Case Study FI, NRP507 Adv Pharmacology.
History and Physical Assessment
Fred lrving is a 45-year-old African American male who checks in at the emergency department for a Deep vein thrombosis (DVT) and his prior hypertension follow-ups. The patient was scheduled for follow ups after he started a BP medication for the last six months, but, he reports not to have complied due to his tight programs.Case Study FI, NRP507 Adv Pharmacology. The patient reports experiencing leg pain and swelling of his left calf after having long flights forcing him to seek ER for assessment last week and was diagnosed with DVT and requested to follow up with his PCP. Fred state that he was to take Xarelto 15 mg twice a day for two weeks totalling 3 weeks for DVT treatment. After taking the dosage, he was to start a new prescription for Xarelto for PCP management. Besides, the patient is concerned about SEs of his medication. The patient denies shortness of breath, edema, chest pain, runny nose, postnasal drip, or changes in eating habits.Case Study FI, NRP507 Adv Pharmacology.
Fred’s medical history indicates he had no reported case. His family history reveals that his mother had died aging 65 from stroke, DM, and HTN. The father died aging 55 due to a heart attack. Mr. Irving’s, other younger brothers, live in a good health condition, but one is reported to have high cholesterol. The patient is prescribed to medication, requiring him to take Xarelto 15mg twice daily started seven days ago, and Lisinopril 10 mg qd began 6 months ago. The patient has no allergic condition. In addition, the patient’s social history indicates he was a divorced father of one and is a sixth-grade teacher. The patient neither smokes nor drink. The patient’s physical assessment shows that he is an African American male maintaining good eye contact, well-mannered and speech, and appropriate dressing. He states he wanted to have full control of his blood pressure. His left calf is still swollen with a mild tenderness with no noted warmth or pain: no noticeable rashes or excessive skin dryness.Case Study FI, NRP507 Adv Pharmacology.
Fredrick Irving is diagnosed with deep vein thrombosis (DVT) and hypertension. This follows his clinical manifestations which include the presence of leg pain, mild tenderness and swelling of his left calf after a long flight. DVT describes a condition characterized by the development of a blood clot in the deep veins of the body particularly in the legs causing swelling or leg pain. The symptoms of this disease include cramping or throbbing pain in one leg often at the thigh or calf together with swelling(Fleck et al., 2017). The painful area also presents with warm skin, reddening or darkening. The swollen veins can be sore or hard to touch. In addition, he has a history of hypertension. His blood pressure is currently elevated at 148/110 contrary to the normal maximum of 120/80. His BMI of 35.9 also indicate that he is obese, a significant risk factor for hypertension and DVT.Case Study FI, NRP507 Adv Pharmacology.
The client’s lab results indicate an elevated VLDL of 60 contrary to the normal VLDL level which ranges between 2 and 30 mg/dL. This high concentration of bad cholesterol increases the risk of DVT as it can clog easily clog the blood vessels. The LDL levels of 168 are also high compared to the optimal levels of 100mg/dL or less. Moreover, total cholesterol of the client is 228mg/Dl while the normal readings should be less than 170mg/dL. Creatinine levels of 2.1 and BUN of 22are also high and are associated with a deviation in normal functioning of the cardiovascular system and presence of high blood pressure. Other possible differential diagnosis includesBaker’s cyst which is characterized by swelling behind the knee, pain and inability to flex the knee fully due to stiffness(Michiels et al., 2017). Cellulitis also has closely related symptoms such as red, painful and warm touch at swollen lower legs skin areas caused by bacterial infection. However, the most appropriate diagnosis is DVT.Case Study FI, NRP507 Adv Pharmacology.Case Study FI, NRP507 Adv Pharmacology.
Deep vein thrombosis can be treated using both the psychotherapeutic and pharmacotherapeutic approaches. The psychotherapeutic intervention for the client included counselling and training on behavioral changes. These include bed rest to prevent clot dislodgment, monitoring of vital signs, warm compressing to reduce swelling, elevation of the left leg as well as conduction of exercise.Case Study FI, NRP507 Adv Pharmacology.
