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CASE STUDY 1:
History of Present Illness:
Sally Smith is a 36-year old female with a history of asthma and GERD. She is a medical secretary and a single mother of two children. Today she states her asthma has been “acting up” and she has been up three or four nights during the past week using her albuterol inhaler. She also tells you that she started to take St. John’s Wort a couple of weeks ago because she was feeling depressed. She smokes a pack of cigarettes daily and would like to stop smoking. She denies recent respiratory infection, heartburn, suicidal or homicidal intention. She is allergic to aspirin and NSAIDS.
Current medications:
Albuterol inhaler prn
Loratadine 10 milligrams PO daily
Omeprazole, 20 milligrams, PO BID
St. John’s Wort, 1 tablet, PO daily
Yasmin
Physical exam:
Pleasant. Well-groomed female NAD. Hgt. 5’5”, Wgt: 152 lbs. 132/70, 92, 22, Oxygen sat 96 %. Frequent bronchospastic cough, + expiratory wheezing. Otherwise exam WNL.
1. Briefly discuss the pathophysiology of asthma, GERD, and depression. Be sure to discuss the aspects that are relevant to the pharmacodynamics of the drug used to treat each condition.
For the herbal preparation, describe the current research on:
Pharmacodynamics; include pharmacokinetics if relevant to pharmacodynamics – for example, active metabolites or limited GI absorption.
Efficacy at treating this condition.
Adverse effects, interactions and prescriber considerations
Discuss the potential risks and advantages in taking herbal preparations, including, but not limited to, the reasons that people might be interested in taking herbal preparations and what type of precautions they should be advised to take.
2. Explain the pharmacokinetics of each medication. Be thorough and specific.
3. Discuss possible adverse effects of these drugs and relevant drug-drug interactions for this patient that require monitoring. Pay particular attention to those adverse effects for which the patient is at increased risk, and to those adverse effects that are potentially serious.
4. Discuss prescriber considerations, appropriate diagnostic tests that should be assessed and relevant patient education for this patient, Explain rationales for your answers.
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