Jack is a 54-year-old patient who has difficulty coming in for primary care visits. He sees cardiology, pulmonary clinic, and

Chapter 13: Drugs Affecting the Cardiovascular and Renal Systems Instructor 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, postcoronary artery bypass grafting (CABG) 2 years ago, and mild chronic obstructive pulmonary disease issues from a 30-pack year 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 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 (BP) 170/110 mm Hg, pulse 88, and respirations

22. His body mass index is 30 and he indicates a pain level of four out of five. His pulse oximetry was 92% on room air.

1. How do you respond to this telephonic request?

( Woo Pharmacotherapeutics 5e ) ( Page 1 of 3 Ch13 Instructor CS )

2. What steps are required to get Jack’s therapeutic plan under control?

3. What is the role of the primary care provider (PCP) in this scenario?

needs to include the results of the labs you will order and any alterations in medication triggered by those results. Attempt to get all medications on a common refill schedule. At first this will require some shorter and/or longer supply dates. A plan to coordinate all the many visits made with the patient and any care givers is important to include. Calling the specialist offices to get a schedule of return to clinic (RTC) visits would be a start. A pointed conversation is also needed as to whether the patient is in a situation that is becoming more difficult to meet his needs. Does he need to consider moving to assisted care, having in-home help, or requesting more family support?

Major themes to discuss with the class:

a. Continuity of care and timing of visits

b. Dealing with telephonic requests

c. Outline specific considerations and their priority for each of the specialists.

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