History of Present Illness:
Mr. Brown is a 51 year old male with hypertension, coronary artery disease, Type 2 diabetes mellitus, and paroxysmal atrial fibrillation. He presents today for his 3-month follow-up asking for a flu shot and complaining of heartburn for which he has been taking cimetidine. He denies dizziness, chest discomfort, shortness of breath, dysnea on exertion, abdominal discomfort or other symptoms. He has no known allergies.
Simvastatin, 40 milligrams, PO, daily
Lisinopril, 40 milligrams, PO, daily.
Byetta 10 mcg SQ BID before meals
Warfarin, 5 milligrams PO daily
Cimetidine, 400 milligrams PO daily
Alert, pleasant male NAD. Hgt. 5’ 9”, Wgt. 184 lbs, 144/82, 68, 20. Exam WNL.
Briefly discuss the pathophysiology of paroxysmal atrial fibrillation and heartburn, and the physiology of influenza viruses. Be sure to discuss the aspects that are relevant to the pharmacodynamics of the drug used to treat each condition.
Explain the pharmacodynamics of each medication. Be thorough and specific.
Explain the pharmacokinetics of each medication. Be thorough and specific.
Discuss possible adverse effects of these drugs and relevant drug-drug interactions for this patient that require monitoring. Pay particular attention to those adverse effects for which the patient is at increased risk, and to those adverse effects that are potentially serious.
5. Discuss prescriber considerations, appropriate lab tests that should be assessed and relevant patient education for this patient. Explain rationales for your answers.