Medical treatment for DVT includes the use of anticoagulants to prevent clotting. Rivaroxaban (Xarelto) is an effective blood thinner that prevents blood clotting. As such, the client is prescribed a Xarelto 15mg twice a day on an empty stomach started 7 days ago. The medication is taken orally twice a day and is expected to be taken for as long as risk of recurrence persists. It is given to prevent the growth of blood clots as well as to stop other clots from forming.Case Study FI, NRP507 Adv Pharmacology.
Xarelto has multiple side effects including serous bleeding. This occurs when the drug affects the proteins involved in blood clotting and can therefore result in adverse consequences. As such, the patient will be engaged in a follow-up after three weeks to determine their response and progress to the medication. Other side effects include bloody stools, bleeding gums, back pain, bladder or bowel dysfunction, breathing and swallowing difficulties, coughing blood and tingling, crawling, burning, numbness or itching feelings. The patient will avoid foods like grape fruit and its juices; leafy greens, green tea and alcohol.Case Study FI, NRP507 Adv Pharmacology.Case Study FI, NRP507 Adv Pharmacology.
The client will also be continued on oralLisinopril 10 mg qdthat was started 6 months ago. This is an ACE inhibitor meant to lower the blood pressure of the patient. It relaxes the blood vessels by blocking the substance that cause the blood vessels to tighten thus increasing the supply of oxygen and blood to the heart by lowering the blood pressure(Tsai et al., 2017). It can be taken with or without food. However, foods rich in potassium and high salt concentration should be avoided. Excess consumption of potatoes, oranges, bananas, squash, tomatoes and dark leafy greens is not recommended. The side effects of dizziness, cough, headache, diarrhea, high potassium levels, low blood pressure, fatigue and chest pain. The patient’s follow-up for lisinopril will be done once a month. The adjustments of the medication will be determined by the client’s tolerance and therapeutic impacts.Case Study FI, NRP507 Adv Pharmacology.Case Study FI, NRP507 Adv Pharmacology.
Teaching and education for the patient includes the awareness of the medical conditions and the serious implications associated. Learning items will entail maintenance of healthy weight, stress management, healthy dieting and foods to avoid. He will also be taught how to monitor his blood pressure at home as well as engagement in physical activities. Proper administration and compliance of the prescribed drugs will also be done. This will seek to enforce adherence as it has been noted that the client has not been adhering to the lisinopril prescription for hypertension citing tight schedules. Since the patient is willing to adhere to the current treatment regime, referrals won’t be necessary unless he develops complications or his case severe with the administration of the current medication.Case Study FI, NRP507 Adv Pharmacology.Case Study FI, NRP507 Adv Pharmacology.
Potential Patient Drug Interactions
Xarelto medication interacts with other anticoagulants, non-steroidal anti-inflammatory drugs (NSAIDs) and painkillers such as aspirin. The use of these drugs can result in unstable blood pressure, valvular heart disease, renal disease, hepatic impairment and bleeding. On the other hand, Lisinopril should not be taken with medicine that contains sacubitril and aliskiren and salt substitutes such as magnesium, calcium and sodium-rich foods. More so, when taking diuretic medications, herbs with the diuretic effect should be avoided as they result in cardiovascular side effects.Case Study FI, NRP507 Adv Pharmacology.
Pharmacokinetics and pharmacodynamics
Xarelto is indicated for treatment and prevention of venous thromboembolism (VTE) and VTE-related death including DVT to reduce the risk of thromboembolic complications. The pharmacokinetics of the drug is characterized by a high bioavailability of 80–100%. It reaches a maximal plasma concentration in 2 to 4 hours through rapid absorption and a moderate distribution. The pharmacodynamics involve the direct binding to factor Xa thus blocking the amplification of the coagulation cascade(Zografosn et al., 2016). This prevents the thrombus formation.Case Study FI, NRP507 Adv Pharmacology.Case Study FI, NRP507 Adv Pharmacology.
Consequently, lisinopril is indicated for the treatment of hypertension in adult patients and pediatric patients 6 years of age and older to lower blood pressure.The pharmacodynamics of lisinopril involves the inhibition of angiotensin-converting enzyme (ACE), a peptidyl dipeptidase involved in catalyzing the conversion of angiotensin I to angiotensin II, a vasoconstrictor substance, that is involved in the production of aldosterone by the adrenal cortex (Tsai et al., 2017). Plasma angiotensin II is decreased by the inhibition resulting in reduced vasopressor activity as well as secretion of aldosterone. This increases the serum potassium. The pharmacokinetics of lisinopril begins at 7 hours after administration with the attainment of peak concentration. It has anoral bioavailability of 25 percent ± 4 percent which is not affected by food. According to Sonn et al. (2019), the terminal serum half-life is approximately 40 hours with an average accumulation half-life of 12.6hours.Case Study FI, NRP507 Adv Pharmacology.
