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Introducing Mrs. J

PHARMACOLOGICAL CASE STUDY. Introducing Mrs. J. Presented by Yvette Johnson, BSN Alverno College Graduate Student. Social/Family History. 73YEARS AA woman Widower, seven children & a host of grandchildren &great grandchildren Lives alone Enjoys spending time with families and friends

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Introducing Mrs. J

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  1. PHARMACOLOGICAL CASE STUDY Introducing Mrs. J Presented by Yvette Johnson, BSN Alverno College Graduate Student

  2. Social/Family History • 73YEARS AA woman • Widower, seven children & a host of grandchildren &great grandchildren • Lives alone • Enjoys spending time with families and friends • Enjoys watching TV and traveling, cooking and baking • Does not exercise regularly/Sedentary lifestyle • Drinks 3-4 beers/day sometimes

  3. Health History • Resistance hypertension/primary aldosteronism • Obesity • Liver mass • Broader line diabetes Hiatal hernia with GERD • Diverticulitis • OA of knees • Peripheral neuropathy

  4. MEDICATION SHEET

  5. MEDICATION SHEET

  6. MEDICATION SHEET

  7. MEDICATION SHEET

  8. MEDICATION SHEET

  9. Health Insurance Information • Client is connected to a medical home & also followed by a cardiologist • Has both private insurance & Medicare • Out of the pocket cost for medication is a~ $80.00/month

  10. Potential Interactions Interactions ALCOHOL may interact with ASPIRIN (in Aspirin Tablets) This interaction is poorly documented and is considered minor in severity. ALCOHOL may interact with ACETAMINOPHEN (in Tylenol Tablets) This interaction is poorly documented and is considered moderate in severity.

  11. Potential Interactions LOSARTAN (in Losartan) may interact with GRAPEFRUIT JUICEThis interaction is poorly documented and is considered minor in severity. DILTIAZEM (in Diltiazem Extended-Release Capsules) may interact with GRAPEFRUIT JUICE This interaction is poorly documented and is considered moderate in severity.

  12. Potential Interactions SPIRONOLACTONE (in Spironolactone Tablets) may interact with LOSARTAN (in Losartan) This interaction is poorly documented and is considered major in severity. SPIRONOLACTONE (in Spironolactone Tablets) may interact with ASPIRIN (in Aspirin Tablets) This interaction is poorly documented and is considered minor in severity.

  13. Potential Interactions ASPIRIN (in Aspirin Tablets) may interact with IBUPROFEN (in Motrin) This interaction is poorly documented and is considered major in severity.

  14. Potential Interactions ASPIRIN (in Aspirin Tablets) may interact with IBUPROFEN (in Motrin) This interaction is poorly documented and is considered major in severity.

  15. Mrs. J’S Concerns Actual problems Potential problems At risk for hyperkalcemia secondary to medications At risk for complications secondary to obesity & sedentary life style Hepatotoxicity secondary to ETOH use and use of drugs with potential for hepatotoxicity • Bradycardia – HR 45-48 • Significant drowsiness & general weakness secondary to medications • SOB with exertion & Left lower edema 2+

  16. Recommendations: Based on the AHA 2008 GUIDELINES NoNPHARMACOLOGIC Health teaching Drug to drug & food to drug potential interactions Side effects of medications Teaching regarding high potassium & high sodium foods Follow up with cardiologist to monitor bradycardia & fatigue/taper med and then d’cor explore need for pace marker • Managed identified risk factors • Weight loss • Exercise • Dietary salt restriction • Limited alcohol intake • Follow up & routine lab testing of potassium level

  17. Medication Recommendations • Avoid ingesting potential hepatotoxic medication with ETOH • Avoid ETOH with centrally acting medications, such as clonidine • Discontinue the ibuprofen and recommend over the counter • glucosamine 500mg orally daily or COX2 inhibitor/celecoxib 1oomg • BID for osteoarthritis • Enteric ASA & avoid taking ASA @ same time as omperprazole • Discontinue the diltiazem which is causing the SOB & LLE edema

  18. References Clip art. Retrieved from http://images.google.com/ Drug to drug interactions sheets. Retrieved from http://www.drugdigest.org/wps/portal American Heart Association hypertension treatment guidelines. (2008). Retrieved fromwww.aafp.org/afp/2008 Edmunds, M.W. & Mayhew, M.S. (2009). Pharmacology for the primary care provider ( 3rd ed.). St. Louis, MO: Elsevier Saunders

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