7/14 Review topic (Thyroid, OAUA, Motion sickness (none), ADHD, Anxiety, Alzhiemer

Terms in this set (27)

Case

History of Present Illness: LY presents to her PCP on August 1st with complaints of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains prescriptions from her PCP, but is often resistant to suggestions and advice from healthcare providers.

Allergies: no known drug allergies

Past Medical History: hypertension, osteoarthritis, allergic rhinitis, asthma, and anxiety

Current Medications (obtained from active prescription bottles on 8/1):
Zestril 10 mg daily
Hydrochlorothiazide 12.5 mg daily
ProAir HFA 2 inhalations Q6H PRN
Protonix 40 mg daily
Prednisone taper 10 mg daily x 4 days, 5 mg daily x 4 days, 2.5 mg x 2 days then stop
Ibuprofen 400 mg daily
Zyrtec D 1 tablet BID
Pulmicort Flexhaler 1 inhalation BID

Expired Prescriptions and No Refills:
3/15: Xanax 0.5 mg TID x 30 days. No refills
3/15: Zoloft 50 mg daily. Disp #30. No refills.
4/25: Valium 2 mg BID x 5 days. No refills.
6/1: Lyrica 50 mg TID. Disp #90. No refills

Vitals:
Height: 5'6" Weight: 125 pounds
BP: 152/86 mmHg HR: 95 BPM RR: 13 BPM Temp: 98.5°F Pain: 2/10

Labs:
Na (mEq/L) = 139 (135 - 145)
K (mEq/L) = 3.1 (3.5 - 5)
Cl (mEq/L) = 100 (95 - 103)
HCO3 (mEq/L) = 25 (24 - 30)
BUN (mg/dL) = 12 (7 - 20)
SCr (mg/dL) = 0.8 (0.6 - 1.3)
Glucose (mg/dL) = 147 (100 - 125)
TSH (mIU/L) = 0.15 (0.3 - 3)
Ca (mg/dL) = 8.8 (8.5 - 10.5)
Albumin (g/dL) = 3.2 (3.5 - 5)

Question

Which of the following may be contributing to LY's anxiety? (Select ALL that apply.)
Answer

A
Use of a steroid
B
Use of a decongestant
C
Incorrect use or overuse of albuterol
D
Untreated hyperthyroidism
E
Use of aripiprazole
Case

History of Present Illness: LY presents to her PCP on August 1st with complaints of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains prescriptions from her PCP, but is often resistant to suggestions and advice from healthcare providers.

Allergies: no known drug allergies

Past Medical History: hypertension, osteoarthritis, allergic rhinitis, asthma, and anxiety

Current Medications (obtained from active prescription bottles on 8/1):
Zestril 10 mg daily
Hydrochlorothiazide 12.5 mg daily
ProAir HFA 2 inhalations Q6H PRN
Protonix 40 mg daily
Prednisone taper 10 mg daily x 4 days, 5 mg daily x 4 days, 2.5 mg x 2 days then stop
Ibuprofen 400 mg daily
Zyrtec D 1 tablet BID
Pulmicort Flexhaler 1 inhalation BID

Expired Prescriptions and No Refills:
3/15: Xanax 0.5 mg TID x 30 days. No refills
3/15: Zoloft 50 mg daily. Disp #30. No refills.
4/25: Valium 2 mg BID x 5 days. No refills.
6/1: Lyrica 50 mg TID. Disp #90. No refills

Vitals:
Height: 5'6" Weight: 125 pounds
BP: 152/86 mmHg HR: 95 BPM RR: 13 BPM Temp: 98.5°F Pain: 2/10

Labs:
Na (mEq/L) = 139 (135 - 145)
K (mEq/L) = 3.1 (3.5 - 5)
Cl (mEq/L) = 100 (95 - 103)
HCO3 (mEq/L) = 25 (24 - 30)
BUN (mg/dL) = 12 (7 - 20)
SCr (mg/dL) = 0.8 (0.6 - 1.3)
Glucose (mg/dL) = 147 (100 - 125)
TSH (mIU/L) = 0.15 (0.3 - 3)
Ca (mg/dL) = 8.8 (8.5 - 10.5)
Albumin (g/dL) = 3.2 (3.5 - 5)

Question

Of all of the medications that have been prescribed for LY, which is considered first-line to treat a chronic anxiety disorder?
Answer

A
Prednisone
B
Xanax
C
Valium
D
Zoloft
E
Lyrica
Question

Johanna Young is a 72 year old female who comes into the clinic for a follow-up on her depression medications on 1/18 with her husband. He states that she is having trouble finding the right words to say and becomes easily frustrated when she can't remember simple things, which is happening quite often. Her MMSE score today is 21.

Allergies: Penicillin

Vitals:
Height: 5'7" Weight: 144 lbs
BP: 137/89 mmHg HR: 72 BPM
Temp: 98.4ºF Pain: 1/10

Past Medical History:
Depression
General Anxiety Disorder
Overactive Bladder

1/18 Medications:
Fluoxetine 40 mg daily
Buspirone 15 mg BID
Ditropan XL 5 mg daily
Ativan 0.5 mg BID prn anxiety
Diphenhydramine 25 mg QHS prn sleep

1/18 Labs:
CH, T (mg/dL)=195 (125 - 200)
TG (mg/dL) = 130 (< 150)
HDL (mg/dL) = 45 (> 40)
LDL (mg/dL) = 110 (< 100)
Glucose (mg/dL)=123 (65 - 99)
Na (mEq/L) = 141 (135 - 145)
K (mEq/L) = 4.2 (3.5 - 5)
Cl (mEq/L) = 100 (95 - 103)
HCO3 (mEq/L) = 28 (24 - 30)
BUN (mg/dL) = 17 (7 - 20)
SCr (mg/dL) = 1.1 (0.6 - 1.3)
Mg (mEq/L) = 1.9 (1.3 - 2.1)
PO4 (mg/dL) = 4.4 (2.3 - 4.7)
Ca (mg/dL) = 9.5 (8.5 - 10.5)
TSH (mIU/L) = 1.9 (0.3 - 3.0)

Diagnosis:
Alzheimer's Disease (mild)

Question:
Ms. Young comes back to the clinic on 2/19 for a follow-up. She was prescribed rivastigmine 3 mg PO BID, however, she cannot tolerate the nausea associated with taking the medication, even with a large meal. Her physician would like to switch her to an Exelon patch. What dosage should the pharmacist recommend when converting the patient to the patch formulation?

Answer

A
Exelon patch 4.6 mg/12 hrs
B
Exelon patch 4.6 mg/24 hrs
C
Exelon patch 9.5 mg/12 hrs
D
Exelon patch 9.5 mg/24 hrs
E
Exelon patch 13.3 mg/24 hrs
;