Ptx Iii - Exam 3 Geriatrics

Front 1

Phadora is 85 years old, widower, and is currently enrolled in Medicare Part A, B and D. She just joined, at your urging, Community CCRx Basic effective Jan 1, 2009. She will NOT spend anymore than the $330 a month out of her pocket for Medicare Part B and D premiums and any prescription, OTC or Herbal drugs. She has been very compliant. If she decides to do something it is done, correctly, if not she doesn’t do it at all. You notice she is using a three legged cane, for the first time. When asked she about it she says her, daughter, had ordered her to get one after a recent fall. She has a new prescription for Aricept 10 mg QD. When asked for her prescription card she hands you her Visa credit card on a second try she hands you her Borders books card. On the third try she hands you two cards and asks you to read them.. Problem List: All Labs within normal limits unless specified.
Urinary Incontinence: Has stopped wearing Depends since her drug was started. Osteoporosis Osteoarthritis refractory to Acetaminophen. NSAID works great. She loves it. HTN 150/90 Depression 12 months of treatment. First episode and complete remission. Hyperlipidemia:
LDL C 150 mg/dl. TG 100 mg/dl. HDL 40 mg/dl
Type II Diabetes HgbA1C 8% Refuses injectable medications Tried Diabeta 5mg QD had recurrent hypoglycemic episodes Peripheral neuropathy, in legs and feet, secondary to Diabetes GERD with Esophagitis Angina Restless leg syndrome (some response but still a problem) TIA X 2. Last one 2 months ago Atrial Fibrillation (non valvular, resting heart rate 70) Needs Herpes Zoster protection
Current medications: Been on for six months except where noted. Ditropan 5 mg B.I.D Alendronate 70 mg Q week. (Follows appropriate administration directions) Naproxyen 500 mg B.I.D HCTZ 25 mg QD Wellbutrin XL 300 mg QD X 12 months. Last dose today. Says she is glad it is one less medicine to take and pay for. Her physician said she did great. Lisinopril 10 mg QD Glucophage XR 1000 mg BID Lipitor 40 mg QD Imdur 60 mg QD Nexium 40 mg QD. Wants her purple pill! Requip 0.25 mg one hour before bed time QD: Started 2 days ago Digoxin 0.25mg QD Neurontin 200 mg T.I.D (physician Doubled dose last week) Calcium and VitaminD 1200 mg and 800 units per day in divided doses. Nitrostat 0.3 mg prn #100 Last filled July 1, 2008. Warfarin 2.5 mg MWF and 4 mg T,Th,Sat,Su INR stable at 2.5 for last 3 months. Plavix 75 mg QD A good friend advised her to use the following: Ginko Biloba 120 mg B.I.D for her memory NyQuil Cough 1 cup, that comes with bottle, full at nighttime for chronic dry cough Tylenol PM 1 tablet at bedtime for insomnia

Which of the following is TRUE about Phadora’s drug related problems:
a. Digoxin should be stopped because it is not working.
b. Glucophage should be discontinued for lack of response and insulin started
c. Continuing Nexium may be necessary if esophagitis is not resolved.
d. Warfarin dose should be decreased because of NSAID increase in INR
e. Stop Tylenol PM. Insomnia is not a problem for Phadora.

Back 1

c. Continuing Nexium may be necessary if esophagitis is not resolved.

a. Incorrect: It is working, note resting heart rate.
b. Incorrect: Glucophage got her HgbAIC to 8.0% and she does NOT want injections.
c. Correct: May even need to increase dose.
d. Incorrect: INR is therapeutic and not increase by NSAID. The affect platelets.
e. Incorrect: Insomnia is a consequence of restless leg syndrome and until she responds to Requip she will need help sleeping.

