Text 1:
Daniel is a 13-year-old male who presents to his primary care physician's office for a sick visit. His asthma symptoms are worsening, and the physician inquires for your help with his asthma management. Daniel notes he has started to experience daily symptoms with worsening at nighttime and when waking. He has gone through an albuterol inhaler in one week. He is deemed as having "moderate persistent" symptoms.
Past medical history: Asthma
Social history: None
Allergies: None
Home medications: Albuterol HFA 2 puffs PRN in anticipation of exercise
Vital signs:
BP 122/45, HR 98, RR 18, Temp 37.1°C, O2 sat 97% RA
Pertinent labs:
Na 137 mEq/L
K 4.1 mEq/L
Cl 102 mEq/L
CO2 28 mEq/L
BUN 15 mg/dL
SCr 1.0 mg/dL
Glucose 98 mg/dL
Mg 2.0 mEq/L
Ca 9.3 mg/dL
Phos 2.4 mg/dL
AST 22 IU/L
ALT 30 IU/L
HgbA1c 7.6%
Text 2:
Ruby is a 24-year-old female who presents to the hospital in acute respiratory failure due to a presumed asthma exacerbation. The ER physician asks for your help with pharmacotherapy recommendations.
Past medical history: Asthma
Social history: None
Allergies: None
Home medications: Advair 500/50 1 puff BID
Vital signs:
BP 89/65, HR 145, RR 35, Temp 37.1°C, O2 sat 86% on 40L high flow
Pertinent labs:
Na 133 mEq/L
K 3.4 mEq/L
Cl 95 mEq/L
CO2 35 mEq/L
BUN 15 mg/dL
SCr 1.0 mg/dL
Glucose 110 mg/dL
Mg 1.7 mEq/L
Ca 9.3 mg/dL
AST 22 IU/L
ALT 30 IU/L
Questions for Text 1:
1) What non-pharmacological recommendations would you recommend for Daniel?
2) What pharmacologic therapy, if any, would you recommend for Daniel and why?
3) Which counseling points would be pertinent for the medication(s)/how would you demonstrate how to appropriately use the inhaler?
4) Are you concerned about any drug interactions with adding the new pharmacotherapy?
5) What monitoring plan would you recommend for Daniel's pharmacotherapy?
Question for Text 2:
1) What non-pharmacological recommendations would you recommend for Ruby?
2) What pharmacologic therapy, if any, would you recommend for Ruby and why?
3) Are you concerned about any drug interactions with adding the new pharmacotherapy?
4) What monitoring plan would you recommend for Ruby's pharmacotherapy?
5) Ruby is transferred out of the ICU to a medical floor after treating her exacerbation. The team is inquiring if there is other pharmacotherapy that can help control Ruby's asthma symptoms. Discuss additional pharmacotherapy options for Ruby.