John is a 24-year-old who presents to urgent care with a 2 week history of cough and congestion. He says it started out as a “normal cold” and it will not go away. He has a productive cough of green mucous and has green nasal discharge. He says that he has had a low-grade temperature for the past 2 days. John reports an intermittent frontal headache with this cold. He is otherwise healthy, with no known drug allergies.

The patient’s assessment is as follows:

Vital signs are stable and temperature is 99.9°F. Tympanic membranes (TMs) are clear bilaterally, pharynx is pink with no exudate, he has greenish postnasal drainage, turbinates’ are swollen and red, there is tenderness when frontal sinuses palpated, there is no cervical adenopathy, and lungs are clear.

Answer the following questions. 

1. What medications do you anticipate being prescribed/recommended and why?
2. What patient education would you anticipate giving the patient regarding the medications you chose?

Patrick is a 24 year old male who was playing soccer and twisted his ankle approximately 4 hours before presenting at Urgent Care. He is healthy and takes no medications on a regular basis.

The patient’s assessment is as follows:

His x-ray is negative for fracture and his examination is consistent with a moderate ankle sprain.

Answer the following questions. 

1. What medication would you anticipate recommending/prescribing and why?
2. What patient education would you anticipate giving this patient relating to the medication that you chose?

Week 6 Case Study

A patient is followed for several years with heart failure. His case is early at stage A.

Answer the following questions. 

1. Which stage A patients would benefit from adding an angiotensin-converting enzyme inhibitor?
2. As the patient progresses through the heart disease stages, when are diuretics typically added? Are all heart failure patients candidates for diuretics at this stage?

Submission Details:

Week 3 Case Study

A 78-year-old male patient comes to your office complaining of increased left knee pain for the past 3 to 4 months. He has had no history of recent injury. An x-ray done less than 4 months ago showed degenerative osteoarthritic changes. He has full range of motion and denies any recent swelling, pedal edema, or discoloration. He has been a long-distance runner for many years and was diagnosed with osteoarthritis of his left knee more than 10 years ago. He has decreased his weekly running, but the pain is persistent and is affecting his daily activities. He has been using over-the-counter NSAIDs on and off, but states they are no longer working and wants something “stronger.” His vital signs are all normal and he has no history of fever, chills, or rashes. He is otherwise healthy.

1. Which medications do you feel would be safe and appropriate for this patient’s chronic pain?
2. What education would you provide when prescribing pain medication for this patient?

Submission Details:

Week 2 Case Study

Aubre R. presents as a new patient to your practice having recently relocated from rural Tennessee. She is 68 years old and complains of irritable bowel syndrome (IBS) with abdominal cramping and frequent diarrhea with occasional constipation. She has a history of domestic violence with resultant anxiety requiring inpatient hospitalization 8 years ago. She is also complaining of urinary retention, insomnia, and hip pain since a hip fracture 4 years ago. Her drugs include zolpidem 10 mg hs, bethanechol 25 mg tid, metoclopramide 10 mg tid, amitriptyline 100 mg hs, alprazolam 0.25 mg tid, hydrocodone/APAP 5/500 tid, and dicyclomine 20 mg four times daily.

1. What are your concerns about this drug regimen?
2. What recommendations do you have for this patient?