UNIVERSITY OF

PERPETUAL HELP
SYSTEM-DALTA
College of Pharmacy

CLINICAL PHARMACY Name:

Date:
Aloyodan, Sittie Fahieda G.
09/27/2021
Assignment 1 Professor: Mr. Jaymie Lauren Martinez
Score:

I. Direction: Identify the PRIME Pharmacotherapy Problems and document the case
using FARM notes.

II. Problem: KP, a 53 y/o M, presented to the ER this morning with the complaint of chest
pain. KP states that the chest pain is substernal and started three days PTA. It has been
intermittent but getting more frequent with increasing intensity. Pt. also says that the
pain subsided w/ SL NTG.

He was found to have a history of smoking and alcohol intake since 21y/o, and on
discharge, he was prescribed Amlodipine, Metoprolol on a daily basis, and SL ISDN
prn for chest pain. Although cholesterol profiles were normal, he was also prescribed
Simvastatin, although his serum triglycerides were also borderline high, and
Fenofibrate was added. If the symptom persists, the MD is contemplating to add
Verapamil to his regimen.

III. Answer

PRIME Pharmacotherapy Problems

P - PHARMACEUTICAL
Current Medications:
• SL NTG Nitroglycerin sublingual tablets used to treat episodes of angina
(chest pain)
• Amlodipine once a day
• Metoprolol once a day
• SL ISDN prn for chest pain
• Simvastatin 40 once a day
• Fenofibrate 1 tablet or capsule orally once a day
• Verapamil 400 once a day

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UNIVERSITY OF
PERPETUAL HELP
SYSTEM-DALTA
College of Pharmacy

All medications are taken at the usual recommended dose, route, duration, form,
frequency, and time

R - RISK
Current Medications:
• KP uses amlodipine to treat chest pain, but if the amlodipine dose increases or
the patient starts taking it, it may worsen the patient's chest pain.
• The doctor prescribed drugs with many interactions that can lead the patient in
danger.
• Despite having normal cholesterol, the patient took Simvastatin. He may
overdose because he is already taking Fenofibrate, which helps reduce
cholesterol and triglycerides in the blood. It also targets cholesterol; that is why
the patient should take only Fenofibrate.

I - INTERACTION
Drug-drug
▪ Amlodipine - Simvastatin. Combining these medications may increase the blood
levels of Simvastatin. This can increase the risk of side effects such as liver damage
and a rare but serious condition called rhabdomyolysis that involves the breakdown
of skeletal muscle tissue.
▪ Simvastatin - Fenofibrate. Using Simvastatin and Fenofibrate may increase the
risk of a rare but serious condition called rhabdomyolysis that involves breaking
down skeletal muscle tissue.
▪ Metoprolol – Amlodipine. Metoprolol and amlodipine may work together to
reduce your blood pressure and heart rate. You may experience headaches,
dizziness, lightheadedness, fainting, or changes in pulse or heartbeat.
▪ Nitroglycerin – Amlodipine. Using nitroglycerin together with amlodipine can
lower your blood pressure. This can cause dizziness or feeling like you might pass
out, especially when getting up from a sitting or lying position.
▪ Verapamil – Metoprolol. When Verapamil and metoprolol when taken together,
they might cause fatigue, headache, fainting, swelling of the extremities, weight
gain, shortness of breath, chest pain, and other side effects.
▪ Verapamil - Simvastatin. Combining these medications may significantly
increase the blood levels of Simvastatin. This increases the chance of side effects
such as liver damage and rhabdomyolysis, an uncommon but deadly illness
characterized by the breakdown of skeletal muscle tissue.

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UNIVERSITY OF
PERPETUAL HELP
SYSTEM-DALTA
College of Pharmacy

