Patient and Setting: Renato Hipolito (RH), a 43-year-old male; inpatient psychiatric unit

Chief Complaint: Auditory hallucinations and paranoid delusions of the NBI & the Armed Forces of the Philippines
together with Ricardo Dalisay is tracking him around the Mt. Makiling, believe they want to arrest him in a plot to
assassinate the Philippine President, agitated and aggressive toward staff and other patients (believes they are part of
NBI & AFP plot to frame him); has been drinking excessive amounts of colas and coffee over previous week or so

History of Present Illness: Stopped taking his olanzapine as an outpatient approximately 3 weeks ago due to weight
gain (-10 kg in 3 weeks), was admitted to unit 3 weeks ago with current chief complaint, has history of akathisiato
antipsychotics (including olanzapine) in the past

Medical History: Hepatitis C positive, HTN

Surgical History: None

Psychiatric History: Schizophrenia with multiple hospitalizations over past 22 years, history of noncompliance with
medications as outpatient, previous antipsychotic trials of olanzapine, risperidone, aripiprazole, quetiapine, haloperidol
& chlorpromazine

Family/Social History: Family History: Father was diagnosed with bipolar disorder, paternal grandmother had
unknown mental illness

Social History: Patient has mother and two sisters that visit him regularly; prior history of IV heroin use—none in more
than 8 years, current cigarette smoker 4 packs/day for 20 to 25 years; no reported alcohol intake

Medications:
Clozapine, 50 mg QAM and 100 mg QHS (started 5 days ago and being titrated upward)
Haloperidol, 10 mg BID
Clonazepam, 1 mg BID
Propranolol, 10 mg BID
Lisinopril, 40 mg PO QD
HCTZ, 50 mg QD
Docusate sodium, 100 mg BID
Multiple vitamin (MVI), QD
Haloperidol, 5 mg IV q8h PRN extreme agitation/ psychosis
Diazepam, 1 mg IV q8h PRN extreme agitation/psychosis
Paracetamol, 325–650 q4–6h PRN pain
MOM, 30 mL QD PRN

Allergies: No known medication allergies

Physical Examination
GEN: Obese, poorly kept, acutely psychotic male
VS: BP 148/92 HR 96, RR 23, T 37.80C Wt 88 kg (Wt 1 month earlier, 76 kg), Ht 178 cm
HEENT: WNL
COR: WNL
CHEST: WNL
ABD: Mildly enlarged liver noted, no tenderness
GU: Deferred
RECT: Deferred
EXT: WNL
NEURO: Alert but inattentive, oriented to person and time only, believes he is in a jail

Results of pertinent Laboratory Tests, Serum Drug Concentrations, and Diagnostic Tests
Drawn this morning (7:45 AM)
Na 132 (132) Hgb 135 (13.5) Glu 5.94 (107)
K 3.7 (3.7) Lkcs 6.8 x 109 AST 1.42 (85) Ca 2.2 (4.4)
CI 99 (99) (6.8 x 103) ALT 1.53 (92) PO4 0.97 (3.0)
HCO3 25 (25) Plts 223 x 109 LDH 4.50 (270) Mg 1.0 (2.0)
BUN 6.4 (18) (223 x 103) Alk Phos 2.25 Uric Acid 309
CR 97.2 (1.1) M CV 103 (103) (135) (5.2)
HgbA1C 0.065 Alb 35 (3.5)
(6.5%) T Bili 34.2 (2.0)
Hct 0.37 (37)
Hepatitis Panel (drawn upon admission): anti-HAVpositive, anti-HBc-negative, anti-HCV-positive
Hepatitis C labs (drawn 2 weeks ago): HCV RNA-positive, genotype-3A
Urine toxicology screen (drawn at admission): negative for cocaine, opiates, barbiturates, and amphetamines; positive
for benzodiazepines

WHAT TO DO?

Accomplish a Drug Therapy Plan and Design a Pharmacist Care Plan

Discuss the Pathophysiology of the Disease
Comment on the Current Drug Therapy of your Patient.