HPI II. is a 59-year-old woman who presents to the community pharmacy with complaints of a based administration at her w

[answerhappygod]

Hpi Ii Is A 59 Year Old Woman Who Presents To The Community Pharmacy With Complaints Of A Based Administration At Her W 1 (38.67 KiB) Viewed 20 times

Hpi Ii Is A 59 Year Old Woman Who Presents To The Community Pharmacy With Complaints Of A Based Administration At Her W 2 (52.45 KiB) Viewed 20 times

HPI II. is a 59-year-old woman who presents to the community pharmacy with complaints of a based administration at her work place. A smoking ban at her health care facility will begin in 3 weeks. She states that I need the income but could work part time to pay the bills. I don't want to quit smoking. What can you suggest to help me get through my shift without going though nicotine withdrawal? Oh, and don't suggest those nicotine patches. I tried those in the past and they just made me want to smoke more." PMH S/P hysterectomy 4 months prior to this visit Hypertension diagnosed at age 41. Depression with anxiety diagnosed at age 35. Chronic back pain diagnosed at age 38 Migraine headaches diagnosed at age 23, increased frequency over the past 6 months. Headaches are so severe now that patient is calling in sick to work at least once per week. Insomnia diagnosed at age 19 FH Mother died at age 78 of natural causes Father died at age 61 of a heart attack. Patient is the oldest child of four siblings. All siblings have smoked cigarettes, but in the past 5 years, two of the siblings have quit smoking Son and daughter do not smoke. Twenty-nine-year-old son has attention deficit hyperactivity disorder (ADHD). Twenty-five year-old daughter was hospitalized with a collapsed lung 8 years ago. SH This pediatric nurse works the night shift (11 PM-7 AM) at a local hospital. She smokes 2 packs of cigarettes daily and has smoked for the past 45 years. She drinks 15 cups of coffee a day when she is working She states that she drinks one glass of wine every 3 months. Son lives in the mother's home intermittently throughout the year. Sonrisa nonsmoker. Conflict arises frequently between patient and her son about her cigarette smoking Meds Imitrex 6 mg injection PRN migraine headache, not to exceed two doses per day Meloxicam 15 mg po dally Amitriptyline 75 mg po at bedtime Hydrochlorothiazide 25 mg po daily Ambien CR 125 mg po at bedtime Escitalopram 10 mg po daily ALI NKDA ROS No problems noted Physical Examination Gen-Disheveled, heavy-set African-American woman who looks older than her stated ape, with an ancies demeanor. Strong oder of cigarette smoke VS - BP 118/75, P 100 obtained at the pharmacy Skin - Pale, yellowed skin on fingers HEENT - Yellow teeth, wrinkled facial skin

Questions 1.a. Create a list of this patient's drug therapy problems. 1.b. What information in the patient's history can be identified as disease or symptoms directly related to the patient's smoking history (Fig. 71-1)? 1.c. Identify the stage of change that the patient is currently in at this time of her life, and describe your intervention plan using one of the A's from the 5A intervention plan for smokers (Table 71-1). 1.d. Describe aspects of the case that reveal the severity of nicotine dependence. Desired Outcome 2. What are the goals of smoking cessation pharmacotherapy for this patient? Therapeutic Alternatives 3.a. Describe nondrug therapies that may help this patient continue to work in her job. 3.b. What pharmacotherapeutic alternatives are available for the treatment of the nicotine dependence, and which would be an acceptable recommendation to make to this patient? 3.c. What economic, psychosocial, racial, and ethical issues need to be considered in this patient's treatment? Optimal Plan 4. What drug dosage form, dose, schedule, and duration of therapy are best for this patient? Outcome Evaluation 5. What clinical and laboratory parameters are necessary to evaluate the therapy for achievement of the desired therapeutic outcome and to detect or prevent adverse effects? Patient Education 6. What information should be provided to the patient about the medication you recommended to enhance compliance, ensure successful outcome, and minimize adverse effects?