Examine the image below to learn more about the client
Examine the image below to learn more about the client to write an appropriate and individualized prescription. Barbara Witten, 67 year old female client is taking methotrexate for RA for last 2 years with doses steadily increasing to attempt the therapeutic response. She was taling the maximum weekly dose for 6 weeks and has still experiencing moderate disease activity. The physical examination is normal otherthan jpint pain and swelling. Along with non-pharmacologic interventions, NSAIDs and glucocorticoids, NP considersother pharmacotherapy for RA. Past medical history: RA Allergies: None Medications: Methotrexate 30 mg PO once per week, folic acid 5 mg PO once per week Social history: Nonsmoker, drinks alcohol a few times per year on special occasions. Physical exam : temp 101.4, BMI: 23.8, BP 130/81 NP prescription for Barbara is: Name: Barbara Witten Date Of Birth: 4/20/1957 Date Prescribed: Current Date Rx: etanercept (Enbrel) 50mg/mL prefilled syringe Disp: 8 Sig: Administer one 50mg prefilled syringe subcutaneously in the upper thigh or abdomen once per week. Refills (O-4): 0 Rationale: The client has been taking the maximum amount of methotrexate without adequate symptom relief. CPGs state that in that case, providers can consider adding a TNF antagonist (biologic DMARD) to methotrexate therapy, in addition to NSAIDs and glucocorticoids for short-term symptom relief. Since the client is not experiencing adverse effects from methotrexate, adding a biologic DMARD to current therapy is indicated. The NP should schedule a follow-up appointment with the client in about six weeks to assess whether the client is experiencing relief and to ensure she is not experiencing adverse effects, which is why no refills are currently prescribed (Fraenkel et al., 2021).
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