2 December 2008, 2:50 pm
Scenario #3 Mr. SF is a 78-year-old Caucasian male who has been experiencing memory decline for the past 2 years. His medical conditions include glaucoma, depression and osteoarthritis. His current medications include Aricept 5mg one tablet at bedtime (started 8 weeks ago), Fluoxetine 20mg one tablet in the morning at 10 AM (started 10 months ago), Xalatan 1-2 drops in each eye at bedtime, enteric-coated aspirin 325mg one tablet at 8 PM, Zyprexa 20mg one tablet at 8 PM (started 4 weeks ago). He has not taken any of the other memory enhancing medications. He is allergic to penicillin. He does not drink or smoke. He denies taking any herbals and over-the-counter medications. His wife administers all of his medications. His wife tells the physician today that she has noticed an improvement since he started the Aricept but that he often complains of not feeling rested when he wakes up and he also recently complained of having difficulty swallowing his pills. During the treatment plan meeting the physician asks for your recommendations with regards to any changes you would like to see implemented in the patient’s medications to resolve his fatigue and dysphagia. What would you recommend for this patient? Remember to be specific! Scenario #4 CC: “ I have trouble writing and I have no motivation.” HPI: Paul Muller is a 60 yo male who presents to the neurology clinic because of tremor in his right hand for the last 6 months. He also complains of stiffness. He is currently taking Sinemet but feels like his symptoms return before his next dose is due. For the last year he feels more apathetic and sad at times. He complains of poor appetite and occasional constipation. He has trouble falling asleep and wakes up early due to excessive worrying. He reports difficulty reading because his vision seems blurry. His wife says that he kicks her during the night and that the bedding is all tangled in the morning. PMH: BPH x 4 years, Restless leg syndrome x 2 years. FH: Mother died at age 74 of complications associated with Alzheimer’s disease; father died of colon cancer. ROS: The patient has no complaints other than those noted in the HPI. He denies any other symptoms of autonomic dysfunction such as problems with swallowing, urination, sweating spells, drooling or dizziness. He has lost 10 pounds over the past six weeks but he attributes this to the fact that his wife recently started the Atkins diet; he has also been eating the same types of food to minimize the preparation of meals. MEDS: Terazosin 1 mg po daily, ferrous sulfate 325 mg tid, Pyridoxine one tablet po daily, Sinemet 25/100 mg po tid with meals. The physician would like to increase the dose of Sinemet to 25/250 po tid but would like for you to evaluate the patient before making this increase. Would you recommend that the physician increase the dose of Sinemet at this time? Why or why not? Please be specific. Scenario #5 JK is a 32 year old female who visits her family doctor today. She tells her doctor that she has been feeling run-down, tired, and extremely depressed after the death of her son. She was in a car accident and did not put her 5-year old son in his seat belt. Since the accident, JK reports having no energy, feeling tired, and crying all the time. She also says that she has difficulty concentrating at work, which is very concerning because she is afraid she is going to lose her job. She is an accountant and cannot afford to make mistakes. She feels very remorseful about the accident and has lost interest in all of the activities that she previously enjoyed. She denies suicidal or homicidal ideas, but reports feeling hopeless and less motivated about life. She and her husband would like to have another baby one day, but she does not feel she is up to the task. Her doctor recommends starting therapy with an antidepressant medication. She expresses serious concerns about being on antidepressants because she heard that they can all cause weight gain, drowsiness, and sexual dysfunction—all of which she cannot deal with right now. She is already tired and has put on 10 lbs from lying around the house all day. In addition to this, she wants to be able to have another baby soon. Her past medical history includes hypertension, atrial DVT, Bipolar Disorder. She is currently taking lisinopril, warfarin, and Zyvox for a skin infection She denies the use of alcohol, but admits smoking 3-4 packs of cigarettes per day. Her doctor advises her to quit smoking if she’s trying to get pregnant. She says she will try. 1.JK wants to know, “which class of antidepressants is the absolute best?” According to the latest guidelines for the treatment of depression, how would you answer her question? 2.Based on the information presented in the case, what therapy (drug and dose) would you use to treat this patient and why?... Read More »
Share on del.icio.us
Share on digg
Share on Technorati
Share on reddit
Share on Yahoo!
Share on Furl