to each question, while using scholarly articles and the required text: Woo, T. M.

Respond to the following case study: Jack is a 54-year-old patient who has difficulty coming in for primary care visits. He sees cardiology, pulmonary clinic, and endocrine clinic for his comorbid conditions of diabetes mellitus, post–coronary artery bypass grafting (CABG) 2 years ago, and mild chronic obstructive pulmonary disease issues from a 30 year pack history of smoking. His last visit with you was over a year ago. Today, your registered nurse brings you a telephone triage call requesting a refill of his rosuvastatin (Crestor) prescription, which was ordered by cardiology soon after his CABG. Per the electronic links to the cardiology service within your facility, the medication was due to be renewed about 2 months ago. His last lipid labs were a year ago and his last complete metabolic panel (CMP) was done at the same time. He was recently at the pulmonary clinic and his last recorded HgA1C was 9.0 from a visit to endocrine 4 months ago. Review of records include a prescription for his hypertension (Lisinopril 20 mg daily), metformin 1,000 mg twice a day for his diabetes, and no known medications for his pulmonary issues. The Crestor prescription appears to have multiple dosing levels over the past few refills. His last vital signs were blood pressure 170/110 mm Hg, pulse 88, and respirations 22. His body mass index is 30 and he indicates a pain level of 4 out of 10. His pulse oximetry was 92% on room air. 1. What additional information (e.g., clinical findings, laboratory test results) will confirm the diagnosis? (Note: the focus is on pharmacotherapy and the diagnosis is HTN) 2. What are your differential diagnoses for this patient? 3. For infectious diseases: what are the suspected pathogens for this type of infection in this patient? 4. What is(are) the desired treatment outcome(s)? 5. What non-pharmacological therapy would you recommend? 6. How would your pharmacotherapeutic plan differ, based on special population patients (such as children, obstetrics, geriatrics, etc)? 7. What pharmacotherapeutic plan (include prescription and non-prescription drugs) would you design for this patient? Rationale for pharmacotherapy to include mechanism(s) of action list drug(s), dose, route of administration, frequency, duration of treatment and one monitoring parameter. 8. What are the clinically significant adverse effects and drug interactions for the agents discussed? 9. How will you monitor the patient’s response to therapy? 10. How will you counsel your patient about the pharmacotherapeutic plan?

 

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