UNIVERSITY OF CONNECTICUT/CT AHEC URBAN SERVICE TRACK
Case of AB CC: “I can’t swallow my pills because my stomach hurts.” HPI: AB is a 65 yo Hispanic female who speaks very limited English that is difficult to understand. She presents to clinic with a complaint of difficulty swallowing and taking medications secondary to dysphagia, bloating, and abdominal pain, which have been present on and off for several months. She states she tries to take her medications anyway by dissolving the tablets in a glass of water, then drinking the glass of water. AB also c/o gas and an “acid” taste in her mouth. She states that she can only eat a small amount of food. She also complains that the food “gets stuck in my throat”, and experiences early satiety. She reports having episodes of vomiting after eating, as well as episodes of diarrhea and constipation. PMH: Type 2 DM (diabetes mellitus), HTN (hypertension), hyperlipidemia, OCD (obsessive compulsive disorder), depression/anxiety, h/o irritable bowel syndrome Allergies: NKDA (no known drug allergies) Medications: paliperidone (Invega) 3 mg QHS – hasn’t taken in 2 months lorazepam (Ativan) 0.5 mg BID prn – hasn’t taken in 2 months amlodipine (Norvasc) 5 mg daily metoprolol succinate (Toprol XL) 25 mg daily glyburide 5 mg BID valsartan (Diovan) 320 mg daily esomeprazole (Nexium) 20 mg daily sertraline (Zoloft) 100 mg BID simvastatin (Zocor) 80 mg daily aspirin 81 mg daily Payer Source: Medicaid (Title 19) SH: lives alone; denies tobacco, alcohol, or illicit drugs Vitals/Labs: (No meds taken today) Wt 180 lbs
BP (sitting, L arm, reg cuff): 150/75 mmHg P 80 RRR
Created by Devra Dang, PharmD & Ruth Goldblatt, DMD, University of Connecticut (01/10) Property of the University of Connecticut Urban Service Track Permission required for use and duplication ([email protected]) UNIVERSITY OF CONNECTICUT/CT AHEC URBAN SERVICE TRACK Questions for students to discuss in groups: 1. What additional information would you ask the patient in order to make a full assessment? Make a list of all the information you want to obtain from the patient and the rationale for each question. You will ask the “patient” (role-played by a faculty member) these questions but remember that in real-life scenarios, you may be constrained by time limits. Therefore, prioritize the questions from most to least important. If there is any information that you would need to get from the medical chart, ask these questions as well. If the information is available, the health care provider taking care of AB (role-played by a faculty member) will provide this information. 2. What is your assessment and plan for helping this patient? (Answer this question after you have obtained the information from the “patient” and “chart” and completed the next 2 learning activities.) Created by Devra Dang, PharmD & Ruth Goldblatt, DMD, University of Connecticut (01/10) Property of the University of Connecticut Urban Service Track Permission required for use and duplication ([email protected])
Anyone remember Jolt Cola back in the 80’s? The young professionals and students’ drink that advertised itself with a slogan of marketing genius, “All the Sugar and Twice the Caffeine”, and was blatantly aimed at keeping you up all night, to work or to party? It seemed a radical beverage at the time and achieved a kind of cult status for its extravagant levels of caffeine but frankly, we
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