HPI: Fredrick Irving is a 45-year-old African American male who comes in for follow-up of his hypertension and follow-up from a visit to the emergency department for a DVT. The patient was due back for a follow-up 1 month after starting his BP medication 6 months ago, but he reports that he was too busy to come in. He states that he was having leg pain and swelling of his left calf after a long flight and took himself to ER for evaluation last week where he was diagnosed with DVT and was told to follow up with his PCP. He states that he is supposed to take Xarelto 15 mg twice a day for the next two weeks for the total of 3 weeks to treat the DVT. When the medication runs out, he was told that he should get a new prescription for Xarelto from his PCP. He is concerned about the SEs of the medication. He denies chest pain, shortness of breath, edema, change in eating habits or activity patterns, sputum production, postnasal drip, or runny nose.Case Study FI, NRP507 Adv Pharmacology.
Medical history: None reported.
Family history:Mr. Irving’s mother died at age 65 from a stroke, HTN, DM. His father died at age 55 from a heart attack. Mr. Irving’s two brothers are living in good health, although one has high cholesterol.
Medications:Lisinopril 10 mg qd started 6 months ago; Xarelto 15mg twice a day started 7 days ago.
Social history:He is a divorced father of one,and he teaches sixth grade.Patient does not smoke or drink.
Physical examination:This is a w/n, w/d African American male with good eye contact, appropriate speech and mannerisms, appropriately dressed and who states he wants to be seen for control of his blood pressure. His left calf is still swollen and mildly tender but no warmth or pain noted. He does not have any other noticeable rash or excessive dryness of his skin.
Vital signs: Ht 6 ft, Wt 265 lb, BP 148/110, P80 & regular
Abbreviated exam: Chest CTA, cardiac NSR without murmurs, abd soft, nontender, liver nonpalpable, nontender, no peripheral edema noted.
Case Study FI, NRP507 Adv Pharmacology.
Free T4: 1.2 (0.8–1.7)
Free T3: 3 (2.0–4.8)
Creatinine: 2.1 (0.8–1.4)
BUN: 22 (7–20)
CMP is otherwise normal.
CBC is normal.
Total cholesterol: 228
Radiology:No tests were performed.
Based on the information provided above, complete the patient’s write-up by giving your diagnosis, justifying your diagnosis with a full written assessment, and delineating your treatment plan.
Write a 1,400-word assessment and treatment plan for Mr. Irving.
Discuss the following in your assessment and treatment plan:
Include a minimum of 5 peer-reviewed, evidence-based articles referenced and formatted according to APA guidelines.
Fill out the blank prescription form below to complete the activity.
Review Figure 10-1 Common Components of a Prescription in Ch. 10 of Pharmacology for the Primary Care Provider (4th ed.)to use as a guideline for filling out the prescription.
SubmitFredrick Irving’s assessment and treatment plan and his written prescription(s).
Week 6 Assignment Instructions for Fredrick Irving Case Study
NRP/507: Advanced Pharmacology
Case Study OutlineGuideExample For Assignment
According to …classic symptoms of COPD include dyspnea, cough, and sputum production as a result of airflow limitation secondary to airway narrowing and/or alveolar destruction…S/S of allergic rhinitis ….Additional diagnostic testing for COPD would include….. What research study presents regarding the additional testing…
– present the standards of care and assessment within scope
– justify differential diagnosis and treatment associated to the condition chosen
– acceptable plan of care with proper follow up with the patient
-right medications using literature and guidelines to justify the choice
-studies related to socioeconomic status, lifestyle, health, race, ethnicity that influence the certain condition
-factors associated with the disease
-drug interactions, vits, supplements
-Teachings and education
-follow up with patient (to increase done? To keep the same doe or decrease?) S/E and Adverse reactions
– Referrals (pulmonologist or allergists)Case Study FI, NRP507 Adv Pharmacology.