College of Pharmacy

CLINICAL PHARMACY LABORATORY

Group # Year and Section:

Name of Group Members Task Assignment:
(in alphabetical order, Last Name, First Name, M.I.)
1.
2.
3.
4.

Exercise No. 04
Title Respiratory Disorder (Chronic Obstructive Pulmonary Disease)
Instruction This exercise will be a group activity. In answering, use Arial for the font type with a font
size of 10. Save your file in pdf format with a file name (Group#_PHCPLab_E4) before
uploading it to canvas. Only one member of the group will upload the file but make sure that
everyone participated.

Objective:
After completing this case study, the reader should be able to:
1. Recognize modifiable and nonmodifiable risk factors for the development of COPD.
2. Interpret spirometry readings to evaluate and appropriately stage the severity of COPD for an individual patient.
3. Identify the importance of nonpharmacologic therapy in patients with COPD.
4. Develop an appropriate medication regimen for a patient with COPD based on disease severity.
5. Evaluate the role of inhaled and/or oral corticosteroids in the management of COPD.
6. Educate patients on using inhaled medications properly and determine which patients may benefit from spacers
and/or holding chambers.

Materials: textbook, medical dictionary, clinical laboratory books

Procedure:
1. Read and analyze the given case.
2. Prepare a patient therapeutic care plan.
3. Answer the questions at the end of the activity

Subjective
Chief Complaint: “Why can’t I just take prednisone every day? It always works when I get admitted to the hospital.”

HPI: Thomas Jones is a 66-year-old man with COPD presenting to the family medicine clinic today for a 1-month follow-
up appointment from his last hospital admission for an acute exacerbation of COPD. This last COPD exacerbation is the
second hospital admission in the last 6 months related to TJ’s COPD instability. After TJ’s hospitalization, his discharge
COPD regimen was changed to include tiotropium, 1 inhalation daily in addition to salmeterol 50 mcg, 1 inhalation Q 12
h, and an albuterol MDI as needed. TJ had pulmonary function tests (PFTs) while he was in the hospital 1 month ago but
has yet to have them reassessed after the change in his COPD regimen. He wants to start taking prednisone every day
because he believes this would prevent him from being readmitted to the hospital. The patient states that his respiratory
symptoms are better than when he was admitted 1 month ago, but he still has shortness of breath every day and a
decreased exercise capacity (e.g., he becomes very short of breath after walking a couple of blocks). He states that he
is adherent to the new medication regimen that was changed on discharge from the hospital. No other medications were
changed at that time that he can recall. His daughter, who is at the appointment today, states that she makes sure he
uses his inhalers but often wonders if he is using them correctly because he still has daily symptoms.

PMH: COPD × 12 years, GERD × 5 years, HTN × 20 years, CAD (MI 5 years ago)

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FH: Mother died from emphysema 4 years ago at the age of 82. Father has a history of coronary artery disease.

SH: He lives with his daughter and her family. His wife died 10 years ago from breast cancer. He has a 35-pack-year
history of smoking. He quit smoking approximately 3 months ago but has had occasional relapses. He states he has not
smoked for approximately a week. He drinks one to two beers every evening.

Meds: Metoprolol tartrate 50 mg PO BID, Salmeterol (Serevent Diskus) 1 inhalation (50 mcg) BID, Tiotropium (Spiriva) 1
capsule (18 mcg) inhaled once daily, Lisinopril 20 mg PO once daily, Esomeprazole (Nexium) 20 mg PO once daily,
Albuterol MDI 1–2 puffs Q 6 h PRN, Aspirin 81 mg PO once daily

ROS: (+) Shortness of breath with chronic nonproductive cough; (+) fatigue; (+) exercise intolerance
Objective

