Advanced Pharmacology

GNUR 570 Advanced Pharmacology
Deprescribing Assignment

Gilbert Smith is a 92 y.o. Caucasian male with PMH of paroxysmal Atrial fibrillation, stroke, gout, Vitamin D deficiency, constipation, Congestive Heart Failure, Hypertension, severe COPD on chronic steroids, constipation, chronic kidney disease IV, benign prostatic hypertrophy with urinary retention, hyperlipidemia, eczema, and anxiety.

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 numerous times for COPD exacerbations and UTIs.

VS: T 98.4, HR 94, BP 129/76. 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,
He is followed by urology, pulmonology, and cardiology.
He is to see you for a routine check up on chronic conditions.

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, irregularly irregular, S1S2.
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 $60 dollars per month. His prescriptions are filled at Walmart Pharmacy, as they have a discount program. (https://i5.walmartimages.com/dfw/4ff9c6c9-9378/k2-_0769cdec-ad81-46f5-9e50-a463dbfabc2e.v1.pdf ). Any other meds (whether OTC or Rx) cost copays $10 each, 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)
Lovastatin (Altoprev)
Allopurinol (Zyloprim)
Lisinopril (Zestril)
Digoxin (Lanoxin)
Budesonide / Formoterol (Symbicort)
Furosemide (Lasix)
Aspirin
Tiotropium (Spiriva)
Albuterol
Alendronate (Fosamax)
Tamsulosin(Flomax)
Calcium/ Vitamin D3
Hydrocortisone topical

10 points: 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

50 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 $60 per month.
Special instructions (if you choose to prescriber these meds…)
– Digoxin calculate the dose based on CrCl.
– Tamsulosin and Colace are both at the max dose.
– Albuterol is as needed medication
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.
10 points- Provide a medication list for Gilbert to take home to his family and hang on the refrigerator. Make sure it is in patient friendly language.
Medication/ dose Indication Price (insurance/ or Walmart 4 dollar program)

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.