Therapeutics 1 Lab

Pharmacist’s Care Plan

Case Title PUD

Patient database
Name ( abbreviated) Justine Ward Creatinine Clearance *After calculating a
Calculations: creatinine clearance you
should determine the
CrCL(ml/min) male = staging/severity of a patient's
chronic kidney disease.
(140-68)*51.9 / 72*0.7*0.85 =
CKD stage GFR level
63.2 ml/min (mL/min/1.73 m2)
Gender female
Stage 1 ≥ 90
Height(cm) 160 cm
Stage 2 60 – 89
Actual Weight(Kg) 68kg
Stage 3 30 – 59
Age 67year
Stage 4 15 – 29
Race American
Stage 5 < 15
Past Allergies no allergies

Past Adverse effects Her stomach hurts so badly for the past month.
It gets worse at night

Tobacco/Alcohol/Substance She has never smoked

Use
And drinks one to two glasses of wine most days
of the week.

BMI (Kg/m^2) (68/1.60/1.60) =26.5

(Overweight)

IBW (Kg) 45+2.3(63-60) =51,9

Adjusted body weight (Kg) 0.4(68-51.9)+51.9= 58.34

Clcr ( ml/min) /stage 63.2 stage 2

Case summary: Justin ward, 67 years old woman, she was suffering from epigastric pain in the past 6 weeks, but the pain wasn't
spreading. However, sometimes it gets worse when she eats meals, but sometimes, meals could help relieve the pain. She also complains
from nausea, bloating and heartburn, and she denies any changes in the bowel movements or in the color of the bowel. Neither bleeding
history for GIT nor for PUD. She has been suffering from headaches for the past month, in which she takes the naproxen sodium 1-2 times
per day for the headache.

Meds
Plavix 75 mg PO daily
Lisinopril 5 mg PO daily
Metoprolol tartrate 25 mg PO twice daily
Aspirin 325 mg PO daily
Synthroid 125 mcg PO daily
Atorvastatin 80 mg PO daily
MVI tablet PO daily
Tums 500 mg PO PRN stomach pain
Naproxen sodium 220 mg PO PRN headache (one to two times daily for the past month)
Lactaid one tablet PO PRN dairy product consumption
Medical Drug Therapeutic Recommendations & Monitoring Follow-up plan What will be
condition therapy goals interventions(non - parameters, desired plan B)
(when should the
problems pharmacological endpoints and
frequency patient return for
&pharmacological follow up )

(plan A))

Monitor patients for

symptomatic relief of H. pyloric test
ulcer pain, potential
non –pharmacological
adverse drug effects,
Lifestyle modifications and drug interactions.
must be implemented
including stress reduction
Suspected and NSAIDs should be Ulcer pain typically
Peptic Ulcer PUD not to relieve ulcer avoided if possible resolves in a few days
pain, heal the when NSAIDs are
because of H There is no specific
pylori but ulcer, prevent discontinued and
ulcer recommended diet, but
because of within 7 days upon
recurrence patients should avoid foods
NSAID. initiation of antiulcer
and drinks that cause
therapy.
indigestion or worsen ulcer
symptoms.

Spicy foods, caffeine and

alcohol).
Pharmacological

- Discontinue
naproxen and add
acetaminophen
(paracetamol) 500
mg prn every 4-6
hours

- I have to change
aspirin to enteric
coated tablets

- Decrease the dose

of aspirin to 81 or
100 mg because
she is taking high
dose and this high
dose may
exacerbate ulcer.
 - Pantoprazole 40
mg up 4 – 8 weeks

- Once daily except

in GI bleeding
condition or H
pylori, taken more
than once.

Drug- Drug interactions

(Drug –Drug) Severe,moderate or minor Management

(Drug-Food )

(Drug –herbal )

interactions

no interactions.

References:

- Drugs.com
- Case study book