Front 2

Phadora is at risk for further falls because of:
a. Increase in Neurontin dose
b. Possible anticholinergic induced confusion
c. Possible Macular Degeneration
d. Possible recurrent TIA
e. All of the above

Back 2

e. All of the above

a. Correct: Can cause confusion with rapid dose increase.
b. Correct: Her total anti cholingeric burden is great
c. Correct: At her age 1 in 4 chance of having this.
d. Correct: None of the stroke prophylaxis stops TIA’s or strokes, completely, they just reduce the chance and/or frequency.

Front 3

Phadora’s Aricept prescription would BEST be dealt with by:
a. Reducing dose to 5 mg QD for 4-6 weeks and if tolerated 10 mg QD.
b. Before starting, determine if the prescribing physician is aware of anti cholinergic burden
c. Stop Ditropan and start Aricept as ordered
d. Stop Warfarin and start Aricept at 5 mg QD
e. Recommend seeing ophthalmologist and start Aricept at 10 mg QD

Back 3

b. Before starting, determine if the prescribing physician is aware of anti cholinergic burden

a. Incorrect: See B for best approach.
b. Correct: Don’t treat drug side effects with another drug, if possible.
c. Incorrect: See B
d. Incorrect: Needs anticoagulation
e. Incorrect: See B. Aricept needs dosage titration.

Front 4

Which of the following BEST describes the expected results from trying to deal with Phardora’s suspected ADR’s:
a. Discontinuing her ditropan will completely resolve her visual difficulties.
b. Discontinuing her Nyquil and Tylenol PM will restore her memory, to normal.
c. Discontinuing her Nyquil, Tylenol PM, Ditropan and starting Aricept will prevent her from falling.
d. Further falls will be prevented by successful treatment of peripheral neuropathy.
e. Discontinue her Tylenol pM and Nquil cough; if needed use non antihistamine containing agents to treat insomnia and cough.

Back 4

e. Discontinue her Tylenol pM and Nquil cough; if needed use non antihistamine containing agents to treat

a. Incorrect: If she has macular degeneration it will NOT resolve
b. Incorrect: She may really have Alzehiemer’s
c. Incorrect: She has lots of other reasons to fall.
d. Incorrect: She has lots of other reasons to fall
e. Correct: Good strategy.

Front 5

Considering Phadora’s current drug regimen and stated conditions you would want to educate her about all of the following EXCEPT:
a. Stroke
b. Myocardial Infarction
c. Diabetic ketoacidosis
d. Bleeding
e. Hypoglycemia

Back 5

c. Diabetic ketoacidosis

Type II diabetics rarely, if ever develop this.

Front 6

Which of the following is true about Phadora’s drug benefit plan, CCRx, and her current drug regimen, as written:

a. No brand name drugs are covered
b. There is no catastrophic coverage
c. All drugs are covered in the GAP
d. She must pay 100%, of the cost, for some of her drugs, for the entire year.
e. The CCRx total annual cost, for Phadora, includes drug cost, premium cost, deductible cost and MTM fee paid to the pharmacist.

Back 6

d. She must pay 100%, of the cost, for some of her drugs, for the entire year.

a. Incorrect Aricept is covered.
b. Incorrect: There is for covered drugs.
c. Incorrect: NO drugs are covered
d. Correct: Those that are NON formulary for CCRx.
e. Incorrect: Not MTM fee is paid by the patient to the pharmacist.

Front 7

Which of the following actions would be BEST for Phardora’s drug related problems:
a. Stop Digoxin and Warfarin the A. Fib needs no further treatment
b. Increase Glucophage XR to 850 mg q 8hrs to lower HgbA1C
c. Increase lisinopril to 20 mg QD for BP control
d. Increase Requip to 0.5 mg QD after 5 more days of 0.25 mg, if RLS not improved
e. Increase Imdur to 120 mg QD for BP control

Back 7

d. Increase Requip to 0.5 mg QD after 5 more days of 0.25 mg, if RLS not improved

a. Incorrect: A. Fib needs continued treatment.
b. Incorrect; Glucophage over maximum recommended dose.
c. Incorrect: Need different drug(s) for BP control because of cough.
d. Correct: Right strategy.
e. Incorrect: Imdur for angina NOT BP control