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Please fill out questions after reading case study. CASE STUDY Seventy-five-year-old Esther is an active grandmother who loves travelling, hiking, and spending time with her grandchildren. Her past medical history includes osteoarthritis, atrial fibrillation, and GERD. While hiking with her senior outing group, she suffered a terrible fall. An emergency squad brought her to the emergency department at OSUWMC, where it was determined she fractured her hip. Esther will require surgery so she has been admitted to the hospital. After she is transported up to the 10th floor orthopedic unit, a nurse practitioner arrives to examine her and to and determine the admission orders (prescriptions and care instructions) for Esther. The orthopedic surgeon will visit and examine Esther later this afternoon after completing his surgeries for the day. Esther’s current medications are as follows: Current Prescriptions: Warfarin Sodium (Coumadin) 5mg once daily Metoprolol Tartrate (Lopressor) 25 mg twice daily Esomeprazole Magnesium (Nexium) 40 mg capsules once daily Current Over-the-Counter Medications: Analgesic (pain medicine): Acetaminophen (Tylenol) 325 mg as needed Nutritional supplement for depression: St. John’s Wort 450mg tablets once daily Answer the questions below regarding Esther’s current prescriptions. Provide an appropriate medical/pharmacy reference for each answer (provide the website name and URL, or provide the reference in AMA or APA format; Wikipedia is not an acceptable source of information). Some suggested references to search (you are not limited to these sources): The FDA provides a list of reliable websites at: U.S. Food and Drug Administration https://www.fda.gov/drugs/resourcesforyou/consumers/. The first three resources (Medication Guides, MedlinePlus: Drugs (NIH), and DailyMed (NIH)) may be the most helpful to you. Drug costs may be found at GoodRx https://www.goodrx.com. You may use other references as well. You may learn more about medical diseases and conditions at: The Mayo Clinic website https://www.mayoclinic.org/diseases-conditions, The Cleveland Clinic website https://my.clevelandclinic.org/health/diseases, Why is Esther taking warfarin? Answer: Reference: What is the laboratory marker used for monitoring warfarin therapy and what is the goal range of this marker for Esther? (A laboratory marker a blood test, urine test, tumor biopsy, etc. that is sent to a laboratory to measure something (i.e., a marker) that would indicate a disease (e.g., the flu) or a condition (e.g., low blood sugar) in an organism (e.g., a human). Answer: Reference: Provide 5 counseling points (i.e., advice) to Esther regarding her warfarin. Reference: How often would you want laboratory tests to ensure Esther is within the goal therapeutic range of warfarin? Answer: Reference: What are other therapeutic (drug) options to use in place of warfarin? Are they more or less expensive? Aspirin is not an option for this patient. Answer: Reference: Do Esther’s current OTC medications make you concerned about using warfarin? If so, why? Answer: Reference: Provide ten considerations the prescriber makes in deciding which medications and dosages to prescribe for this patient. Explain why each is a consideration. There are many possible answers! Reference(s):
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