4
Patient Care Pharmacist Care Plan
Date: January 7, 2014
Submitted to:
Reeva Ann Sumulong, MS PHARM, R.Ph.
Submitted by:
Laxamana, Ma. Cristina D.
Section: Pharma 4B
Patient name: FMS
Address: Makati City
Telephone: 531-8502
Insurance: AAS insurance
Medical condition: Osteoarthritis left knee
Tobacco/Alcohol/Substance use: Occassional cigar
3x/week; EtOH 3x/week: no caffeine
Gender: Female
Race: White
Actual Weight: 80kg
Ideal Weight: 75.3kg
Allergies: Penicillin Hives
Adverse reactions: Ibuprofen dyspepsia
Medication Record
Start Date
Stop Date
Indication
Drug Name
Strength
Osteoarthritis
Relafen
750mg
Actual
Regimen
2 tab po QD
HTN
HCTZ
25mg
1 tab po QD
5/17/14
HTN
Triamterene/
HCTZ
37.5/25mg
1 tab po QD
5/31/14
HTN
Atenolol
50mg
1 tab po QD
12/14/12
5/03/13
5/17/13
Clinical
Impression
Tolerating
well; min
knee pain
5/17/13: D/C
due to
hypokalemia
5/13/14: K
WNL; HTN
partially
improved
SOAP
Subjective
Knee pain
Objective
Osteoarthritis left knee
Race: White
Actual Weight: 80kg VS Ideal Weight: 75.3kg (OVERWEIGHT)
Allergies: Penicillin Hives
Assessment
Drug interactions to drug interactions with its medications
Complications with Drugs
Osteoarthritis
Hypertensive
Plan
Health care Need
Drug-drug
interactions with
medications
Pharmacotherapeutic Goal
Eliminate all possible drug-drug
interactions
Recommendation
Monitoring
Parameters
Monitor K serum
level
Complications with
drugs
Nabumetone + Atenolol:
Nabumetone decreases the effects of atenolol by
pharmacodynamics antagonism and also both drug
increase serum K
(ineffective anti-HTN drug; Hyperkalemia)
Discontinue use of Triamterene:
Monitor K serum
level
Eye examination
Osteoarthritis
Hypertension
Date
06/7/14
06/7/14
Normalize patient BP
Medical
Condition
HTN
Osteoarthritis
Drug Therapy
Problem
Ineffective drug
therapy due to drugdrug interactions
Troponins,
Myogloblin
Pain: N/A
Monitor Calcium
Levels
Monitor blood
pressure and
electrolytes level
specially serum K
level
Calcium supplementation
Continue Atenolol and HCTZ
Goal
Normalize BP and
eliminate all
possible drug-drug
interactions
Eliminate pain by
pharmacologic or
non-pharmacologic
therapy
Ca
supplementation
Current
Status
Untreated
Tolerating
well; min
knee pain
Interventions
Discontinue: usage of
nabumetone and
triamterene
Continue Atenolol and
HCTZ
To consider other drug
therapy or nonpharmacologic
therapy
Advise patient of
proper diet and
exercise
Follow-up Plan
After 1 week
check BP and
serum K level
After 1 week
assess patient if
condition had
improved and
assess if there are
other concerns
regarding health
B. Questions
1. What is the importance of formulating a complete and efficient pharmacist care plan?
Pharmacy Practice has changed significantly over recent years and continues to evolve toward the provision of pharmaceutical care.
Pharmaceutical care required the effective use of care plans and documentation. "Maintaining adequate records of drug therapy to
facilitate the prevention, identification and management of drug related problems or concerns. These records should contain, but are
not limited to, each patient's current and past drug therapy (including both prescribed and selected over-the counter drugs), drug
allergy history, appropriate demographic data and if known the purpose of therapy and progress toward treatment goals, adverse
reactions to therapy, the patient's history of adherence to treatment, attitudes toward drugs, smoking history, occupational exposure or
risk, and known patterns of alcohol or substance use that may influence his or her response to drugs. Records should also document
patient counseling and advice given, when appropriate."
2. What are examples of drug therapy problems that are needed to be resolved or prevented?
I. INDICATION
Unnecessary Medication
The patient had failed attempts at lifestyle
changes(e.g., exercise, diet, smoking), so a medication
regimen is easier to follow for the patient. As the
patient states, Its just easier to take the pill. It works
great!
II. EFFECTIVENESS
Needs Synergistic Drug Therapy
The patient feels like she is already treating her
breathing problem. She does not understand why she
should take additional medications to treat the same
condition.
Agree that lifestyle changes are important and offer to work with her on
those changes. Share additional benefits of those changes.
Explain basic pathophysiology on why lifestyle changes may not be as
effective as we would hope.
Involve the patient in shared decision - weigh risks/benefits.
III. SAFETY
Dosage Too High
The patient skips the first dose of the medication and
doubles the second in order to simplify his regimen.
IV. COMPLIANCE
Patient Forgets to Take Medications
The patient has 4 children, and often cares for her sick
mother. She maintains the household and gets her kids
to various activities. Each day is different, routines,
and mealtimes vary. Medications are not a priority in
patients life.
Help patient to identify things that she does each day at roughly the same
time: brush her teeth, drink coffee, bedtime routines.
State reasons why taking the medication or improving her health will help
her feel better in the short term, become better able to handle stresses
associated with current situations.
Help the patient with some objective measures, home monitoring to allow
her to see the numbers. Either blood pressure monitoring or home glucose
monitoring can help. Give her a short time frame (2-4 weeks) if possible.
Talk about her health goals, let her do the monitoring and realize that the
numbers are above goal.
Educate about the preventive nature of the medication. Agree that she
may or may not feel any different without the medication. Explain her
increased risk without the medication.
Explain how medication can complement each other to provide even
better outcomes or risk reduction.
Involve the patient in shared decision making to weigh risks and benefits
of the preventive drug therapy.
If cost is a barrier, consider a less-expensive alternative if possible.
Reference:
Leendertse et al. BMC Health Services Research 2011 11:4 doi:10.1186/1472-6963-11-4
Shoemaker S., et al. Preventing and Resolving Drug Therapy Problems through Patients Medication Experience: Strategies
employed by MTM Pharmacists. MTM Fairview Pharmacist Services.
http://www.health.state.mn.us/asthma/documents/0511aasummitaphabrochure.pdf
Pharmacy Care Plans. National Association of Pharmacy RegulatoryAuthorities.
http://napra.ca/pages/Practice_Resources/pharmacy_care_plans.aspx?id=2165
Medscape Reference apple app- Nabumetone, HCTZ, Triamterene, Atenolol