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Pharmacology Case Study NGR 6301
HPI:
A 17-year-old female presents to the clinic for follow-up and evaluation of asthma. She reports using her albuterol inhaler 3-4 times a week over the past several months but has been using it daily for the past 2 weeks because of the “weather change”. She reports having been awakened at night with coughing and wheezing three times in the past month. She complains of becoming short of breath when exercising in PE class at school but also notes that sometimes she gets short of breath when just hanging out with friends. She states she also takes fluticasone when she gets short of breath this time of year.
PMHx:
Asthma. Diagnosed at age 7 and described as mild persistent. No history of intubations or ICU admits. Hospitalized twice in the past year with poorly controlled asthma. Three visits to the ER in the past 6 months for asthma. Treated on each admission and ER visit with IV/oral corticosteroids.
Migraine Headache Disorder. Diagnosed at age 15. Currently taking prophylactic medication. Only reports one headache episode in the past year.
FHx:
Mother: 47 years old. HTN, migraine disorder. Father: 49 years old, HTN, T2DM, smoker. Brother: 21 years old, smoker, no medical issues. Sister: 15 years old, sickle cell trait.
SHx:
No alcohol, tobacco, illicit drug use. Single, sexually active, heterosexual. Lives at home with parents and sister. Father is a carpenter; mother is a nursing assistant. Brother is away at school. Two cats and one dog in the home.
Medications:
Fluticasone HFA 44mcg. 2 puffs BID.
Albuterol HFA 90mcg. 2 puffs every 4-6 hours PRN shortness of breath
Yaz one pill daily
Propanolol 80mg PO BID
Maxalt -MLT 5mg PO PRN acute migraine
Allergies:
PCN- rash
Physical Exam:
Gen: WDWN AA female in NAD complaining of increasing shortness of breath requiring more frequent use of albuterol inhaler.
VS: BP: 110/72; HR: 68; RR: 22; T: 98.4 oral; WT: 59kg; HT: 66 inches
HEENT: PERRLA, TMs intact with COL visualized, mild white plaques on tongue and oral mucosa. Pharynx non-erythematous with 1+ tonsils bilat. No lymphadenopathy or thyromegaly
CV: RRR, no murmurs, rubs, or gallops appreciated. Peripheral pulses 2+ in all extremities. No edema noted.
Pulm: Prolonged expiratory phase. Diminished breath sounds throughout posterior lung fields with mild expiratory wheezing bilat. Breasts supple without masses.
GI: Abd soft, NTND with + BTs X 4 quads. No HSM.
GU: Genito/rectal exam deferred.
Neuro: A/A/O x3. MOE x 4. No motor deficits. C 2-12 grossly intact.
Labs:
Na: 136 HgB: 12 WBC: 6.2
K: 3.9 Hct: 37 PMNs: 56%
Cl: 101 RBC: 5 Bands: 1%
CO2: 28 MCH: 28 Eosinophils: 3%
BUN: 17 MCHC: 34 Basophils: 2%
Cr: 0.7 MCV: 90 Lymphocytes: 33%
Glu: 98 Plts: 194 Monocytes: 5%
Ca: 9.4
Problem Identification (Assessment & Diagnosis)
List the patient’s differential diagnoses.
List the patient’s drug therapy issues.
What identified information denotes the presence of uncontrolled chronic asthma?
What are the potential contributing factors?
According to NH guidelines how would you classify the level of asthma control?
Desired Outcomes (Plan)
What are the desired goals of pharmacotherapy in this case?
Therapeutic Alternatives (Plan)
What pharmacotherapeutic alternatives are available for the treatment of this patient?
What non-pharmacologic therapies might be helpful for this patient?
Plan of Care (Plan & Implementation)
Outline an optimal plan of care for this patient’s chronic asthma.
If the initial plan of care fails what would be appropriate alternatives?
Evaluation of Outcomes (Evaluation)
What clinical parameters are necessary to evaluate the therapy for achievement of the desired therapeutic effect and to prevent or detect adverse effects?
Education
What information should be provided to the patient regarding the use of her asthma medications, and how she can use her peak flow readings to better manage her disease?
Additional Question:
Review the NIH guidelines on the management of asthma during pregnancy and develop a pharmacotherapeutic treatment plan for this patient if she were to become pregnant.
Now change the patient’s age to 4 years old. Remove the diagnosis of migraine headache. Delete the following medications: yaz, maxalt-MLT, propranolol. The child’s only medications are fluticasone and albuterol. The HPI, PMHx, SHx, FhX, and Physical exam are the same. Answer the above questions 1-6 based on the new age and current medications.
SCIENCE
HEALTH SCIENCE
NURSING
NGR 6301
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