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Question                    Chief ComplaintHPIPMH2Dyslipidemia × 6 yearsHTN × 10 years"I am here to see if I need additional meds."Thomas Smith is a 52-year-old man who presents to pharmacotherapy for optimization of risk reduction therapy clinic by referral from his primary care provider following an ST-elevation myocardial infarction (STEMI) 6 months ago. He reports good adherence to his medications since having his heart attack.Obesity (BMI 30.5 kg/m)Chronic kidney disease (stage 3) × 5 years                                                                                                 CAD, s/p STEMI 6 months ago (drug-eluting stents placed in right circumflex and left anterior descending arteries)GERD × 5 years FHFather: age 72 with MIs at age 50 and again at age 60Mother: age 70 with no major medical conditions notedPatient has one older brother age 55 with HTN and a history of one MI at the age of 48.He has no children.      SHPatient is married and lives with his wife.College graduate, works as an accountant.Admits to drinking one to two beers most days of the week and has never used tobacco.Exercise regimen has increased since his MI; currently rides the bike at the gym for 30 minutes 2-3 days a week. Meds (Per medication fill history)        Carvedilol 25 mg PO BIDAtorvastatin 80 mg PO once dailyASA 81 mg PO once dailyClopidrogel 75 mg PO once dailyPantoprazole 40 mg PO once dailyLisinopril 40 mg PO dailyChlorthalidone 25 mg PO dailyAPAP 500 mg, one to two tablets PO PRN every 6 hours for painGarlic capsules AllergiesNo known drug allergiesROSPatient states that he had a heart attack about 6 months ago and was put on a number of medications after that happened. He saw his PCP last month who said he should be seen in the pharmacotherapy clinic for evaluation of his cardiovascular risk reduction medications. He reports he has been adherent to his medication regimen over the last 6 months. He went to cardiac rehab for the first 3 months after his MI but has just been going to the gym to ride the bike two to three times a week now. He denies unilateral weakness, numbness/tingling, or changes in vision. He denies CP and only has SOB if he really pedals hard on the bike for longer than 15 minutes. He denies changes in bowel or urinary habits. He denies any lower extremity edema.  Physical ExaminationGen: Obese, African-American manVS: BP 136/84, P 64, RR 18, T 38.2°C; Wt 102.3 kg, Ht 6′0″Skin: Warm and dry to touch, normal turgor, (-) for acanthosis nigricansHEENTPERRLA; EOMI; funduscopic exam deferred; TMs intact; oral mucosa clearNeck/Lymph NodesNeck supple, no lymphadenopathy, thyroid smooth and firm without nodulesChest: CTA bilaterally, no wheezes, crackles, or rhonchiCV: RRR, no MRG, normal S1 and S2; no S3 or S4Abd: (+) BS, no hepatosplenomegalyExt: No pedal edema, pulses 2+ throughoutNeuro: No gross motor-sensory deficits present Labs (Fasting)Image transcription textNa 140 mEq/L Ca 8.2 mg/dL Fasting lipid profile K 4.6 mEq/L Mg 2.1 mEq/L TC 190 mg/dL Cl 103 mEq/L AST45 units/L HDL 40 mg/dL CO2 23 mEq/L ALT 40 units/L LDL 121 mg/dL BUN 19 mg/dL T. bili 0.5 mg/dL TG145 mg/dL SCr 1.6 mg/dL T. prot 7.1 g/dL Glucose 119 mg/dL Hgb 12.0 mg/dL Hct 36%... Show more      AssessmentMr Smith is an obese African-American man who presents to pharmacotherapy clinic for follow-up about further optimization of this cardiovascular risk reduction therapy. He had a STEMI 6 months ago and has a significant family history of cardiovascular disease. He has uncontrolled dyslipidemia treated with atorvastatin and uncontrolled HTN treated with carvedilol, lisinopril, and chlorthalidone. He reports no drug allergies and rides the bike at the gym two to three days a week. He reports using acetaminophen, but no NSAIDs for occasional aches and pains. Patient is interested in what can be done to lower his risk of another heart attack as his dad has had two and his brother has had one. He consistently drinks one to two beers a day but has no history of tobacco use.QuestionsCollect Information1.a. What subjective and objective information indicates the presence of dyslipidemia?1.b. What additional information is needed to fully assess this patient's dyslipidemia?Assess the Information2.a. Assess the severity of dyslipidemia based on the subjective and objective information available.2.b. Create a list of the patient's drug therapy problems and prioritize them. Include assessment of medication appropriateness, effectiveness, safety, and patient adherence.2.c. What economic, psychosocial, cultural, racial, and ethnic considerations are applicable to this patient?Develop a Care Plan3.a. What are the goals of pharmacotherapy in this case?3.b. What nondrug therapies might be useful for this patient?3.c. What feasible pharmacotherapeutic alternatives are available for treating dyslipidemia?3.d. Create an individualized, patient-centered, team-based care plan to optimize medication therapy for this patient's dyslipidemia and other drug therapy problems. Include specific drugs, dosage forms, doses, schedules, and durations of therapy.Implement the Care Plan4.a. What information should be provided to the patient to enhance adherence, ensure successful therapy, and minimize adverse effects?Follow-up: Monitor and Evaluate5.a. What clinical and laboratory parameters should be used to evaluate the therapy for achievement of the desired therapeutic outcome and to detect and prevent adverse effects?CLINICAL COURSE: ALTERNATIVE THERAPYMr Smith is already taking garlic capsules, but he is not sure about the type or dose. Because you are making changes to his current prescription regimen, you need to investigate the advisability of continuing the garlic. Because Mr Smith is taking a statin drug as indicated, he should not take red yeast rice, a common supplement used for dyslipidemia, because it contains mevacolin K, a lovastatin analogue, and would be duplicative therapy. Would fish oil be a possible option for him?   Health Science Science Nursing LPN MISC Share QuestionEmailCopy link Comments (0)
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An example of the individual receiving support, or their family/ carers responsibility. what would be their responsibility?