▪ Verapamil – Nitroglycerin. Verapamil combined with nitroglycerin can reduce

blood pressure. This might produce dizziness or the sensation of passing out,
significantly when rising from a sitting or lying position.
▪ Verapamil – Amlodipine. Verapamil may increase the blood levels of amlodipine.
You may be more likely to experience severe side effects such as irregular heart
rhythm, fluid retention, swelling, heart failure, and external blood pressure.
Drug-food
▪ Simvastatin - Grapefruit juice can significantly increase the blood levels of
Simvastatin. This can increase the risk of side effects such as liver damage and a
rare but serious condition called rhabdomyolysis that involves the breakdown of
skeletal muscle tissue.
▪ Verapamil - You may take Verapamil with or without food but take it the same
way every time. You should avoid eating grapefruit or drinking grapefruit juice as
much as possible while taking Verapamil.
▪ Metoprolol - Food can enhance the levels of metoprolol in your body. It would be
best if you take metoprolol at the same time each day, preferably with or
immediately following meals. This will help your body absorb the drug more
efficiently. Avoid consuming alcohol, as it may cause drowsiness and dizziness
while taking metoprolol.
▪ Nitroglycerin - The ethyl alcohol and propylene glycol vehicle of some
intravenous nitroglycerin preparations may cause sedation and hypotension.
Sedation and hypotension also may result when one of these preparations is co-
administered with ethanol. Management consists of monitoring mental status.

M - MISMATCH
Current Medications:
• KP uses amlodipine to treat chest pain, but if the dose increases or the patient
starts taking it, it may worsen the patient's chest pain.
• The patient used Simvastatin even though his cholesterol was normal. This may
lead to overdose because it already has Fenofibrate, which helps reduce
cholesterol and triglycerides in the blood. The patient should take only the
Fenofibrate since it also focuses on cholesterol.

E - EFFICACY
• The medicines given to the patient may lead to overdose. This is because some
drugs are the same.

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 UNIVERSITY OF
PERPETUAL HELP
SYSTEM-DALTA
College of Pharmacy

FARM notes

F - FINDINGS
1. KP, a 53 y/o M, presented to the ER with the complaint of chest pain.
2. All drugs that the Doctor prescribed have much interaction with each other, and
some of them may have interaction that can harm the patient.
3. The Doctor prescribed drugs without giving an indication.

A - ASSESSMENT
1. At the age of 21, the patient has a history of smoking and consuming alcohol.
2. Smoking can irritate the lungs, causing chest pain to the patient, raising blood
pressure when paired with alcohol.

R - RESOLUTION
1. 1. In this case, the patient should adopt a new lifestyle that will allow him to treat
himself using home remedies. Some medical conditions, such as heart failure, can
be treated by changing one's lifestyle. It has the potential to increase your body's
productivity and health.
2. 2. It is best to do what is best for the patient to avoid medication misunderstandings
or overdoses when it comes to drugs.
3. It is also preferable to schedule a doctor's appointment to monitor the patient's
health.

M- MONITORING
1. His doctor should monitor the patient.
2. The medications he is taking should be taken on time and under the supervision of
someone who is always with him.
3. A patient must constantly be tracked and visit his doctor to understand his condition
fully.

IV. Reference

Cardura XL (doxazosin) and Alcohol/Food Interactions. (n.d.). Retrieved from the drug:
https://www.drugs.com/food-interactions/doxazosin,cardura-xl.html

Drug Interactions between amlodipine and Metoprolol Succinate ER. (n.d.). Retrieved from Drug:
https://www.drugs.com/drug-interactions/amlodipine-with-metoprolol-succinate-er-172-0-
1615-14142.html

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 UNIVERSITY OF
PERPETUAL HELP
SYSTEM-DALTA
College of Pharmacy

Drug Interactions between grapefruit and Simvastatin. (n.d.). Retrieved from Drug:
https://www.drugs.com/drug-interactions/grapefruit-with-simvastatin-2624-0-2067-0.html

Drug Interactions between metoprolol and Verapamil. (n.d.). Retrieved from Drugs:
https://www.drugs.com/drug-interactions/metoprolol-with-verapamil-1615-0-2297-0.html

Drug Interactions between nitroglycerin and Verapamil. (n.d.). Retrieved from Drug:
https://www.drugs.com/drug-interactions/nitroglycerin-with-verapamil-2342-0-2297-0.html

Lipitor (atorvastatin) and Alcohol/Food Interactions. (n.d.). Retrieved from drug:

https://www.drugs.com/food-interactions/atorvastatin,lipitor.html

Metoprolol and Alcohol/Food Interactions. (n.d.). Retrieved from drug: https://www.drugs.com/food-

interactions/metoprolol.html

Propranolol Side Effects. (n.d.). Retrieved from Propanolol: https://www.propranolol.org/propranolol-

side-effects/

Verapamil and Alcohol/Food Interactions. (n.d.). Retrieved from drug: https://www.drugs.com/food-

interactions/verapamil.html

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