Case Study #3- Patient Variables
Spring Semester
Bob Barkley is a 92 y.o. Caucasian male with PMH of HTN, diastolic heart failure, Type 2 Diabetes,
Constipation, Hypothyroidism, asthma, chronic kidney disease (CKD) IV, benign prostatic hypertrophy
with urinary retention, hyperlipidemia, insomnia, eczema, and depression.
He is widowed and lives on his own, with minimal assistance from adult children who live next door.
In the past year, he has hospitalized for a UTI and once for a broken hip requiring surgical repair.
VS: T 98.4, HR 94, BP 129/76. SpO2 94%. His weight is 176lbs. Height = 64 inches.
Lab values are:
Complete Blood Count: WBC 7.6, Hgb 13.5, HCT 42, Plt 290,
Comprehensive Metabolic Profile: Na 141, K 4.0, Cl 95, CO2 31, UN 30, Cr 1.8, Glu 101, Ca 8.4, TP
6.4, Alb 4.0, AST 22, AP 44, ALT 16, Tbili 0.5, Mg 1.3, GFR (calculated) 25ml/minute
Lipid panel: Chol 164, TG 148, LDL 66, HDL 48,
TSH: 2 Hemoglobin A1C: 6%
He denies sore throat, fevers, chills, chest pain, dizziness, nausea, dysuria or fatigue.
Your exam shows:
General: A&O x 3, appears comfortable.
Resp: respirations slightly labored. Lungs have expiratory wheezes bilateral that clears with cough
CV: no jugular venous distention, S1S2 regular.
Abd- soft, NT, ND, +BS x 4.
Ext- trace edema.
Skin: eczematic patches flexure surfaces of elbows.
He is concerned about the number of medications he takes and about his ability to afford them. He can
afford $70 dollars per month. His prescriptions are filled at Walmart Pharmacy, as they have a discount
program. (See the price list in BB). Any other meds (whether OTC or Rx) cost copays $10. RXs may only
be written for 30-day supply, with refills as appropriate
** No medication substitutions allowed. You may order a combo tablet when available to save money**
This is a list of his medications:
Docusate sodium (colace)
Lisinopril (Zestril)
Metoprolol
Budesonide / Formoterol (Symbicort)
Furosemide (Lasix)
Aspirin
Tiotropium (Spiriva)
Albuterol
Alendronate (Fosamax)
Tamsulosin (Flomax)
Calcium/ Vitamin D3
Hydrocortisone topical
Fluoxetine
Atorvastatin
Metformin
Levothyroxine
Diphenhydramine
20 points: Review his listed medications. Given his chronic conditions, kidney function, age/ Beer’s
criteria, and cost, choose the meds that you are going to renew. Remember, he cannot afford more
than $70 per month.
Provide rationale for keeping the meds you are prescribing.
Provide rationale for why you decided to discontinue other meds.
Medication to Rx Rationale Medication to stop Rationale
40 points- Write the remainder of the medications at starting doses Write each medication on a
prescription blank. Be sure to include all elements for a valid prescription. Be sure to include the
indication/ rationale for each medication you are writing for. Use the history in the case study to help
you. Include 3 brief patient teaching points for each medication.
Special instructions
- Tamsulosin and Colace are both at the max dose.
- Albuterol is as needed (PRN) medication
- Atorvastatin is moderate-intensity dosed
- Levothyroxine at 1.6mcg/kg daily
10 points- Provide a medication list for Bob to take home to his family and hang on the refrigerator.
Make sure it is in patient friendly language.
Medication/ dose Indication Price
Total monthly cost:
30 points - pick three medications that you have written, report the pharmacokinetics,
pharmacodynamics, and ADR profile **SPECIFIC TO THIS PATIENT**, any monitoring (for the
patient/family or APRN), and any teaching for the patient and/or family. You may write each in a brief
paragraph. Citation of references must be included.