Responses 1. The patient reported the presence of multiple comorbid conditions including hypertension, gout, bone disease/ hypocalcemia, and being a transplant recipient. He appeared to take the appropriate prescription medication(s) for treating/managing each of the comorbid conditions he discussed during the subjective examination and history taking (see Tables 20). Table 20: Comorbidities Reported versus Prescription Medications Comorbid Condition Reported Prescription Medication Reported Kidney transplant Tacrolimus Hypertension Amlodipine, carvedilol, & losartan Bone disease/hypocalcemia Calcitriol Gout Colchicine 2. There were three prescription medications the patient reported taking that did not appear to be directly linked to a comorbid condition for which those drugs are normally prescribed. The patient did not provide any reason for taking these medications. The prescription medications that were not “matched” to a comorbid condition included levothyroxine , pravastatin , and potassium chloride . Levothyroxine is a thyroid hormone supplement that is prescribed to treat hypothyroidism , a condition the patient had not mentioned during the interview. Pravastatin is a statin used to treat hypercholesterolemia in an attempt to prevent coronary artery disease. The patient did not note the presence of hypercholesterolemia nor coronary artery disease during the history. Potassium chloride is a drug given to treat hypokalemia . The presence of hypokalemia is often a side effect of diuretics used to treat hypertension. While the patient is taking three medications for hypertension, he is not currently taking a diuretic . Diuretics are often used to treat hypertension prior to, or in combination with, the use of the three drugs listed for the treatment of his hypertension . The possibility exists that the patient was previously taking a diuretic but that medication may have been discontinued when one or more of the current medications for hypertension was started. However, the potassium chloride is typically discontinued when the diuretic is stopped. There are other indications for this medication but the patient did not provide any reason for taking the potassium chloride . In addition, the patient reported a single dose of aspirin daily for pain. This dose is too low to have a significant analgesic impact , but this dose will still impact the blood coagulation profile and reduce the risk of a thromboembolic event. His hypertension and potential hypercholesterolemia increase the risk of a thromboembolic event and the aspirin may be counteracting the elevated risk of a thromboembolic event (see Table 21).
● Integumentary system : not impaired based on observation, although the patient did have a well-healed surgical scar secondary to kidney transplant. ● Communication ability : impaired secondary to hearing loss. The patient reported the use of a hearing aid but he was otherwise unimpaired in his ability to communicate. Therapist will encourage the patient to bring his hearing aid to all therapy sessions. Prescription medications Following the initial subjective evaluation and medical history, but prior to the objective examination, the patient was requested to provide a list of all of his prescription medications, OTC drugs, and supplements taken on a regular basis. The patient provided a list of prescription medications that can be found in the left-hand column of Table 19. Dosage taken and typical reasons for taking each medication are provided in the other columns. The patient denied the use of supplements and OTC medications. Table 19: Medication List for Case Study 2 Medication Dosage Reason Amlodipine 2.5 mg tab 1x/day High blood pressure and angina
Aspirin
325 mg tab 1x/day Pain and inflammation
Colchicine
0.6 mg tab 1x/day as needed 0.25 mcg tab 1x/d 5 days per week
Pain associated with gout Treat and prevent low levels of calcium (hypocalcemia) and bone disease in patients whose kidneys or parathyroid glands are not working properly
Calcitriol
Coreg
25 mg tab 2x/day
Heart failure and hypertension
Levothyroxine
25 mg tab 1x/day
Hypothyroidism
Losartan
Half a 50 mg tab 1x/day 10 mEq CR-Cap 1x/day
Hypertension
Potassium chloride
Low blood levels of potassium
Pravastatin
40 mg tab 1x/day High cholesterol
Tacrolimus
0.5 mg cap 1x/ evening; 1 mg cap 1x/morning
Prevent rejection of a kidney transplant
Questions 1. The patient noted several chronic, comorbid conditions that require prescription medications to manage properly. Does the medication list include medications to treat each of the comorbid conditions noted in the patient description above? 2. Several prescription medications listed are not used to treat the comorbid conditions the patient included during the interview. Which medications in his medication list are prescribed for specific medical disorders that were not included on the list of comorbid conditions and what comorbidities are these drugs normally used to treat?
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Book Code: PTOH1324
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