Case Study

Post your answers to the 6 questions corresponding to this week’s content on primary care medication management. Provide your responses and rationales. Support your rationales with high-level evidence. (See Post Expectations)

A 12-year-old boy has occasional episodes of mild asthma while playing soccer with his friends.

Q1. What treatment should this patient receive to relieve symptoms during an asthma attack?

Q2. If the patient’s asthma attacks occur more frequently, what changes in therapy might be appropriate?

A 19-year-old college student is asking for contraceptives. 

Q3. What will you assess to determine if this patient is a good candidate for contraceptives, and what will you prescribe? (Include brand and generic name, route, frequency, and dose). What is the mechanism of action of the contraceptive you prescribed and the adverse effects?

Q4.  The patient states she heard a pill can help her acne. What would you prescribe and your rationale? (Include brand and generic name, dose, route, and frequency).

Q5. The patient is concerned because her mother and sister developed fractures in their legs and vertebra after menopause. She wants to know what medication and other advice will prevent osteoporosis. You discuss bisphosphonates. How are they used in the prevention and treatment of osteoporosis?

A 48-year-old man has occasional episodes of gout that are painful and debilitating. He requires drugs to treat the symptoms of acute gout attacks and prevent recurrent attacks.

Q6. How would you treat this patient’s acute gouty attack? Please list the trade and generic name and the dose of therapy. What is the mechanism of action of your choice of prescription?

Case Study

An obese patient, age 45, comes to your office. She recently moved from another state three weeks ago and told you that her FNP diagnosed her with type 2 diabetes mellitus. She is currently not on any medicine for her diabetes, and she wishes to avoid insulin, if possible. She is a non-smoker. Her blood pressure is 138/74 mmHg. Labs from 3-weeks ago was hemoglobin A1C = 8.4%; total cholesterol = 260 mg/dL, triglycerides = 290 mg/dL, HDL = 49 mg/dL, LDL = 170 mg/dL (calculated 10-year ASCVD risk = 6.2%). You discuss current treatment goal recommendations endorsed by the ADA regarding glycemic control, blood pressure control, and lipid management. She agrees to start any medications that you recommend with lifestyle modification and a DASH diet to treat hypertension.

Q1. Which classes of diabetes medications are either weight neutral or cause weight loss? Please give one (1) example of a drug’s generic and trade name in that class.

Q2. Based on the current guidelines of the ADA, it would be appropriate to treat her with monotherapy since the patient is hesitant to take any injections. What agent would you recommend? Please provide the trade name, generic name, the dose you would start the patient with frequency, and route.

Q3. What are the contraindications of your selected diabetic therapy?

The patient returns to your office six months later complaining of fatigue for the past two months, constipation, and heavy, irregular menses. Upon examination, you note that her skin is dry, and her fingernails are brittle. You suspect she has hypothyroidism.

Q4. What lab workup should you obtain? What sort of results will you see in patients who have hypothyroidism and hyperthyroidism? 

Q5. What is the treatment of choice for hypothyroidism? What is the mechanism of action? Please provide the initial dose, trade, and generic name of the drug, route, and frequency.

Q6. What are the adverse effects, and what important teaching will you provide this patient on thyroid replacement therapy?

Case Study

A 6 year old male fell out of a tree and broke his left ulna.

1. What is the significance of a bone plate?
2. How is bone formed?
3. What is the role of the following bone formation: hormones (GH + sex hormones), Ca2+, stress; low Ca2+ increases PTH.
4. Compare and contrast the various types of fractures.

Case Study

A 32 year old female who recently delivered twins presents with  colicky type pain, URQ pain radiating to the shoulder.  After workup, she is diagnosis with cholecystitis.

1. What is the role of the gallbladder?
2. Would you expect her to have nausea and vomiting? Defend your answer.
3. Why does the patient have referred pain?
4. How do gallstones form?

Case Study

A 19 year old presents with a deep laceration on the left leg. After sutures the patient is discharged.

1. Disucss the pathophysiology of wound healing.
2. What is a granuloma and what is it’s significance?
3. Discuss graft host disease and is this patient appropriate?  Discuss you answer.