Case Studies for Hospital Pharmacy PDF

Preview

Summary

Case Studies for Hospital Pharmacy...

Description

Activity for Hospital Pharmacy Internship CASE STUDIES Student Name: __________________ Instructions: Analyze the following cases and choose among the given choices. Rationalize your answer(s) properly. Provide your references/ basis when necessary.  3 points will be given for each question. CASE STUDY NO.1 A 40-year old woman with history of deep vein thrombosis is stabilized on 5mg warfarin daily. She is again admitted to the hospital because of a suspected duodenal ulcer. In addition to the drug listed below, her warfarin is maintained at 5mg daily. After several days, her prothrombin time (PT) increases from 27 seconds to 80 seconds (control value is 11 seconds). Which of her medicines may be responsible for this increase on PT time? a. b. c. d.

Paracetamol tab 650 mg q4h Cimetidine tab 300 mg qid Diazepam tab 5mg qid Ampicillin cap mg qid

Rationale:

CASE STUDY NO. 2 An adult patient who has ingested 30 paracetamol tablets (325mg/tab) 6 hours ago should be treated with/by a. b. c. d.

Careful observation for signs of central nervous system toxicity Activated charcoal N-acetylcysteine Glutathione

Rationale:

CASE STUDY NO. 3 A middle-aged patient is at the prescription counter to buy her first refill on a chlorpromazine prescription. She is also about to purchase aspirin which she says if for her fever. She also asks you what you would recommend for a “sore throat” she has had for several days. Having this information, you would; a. b.

Tell the patient that she is allergic to chlorpromazine and contact the patient’s physician Recommend a cough–cold preparation that does not contain a sympathomimetic

c.

Contact the patient’s physician and discuss the possibility of chlorpromazine-induced agranulocytosis

Activity for Hospital Pharmacy Internship

d. e.

CASE STUDIES Tell the patient to see her doctor if her fever and sore throat do not improve in a day or two Inquire about these symptoms the next time the patient comes in to refill the prescription

Rationale:

CASE STUDY NO. 4 A man of around 30 years of age approached the Rx counter and request for the best emergency advice that a pharmacist could give for minor burn. a. b. c. d. e.

Apply butter to the burn Apply Vaseline to the burn Contact a physician immediately Immerse the burn area in warm water followed by cold water Immerse the burn area in cold water

Rationale:

CASE STUDY NO.5 Six weeks ago, a 32 -year old female with a history of recurrent urinary tract infections was treated with a 10day dosage regimen of ampicillin 250mg q6h for an E-coli urinary tract infection. She now presents with signs and symptoms of another UTI. The physician asks the pharmacist what is the best antibiotic for his patient. The pharmacist should recommend: a. b. c. d. e.

Gentamicin Co-trimoxazole Tetracycline Amoxicillin Nitrofurantoin

Rationale:

Activity for Hospital Pharmacy Internship CASE STUDIES CASE STUDY NO. 6 A patient who has been stabilized on 300 mg of phenytoin per day is having difficulty swallowing capsules, His physicians writes a new prescription for phenytoin suspension mg once daily. This change is likely to a. b. c. d.

Reduce the phenytoin level because of decreased bioavailability from the suspension Increase the phenytoin level because of increased bioavailability from the suspension have no impact on the phenytoin level increase the phenytoin level because the 300 mg dose of suspension contains more of the active form of the drug e. decrease the phenytoin level because the 300 mg of suspension contains less of the active form of the drug

Rationale:

CASE STUDY NO. 7 A patient has been receiving 50 mg hydrocortisone intravenously q6h for acute exacerbation of ulcerative colitis. After several days of IV therapy, the physician wishes to switch the patient to an equivalent dose of oral prednisone. The equivalent total daily dose of prednisone would be a. 10mg b. 25mg c. 50mg d. 100mg e. 200 mg Rationale:

CASE STUDY NO. 8 Patient Profile: Diagnosis: Current Medications: Diet:

Conrado Tomas, 57 year-old male, 200 lbs, 5’11 Primary – Congestive Heart Failure Secondary – Ascites, pedal edema Digoxin 0.25 mg PO OD Furosemide 40mg PO BID Low sodium

Refer to the Patient Profile above for the 2 questions below. 1. What drug interactions may occur as a result of the addition of verapamil to Mr. Tomas’ drug therapy? a. None; there are no known interaction between verapamil and digoxin or furosemide b. Verapamil may cause an increase in digoxin levels

Activity for Hospital Pharmacy Internship CASE STUDIES c. Verapamil may cause an increase in furosemide elimination d. Digoxin may inhibit the metabolism of verapamil e. Verapamil may stimulate the metabolism of digoxin Rationale:

2. The pharmacist has been asked to educate the patient about the signs of digoxin toxicity that require immediate notification of physician. The pharmacist includes: I. Ringing in the ears II. Changes in vision III. Palpitations a. 1 only b. 3 only c. 1 and 2 only d. 2 and 3 only e. 1,2 and 3 Rationale:

CASE STUDY NO. 9 Prescription for Ms. Tessa Rodriguez Rx Ibuprofen 400 mg # 60 tabs Signa: 1 tab qid Which of the following auxiliary labels should be placed on the medicine container? a. Keep refrigerated b. Protect from heat and light c. Take with food or milk d. Take at least one hour before meals e. May cause drowsiness Rationale:...