PHILIPPINE COLLEGE OF HEALTH SCIENCES, INC

1813 & 1880 Claro M Recto, Avenue, Quiapo, Manila 1015

College of Pharmacy

CLINICAL PHARMACY
CASE STUDY PART 2 LONG QUIZ

Name: __________________________________________________ Date: ___________________

Instructor’s Name: _________________________________________ Score: __________________

INSTRUCTIONS: Assess the following cases based in the data given.

1. Chief complaint: “Why can’t I just take prednisone every day? It always works when I get
admitted to the hospital.”

History of present illness: Thomas Jones is a 66-year-old man with COPD who is
presenting to the family medicine clinic today to have a 1-month follow-up appointment from his
last hospital admission for an acute exacerbation of COPD. This last COPD exacerbation is the
second hospital admission in the last 6 months related to TJ’s COPD instability. After TJ’s
hospitalization, his discharge COPD regimen was changed to include tiotropium, 1 inhalation daily
in addition to salmeterol 50 mcg, 1 inhalation Q 12 h, and an albuterol MDI as needed. TJ had
pulmonary function tests (PFTs) while he was in the hospital 1 month ago but has yet to have
them reassessed after the change in his COPD regimen. He wants to start taking prednisone
every day because he believes this would prevent him from being readmitted to the hospital. The
patient states that his respiratory symptoms are better than when he was admitted 1 month ago,
but he still has shortness of breath every day and a decreased exercise capacity (e.g., he
becomes very short of breath after walking a couple of blocks). He states that he is adherent to
the new medication regimen that was changed on discharge from the hospital. No other
medications were changed at that time that he can recall. His daughter, who is at the appointment
today, states that she makes sure he uses his inhalers but often wonders if he is using them
correctly because he still has daily symptoms.

Laboratory : Na 135 mEq/L Hgb 12.1 g/dL AST 40 IU/L Ca 8.9 mg/L K 4.2 mEq/L Hct
38.5% ALT 19 IU/L Mg 3.6 mg/L Cl 108 mEq/L Plt 195 × 103 /mm3 T. bili 1.1 mg/dL Phos 2.9
mg/dL CO2 26 mEq/L WBC 6.4 × 103 /mm3 Alb 3.1 g/dL BUN 19 mg/dL Pulse Ox 93% (RA) SCr
1.1 mg/dL Glu 109 mg/dL

Medication : Metoprolol tartrate 50 mg po BID Salmeterol (Serevent Diskus) 1 inhalation

(50 mcg) BID Tiotropium (Spiriva) 1 capsule (18 mcg) inhaled once daily Lisinopril 20 mg po once
daily Esomeprazole (Nexium) 20 mg po once daily Albuterol MDI 1–2 puffs Q 6 h PRN Aspirin 81
mg po once daily

Assessment :________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
__________________________________________________________________________
 PHILIPPINE COLLEGE OF HEALTH SCIENCES, INC
1813 & 1880 Claro M Recto, Avenue, Quiapo, Manila 1015
College of Pharmacy

2. Chief complaint : “A few hours ago, I felt really dizzy and short of breath, and I suddenly
passed out on the bathroom floor.”

History of present illness: Cindy Price is a 32-year-old woman who presents to the ED
complaining of episodes of dyspnea and dizziness. While stepping out of the shower this morning,
she became very weak and experienced a syncopal episode. She remembers falling to the floor
and hitting her head but remembers nothing after that. She was brought to the ED this morning
by her sister.

Laboratory : Na 138 mEq/L Hgb 14 g/dL WBC 8.8 × 103 /mm3 Mg 2.1 mg/dL K 3.8 mEq/L
Hct 40% Neutros 62% Ca 8.4 mg/dL Cl 98 mEq/L RBC 5.1 × 106 /mm3 Bands 2% BNP 60 pg/mL
CO2 28 mEq/L Plt 311 × 103 /mm3 Eos 1% BUN 12 mg/dL MCV 84 µm3 Lymphs 32% SCr 0.9
mg/dL MCHC 34 g/dL Monos 3% Glu 88 mg/dL

Medication : Hydrochlorothiazide 12.5 mg po Q AM Albuterol MDI 1–2 puffs Q 4–6 h PRN

SOB Famotidine 10 mg po once daily PRN

Assessment :________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
__________________________________________________________________________

3. Chief complaint : “I’m having a lot of heartburn, especially after eating. These pills and
liquids I’ve tried seem to work for a little while, but then they wear off.”

History of present illness: George Anderson is a 58-year-old man who presents to the
community pharmacy with complaints of heartburn four to five times a week over the last 4
months. This also includes episodes of regurgitation, after which he is left with an acidic taste in
his mouth. The heartburn and regurgitation often occur after meals, but there are times when he
experiences these symptoms between meals. These symptoms wake him up at night
approximately once a week. He reports no difficulty swallowing food or liquids. He tried Extra
Strength Maalox liquid first and then Pepcid AC tablets, both of which were recommended by his
coworkers. The Maalox provided some relief, but he had to take it several times a day. He took
 PHILIPPINE COLLEGE OF HEALTH SCIENCES, INC
1813 & 1880 Claro M Recto, Avenue, Quiapo, Manila 1015
College of Pharmacy

the Pepcid AC 10 mg twice daily for 1 week. This worked intermittently but didn’t provide enough
relief.

