NR 508 Week 3 Discussions 1 (Part Three) Recent

discussion part three

he returns a month later complaining of increased fatigue, visual disturbances, weakness, and nausea; however, his ecg is normal.

based on this information, what is occurring in this patient? include precise mechanism(s) of how it is occurring.

additionally, please include any drug interactions associated with any new medications initiated keeping in mind the current regimen.

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discussion part one

barbara is a married 39-year-old woman with no children, smokes 1 pack/day, and weighs 180 pounds who has scheduled an appointment with you to discuss feelings of anhedonia that she has been experiencing for the past few months. she has a history of depression as a teenager, but has not needed or received therapy for ~20 years. at the appointment, she relays that she has been experiencing chronic fatigue/loss of energy, feelings of worthlessness, appetite disturbances, weight gain, inability to concentrate, psychomotor disturbances, and insomnia.

please provide a list of differential diagnoses, as well as an indication of your primary diagnosis.
once this has been completed, please indicate and describe your chosen pharmacological treatment with inclusion of dose and mechanism of action of your chosen prescription.

discussion part one

elliot is a 74 year-old male who presents to your clinic with complaints of frequent nosebleeds (4 in the past week) and several severe bruises scattered variously throughout his anatomy. the patient is also complaining of a runny nose, cough, and head/chest congestion. he has a history of chronic atrial fibrillation and is currently prescribed and taking warfarin. approximately 3 weeks previously, he started taking over-the-counter cimetidine for heartburn he was experiencing. below is a list of the patient’s medications, his physical examination, and his laboratory findings:

medications

digoxin 0.25 mg qd cimetidine otc bid

pseudoephedrine sr 120 bid warfarin 7 mg qd

allergies: nkda

physical examination

vs: bp: 180/95, hr 75, irregularly irregular, rr 17

weight: 95 kg

heent: wnl

abd: + bowel sounds ext: bruising on arms and legs

neuro: alert & oriented x 3 gen: well developed, well-nourished male

ecg: atrial fibrillation

laboratory

na 143 meq/l k 4.5 meq/l

cl 99 mmol/l co2 25 meq/l

bun 18 mg/dl scr 0.9 mg/dl

inr 4.8 hct 42%

hbg 15 mg/dl digoxin 3.8 ng/ml

what problems should be identified in this patient?

what are the precise mechanisms of action of each drug?

what do you think is contributing to the patient’s hypertension?

are there any drug interactions that you can identify as associated with this current drug regimen, and if so how, mechanistically, are they occurring?

what is the clinical significance of these interactions?