Case Study for Advanced Pharmacotherapy: Clinical Approach

Case Study for Advanced Pharmacotherapy:

Clinical Approach

Eloisa Española
Ian Ace Pacquiao
Marilou Vicente Tablizo
Ma. Eva San Juan
April 2020
TASK 1
Based on the Case Study Provided:

1. Describe the following outcomes:

a. Mortality outcomes
The patient possesses respiratory, cardiovascular, thromboembolic and
endocrinologic risk factors that predisposes the patient to an increased
percentage of mortality. Life expectancy for the patient will be significantly
lowered if no interventions will be applied.

The patient possesses three of the 10 leading causes of death worldwide mainly
heart disease, chronic lower respiratory disease and diabetes. Mortality
outcomes for this patient should be centered on reducing the exposure to
elements that increase the risk for the diseases mentioned above. Prevention of
premature death by reducing risk factors associated with cardiovascular disease,
asthma and diabetes are the focal point in the treatment and management of this
patient.

b. Morbidity outcomes
1. Disease – related
There is a need to reduce the progression of the patient’s current disease
profile as well as prevent the progression of the diseases the patient
possesses. Preventive measures and treatment is vital and should be
undertaken to avoid further complications, to which may include
neuropathy, eye disease, cardiac disease, nephropathy and amputation.

Prevention of chronic symptoms of asthma should also be undertaken,

Monitoring and blood sugar and normalcy of lung function should be
performed routinely so as to have a better understanding of the patient’s
history.

Lastly, prevention of recurrent exacerbation of chronic conditions should

be performed to avoid frequent visits to the emergency room as well as
prevention of recurrence of atrial fibrillation.
2. Drug – related
Proper management and counselling of patient use of medications is a
needed course of action due to manifestation of probable drug-induced
adverse effects. Monitoring of side effects, toxicity, drug-drug, drug
disease and drug food interactions should be warranted and patient
participation in these activities should be encouraged

c. Behavioral outcomes
The involvement of family members in the treatment process is important
in order to achieve the intended therapeutic goals. Also, the adherence to
a medication regimen and routine medical examinations and laboratory
tests are a must in order to improve the delivery of needed healthcare
services

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 Patient should be prompted to obtain eye exams annually due to the
nature of her uncontrolled diabetes. Possible neuropathy and macular
degeneration may lead to partial or full blindness if not monitored
properly.

Instruct patient to avoid food products and other related material that
may influence her blood glucose, asthma or circulation. Some products
that should be avoided include caffeinated products, nicotine-containing
products and decongestants

d. Pharmacoeconomic outcomes

In order for the patient to achieve intended outcomes, it is important that

the therapy should take into consideration of the patient’s financial and
healthcare resources; making use of all available programs and increasing
access of the healthcare needs of the indicated patient

e. Quality of life outcomes

Treatments or interventions used should be in line with the patient’s
lifestyle, or slight modifications should be employed so as to promote and
improve patient adherence. Patient’s daily activities should not be
hindered with the presence of the diseases mentioned and patient
satisfaction of delivered healthcare services should be prioritized.

2. List all clinical problems/diagnoses.

a. Asthma
b. Diabetes
c. Dyslipidemia
d. Persistent Lower Extremity edema
e. Hypokalemia
f. Biochemical Imbalances
g. Hypertension
h. Coronary Artery Disease
i. Obesity
j. Chronic Pain
k. Financial Constraints

3. Describe the goals of therapy for each of the clinical problem/diagnosis identified.
a. Asthma
 Lessening of daytime asthma symptoms to a minimum of 2 times a
week. Whereas for night time symptoms no more than twice a
month
 Patient should respond positively to inhaled b2 agonist within 15
minutes of administration

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b. Diabetes
 Twice daily monitoring of blood glucose with a target of less than 140
mg/dl. Range of blood glucose should be at 105-175 mg/dl and should
be achieved within 3-6 months after initiation of intervention
 Hemoglobin A1c should be lowered to less than 6% within 3-6 months
of application of said intervention. Aggressive lowering of HA1c is not
recommended for the patient due to co-morbidities (hyperlipidemia
and hypertension)
 Patient should be well educated on the recognition of hypoglycaemic
symptoms and no more than 1 or two episodes of mild hypoglycaemia
per week should occur. Additionally, no severe hypoglycaemia
necessitating emergency care should occur during the entire course of
treatment.
c. Dyslipidemia
 LDL-C should be lowered to less than 100 mg/dl
 HDL-C should be lowered to less than 55 mg/dl
 Triglycerides should be lowered to less than 150 mg/dl
d. Persistent Lower Extremity Edema
 Patient should have little to no episodes of edema
e. Hypokalemia
 Potassium level should be within normal limits so as to limit the
causation of digoxin induced bradycardia
f. Biochemical Imbalances
 Serum electrolyte and other important biochemical markers
should be within normal levels
 Urinary albumin excretion should be less than 30 mcg albumin/mg
creatinine
g. Hypertension
 Lowering of blood pressure to less than 130/80 mmHg and patient
should have minimal or if possible no experience of orthostatic
hypotension
h. Coronary Artery Disease
 Sublingual nitroglycerin use should be limited to identifiable
causes like exertion or in cases where exertion is pre-determined,
prophylactic dose should be taken as needed
 Maintain ventricular rate of less than 100 bpm
 Serum digoxin concentration should be limited to 1.5-2.0 ng/mL
i. Obesity
 Lowering of weight to healthy BMI levels within the span of 6
months to 1 year

j. Chronic Pain
 Use of NSAID products should be limited to breakthrough pain
only
k. Financial Constraints
 Lessen financial burden on the patient while increasing access to
healthcare

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