NR 508 Week 7 Discussions 1 (Part One) Recent

discussion part one

adam is an active, healthy 5’10” 34 year-old man weighing 145 pounds. he presents to your clinic with complaints of wheezing, dyspnea, cough, and sputum production, especially when running. he informs you that he is an avid marathon runner competing in one to two 5 or 10k runs per month. he tells you that he is symptomatic more than 2 times per week, but less that 1 times per day, and nighttime symptoms hardly ever occur. he also adds that his symptoms can get worse after and sometimes during his runs, especially when the outside temperature drops below 50°f.

please provide a list of differential diagnoses, as well as indication of your primary diagnosis.
what is your pharmacological plan for your primary diagnosis including the medication, dose, and mechanism of action?

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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?