PHYSICAL EXAMINATION
• Gen: WDWN man appearing in mild respiratory distress after walking to the end of the hall to reach the exam
room
• VS: BP 138/88, P 85, RR 26, T 37.5°C; Wt 95 kg, Ht 5'11''
• Skin: Warm, dry; no rashes
• HEENT: Normocephalic; PERRLA, EOMI; normal sclerae; mucous membranes are moist; TMs intact;
oropharynx clear
• Neck/Lymph Nodes: Supple without lymphadenopathy
• Lungs: Tachypnea with prolonged expiration; decreased breath sounds; no rales, rhonchi, or crackles
• CV: RRR without murmur; normal S1 and S2
• Abd: Soft, NT/ND; (+) bowel sounds; no organomegaly
• Genit/Rect: No back or flank tenderness; normal male genitalia
• MS/Ext: No clubbing, cyanosis, or edema; pulses 2+ throughout
• Neuro: A & O × 3; CN II–XII intact; DTR 2+; normal mood and affect

LABORATORY EXAMINATION

Pulmonary Function Tests (during Hospital Admission 1 Month Ago):

• Prebronchodilator FEV1 = 1.1 L (predicted is 3.1 L)
• Prebronchodilator FVC = 3.2 L
• Postbronchodilator FEV1 = 1.6 L

Pulmonary Function Tests (during Clinic Visit Today):

• Prebronchodilator FEV1 = 1.3 L (predicted is 3.1 L)
• Prebronchodilator FVC = 3.2 L
• Postbronchodilator FEV1 = 1.47 L

CLINICAL PHARMACY LABORATORY

A. CASE ANALYSIS:
Complete the patient therapeutic care plan record below:

PATIENT THERAPEUTIC CARE PLAN RECORD

PATIENT DEMOGRAPHICS
Name: Age: Sex:
Birthday: Weight: Height:
Race: BMI:

MEDICAL INFORMATION
Chief Complaint:
HPI:

PMH:

Allergies:
Family History:

Social History: Tobacco use: ___Yes ___ No Caffeine use

If yes, how many sticks per day? ( ) Tobacco use: ___Yes ___ No
If yes, how many cups a day? ( )

Alcohol use: ___Yes ___ No Recreational Drug: ___Yes ___ No

If yes, how often? ( ) If yes, enumerate:

Others:
ROS:

PHYSICAL EXAMINATION
Vital Signs BP: ______ PR: _____
Temp: _____ RR: _____

Others:

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MEDICATION RECORD
Drug Name Indication Dosage Strength Dosage Regimen

LABORATORY EXAMINATION RESULTS

Test Result Normal Values Interpretation

ASSESSMENT OF THE MEDICAL CONDITION OF THE PATIENT:

a. What subjective and objective information indicates the presence of COPD in this patient?

b. What is the patient's COPD severity based on the subjective and objective information available?

CLINICAL PHARMACY LABORATORY

ASSESSMENT OF DRUG-RELATED PROBLEMS:

a. Create a list of the patient’s drug therapy problems and prioritize them. Include an assessment of medication appropriateness,
effectiveness, safety, and patient adherence. Discuss also whether there is an adverse effects and drug interactions.

PLAN
a. Therapeutic Interventions:
What are the goals of pharmacotherapy and nondrug therapy in this case?
Pharmacologic Interventions: Non-pharmacologic interventions:

b. Patient Education and Counseling:

What information should be provided to the patient to enhance adherence, ensure successful therapy, and minimize adverse effects?

c. Follow-up plan:
What clinical and laboratory parameters should be used to evaluate the therapy for the achievement of the desired therapeutic outcome
and to detect and prevent adverse effects?

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B. RELATED QUESTIONS:

1. Discuss what is COPD and its pathophysiology.

REFERENCES:
(Type your reference here in APA format)

2. Discuss the role of inhaled and/or oral corticosteroids in the management of COPD.

REFERENCES:
(Type your reference here in APA format)

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3. What is spirometry? Discuss the process of interpreting FEV1/FVC results.

REFERENCES:
(Type your reference here in APA format)

4. Describe the relationship between α1-antitrypsin deficiency and the development of emphysema

REFERENCES:
(Type your reference here in APA format)

CLINICAL PHARMACY LABORATORY