His blood pressure (BP) is 118/72. Laboratory values are normal complete blood count (CBC) and a positive serum Helicobacter pylori test.
1. What would you prescribe initially?
2. How long would you prescribe these medications?
3. What other possible meds could you prescribe to assist with the side effects
from the medications prescribed?
4. How would the treatment vary if the patient has GERD instead?
5. Famotidine indication?
Discussion Question 2 (1 page)
List differential diagnosis that would help confirm GERD while ruling out other diagnosis. Which medication is the best medication for treatment of GERD and why? What labs or other diagnostic tests that are used to confirm GERD?

B
Discussion 1 (2 pages)
Tom, a 26-year-old runner, came into the office today complaining of constant pain in the right ankle. While running his usual route, he accidentally stepped on a branch lying in his path, twisting his ankle inward. He denies hearing a "pop." He was able to walk, or limp, the remaining ¼ mile back to his home, where he immediately elevated and iced the ankle for 30 minutes. He took two acetaminophen 325 mg, showered and dressed for work, and drove to his place of employment. He continued to experience significant pain in the ankle, worse when walking. His foot became swollen. Since his job in a sporting goods store requires that he be on his feet most of the day, he was unable to continue his normal workday, and made a same-day appointment to be seen. He has no chronic diseases, takes no medication, and denies recent use of NSAIDs, as aspirin and ibuprofen cause him to have gastritis. He sprained the ankle last year, but was able to manage that injury at home.

Assessment
A 26-year-old, otherwise healthy male presents limping into the examination room, holding his right shoe in his hand. He grimaces with partial weight-bearing of the affected foot. He has local ecchymosis and 1+ edema over the anterolateral ligaments of the right ankle. Capillary refill, pulses, and sensation of the foot and toes are intact. There is no lateral or anterior instability of the joint or tendons. X- ray of the ankle and foot are negative for fracture or dislocation. He has a grade I lateral ankle sprain.
1. What pain relieving medications would you prescribe? Defend your choice.
2. How would you prescribe them?
3. What side effects should you educate the patient about?
4. Does the age of the patient influence what your choice?
Discussion Question 2 (2 pages)
What organs are damaged mostly by taking NSAIDS? What patient education would you provide to someone taking NSAIDS? What organ is damaged by taking too much aspirin? What patient education should you provide to a patient taking Aspirin? List 3 diagnosis for which you would administer NSAIDS. List 3 diagnosis for which you would administer Aspirin. What labs or diagnostic tests would you perform for a patient who has consumed too much Aspirin and NSAIDS. Your response should be at least 350 words.

C
Discussion 1: (2 pages)
Margaret is a 40-year-old white female in for her annual examination. She states she has been under increased stress in her life for the past few months. She and her husband are currently separated and considering divorce. Her teenaged sons are acting out and she is working extra hours to make ends meet. Secondary to the increased stress she has started smoking again, "about a pack per day" and states "I know that I am not eating right." Margaret has been on the "pill" for almost 20 years and has always liked the method. She states the she has heard that smoking and taking the pill are not good, and she is worried about that. "I really do not need birth control since I am separated but just in case I probably need something." She states that she has been in a mutually monogamous relationship (as far as she knows) since her marriage 18 years ago. She denies a new partner since her separation. Menarche was at 11 years, her cycles when on the pill are regular and very light. Her menstrual period should start tomorrow as she just finished her active pills. She denies a personal history of abnormal Pap smears, gynecological issues, hypertension (HTN), or diabetes. She is G2P2002, and her pregnancies were full term and uncomplicated at ages 24 and 26. Family history is significant for both parents with HTN and mom has type 2 diabetes. Her paternal grandfather died at age 64 years from type 2 diabetes, HTN, and coronary artery disease. Her other grandparents died in their late 70s early 80s and she is unaware of any medical issues.
Assessment:
Margaret’s examination finds her height 5'5", weight 172 lb (up 10 lb. from last year), current body mass index (BMI 28.6), and blood pressure (BP) 148/88. Head, eyes, ears, nose, and throat (HEENT) are grossly within normal limits (WNL). No thyromegaly or lymphadenopathy. Heart rate is regular and rhythm is without murmurs, thrills, or rubs. Lungs are clear to auscultation in all lobes. Breasts are without masses, nipple discharge, asymmetry, or lymphadenopathy; self breast examination techniques and frequency reviewed during examination. Abdomen is soft, nontender, with no masses or hepatosplenomegaly; bowel sounds present in all four quadrants. Pelvic examination reveals normal vulva and negative Bartholin's and Skene's glands; vagina is pink, rugated, with minimal white nonodorous discharge; cervix is pink, multiparous os. Pap smear collected during speculum examination was normal. Bimanual examination reveals a retoverted, firm, mobile, nonenlarged, nontender uterus with negative cervical motion tenderness; adnexa nontender; and ovaries palpable bilaterally, mobile, without masses. Lower extremities were without edema or varicosities.

1. What options are appropriate for this patient?
2. What contraceptive options are contraindicated?
3. What type of patient education is indicated?
4. Given that she has a normal pelvic exam, does that change would that influence
your decision?

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