Laboratory : Na 138 mEq/L Hgb 14 g/dL WBC 8.7 × 103 /mm3 AST 21 IU/L K 4.8 mEq/L
Hct 42% ALT 24 IU/L Cl 108 mEq/L RBC 4.6 × 106 /mm3 Neutros 60% Alk Phos 55 IU/L CO2 21
mEq/L Plt 400 × 103 /mm3 Bands 1% Fasting Lipid Panel: BUN 18 mg/dL Eos 2% TC 230 mg/dL
SCr 1.9 mg/dL Lymphs 32% LDL 146 mg/dL Fasting Glu 200 mg/dL Monos 5% TG 187 mg/dL
Ca 8.9 mg/dL A1C 8.6% HDL 39 mg/dL Phos 4.1 mg/dL

Medication : Amlodipine 5 mg once daily Glyburide 5 mg twice daily Aspirin 81 mg daily

Ibuprofen 200–400 mg PRN for headaches and pai

Assessment :________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
__________________________________________________________________________

4. Chief complaint : “My stomach has been hurting for the past few weeks. Over the
weekend, I noticed my bowel movements were black and tarry.”

History of present illness: William Smith is a 62-year-old man who presents to the
emergency department on Sunday evening complaining of intermittent burning epigastric pain for
more than 2 months. His pain is non-radiating and occurs to the right of his epigastrium. This pain
changes in intensity and is worse with meals. He also has noticed intermittent belching, being
bloated, being weak when walking, and complains of nausea after eating. Since last Friday, he
has been having black, tarry bowel movements. He does not have any history of PUD or GI
bleeding and has not experienced anorexia or vomiting.

Laboratory : Na 144 mEq/L Hgb 9.2 g/dL Ca 9.2 mg/dL K 3.9 mEq/L Hct 26.2% Mg 2.0
mEq/L Cl 98 mEq/L Plt 230 × 103 /mm3 Phos 4.0 mg/dL CO2 30 mEq/L WBC 8.4 × 103 /mm3
Albumin 3.9 g/dL BUN 10 mg/dL MCV 74 µm3 SCr 1.1 mg/dL Retic 0.3% FBG 154 mg/dL Fe 49
mcg/dL

Medication : Metformin 500 mg po twice daily EC aspirin 325 mg po once daily

Ipratropium MDI 2 puffs 4 times daily Albuterol MDI 2 puffs PRN Ibuprofen 200 mg 2 tablets PRN
shoulder pain Maalox 1 tablespoonful PRN stomach pain

Assessment :________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
__________________________________________________________________________
 PHILIPPINE COLLEGE OF HEALTH SCIENCES, INC
1813 & 1880 Claro M Recto, Avenue, Quiapo, Manila 1015
College of Pharmacy

5. Chief complaint : “I have had some black stools and stomach pain in the past 2 weeks. I
am worried that my ulcers have come back.”

History of present illness: Joan Davis is a 66-year-old retired police officer who presents
to her PCP with complaints of black, tarry stools, and epigastric pain for 2 weeks. She stated that
she started taking bismuth subsalicylate for the stomach upset with partial relief but the symptoms
persisted. They are consistent with those she experienced 4 months ago when she was
diagnosed empirically with bleeding gastric ulcers. When questioned, she states that she was
diagnosed with bacteria in her stomach but never had a tube inserted down her throat. She recalls
being given antibiotics including clarithromycin, but she developed an odd taste in her mouth and
did not complete the antibiotic course. She also says that acetaminophen has failed to provide
much symptom relief from her osteoarthritis so she currently uses a variety of OTC NSAID
products. Additional review of her pharmacy records shows that she was prescribed a 2-week
course of clarithromycin and omeprazole 4 months ago

Laboratory : Na 141 mEq/L Hgb 7.2 g/dL Fasting Lipid Profile: K 4.6 mEq/L Hct 21% T.
Chol 195 mg/dL Cl 107 mEq/L Plt 390 × 103 /mm3 LDL-C 125 mg/dL CO2 27 mEq/L WBC 7.0 ×
103 /mm3 HDL-C 39 mg/dL BUN 21 mEq/L Retic 1.8% TG 195 mg/dL SCr 1.1 mg/dL A1C 6.9%
TSH 2.93 µIU/mL Glu 119 mg/dL

Medication : ASA 81 mg po once daily Lisinopril 20 mg po once daily Alendronate 10 mg

po once daily Gemfibrozil 600 mg po twice daily Glyburide 5 mg, 1 /2 tablet po twice daily OTC
naproxen (Aleve) 200 mg 1–2 tablets po 1–3 times daily for OA pain OTC bismuth subsalicylate
262 mg, 1 tablet 2–3 times daily for epigastric pai

Assessment :________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
__________________________________________________________________________