Texts: Brian is a 61-year-old man who presents to his primary care physician's office for an annual check-up.
Past medical history: HTN, Lupus
Social history: Current smoker for 20 years (1/2 PPD); he has been trying to quit. Drinks beer usually on weekends.
Allergies: statins
Home medications: Prednisone 5 mg by mouth daily, metoprolol 25 mg ER once a day
Vital signs:
BP: 122/45, HR: 65, RR: 18, Temp: 37.1°C, O2 sat: 97% RA
Ht: 65 in, Wt: 125 kg, BMI: 30.1 kg/m2
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%
WBC: 5.0 x 103/mm3, Plt: 268 x 103/mm3, Hgb: 13 g/dL, Hct: 44%
PT: 12.5 sec, aPTT: 32.4 sec, INR: 1.0
Fasting Lipids:
Trig: 183 mg/dL, LDL: 165 mg/dL, HDL: 41 mg/dL
Questions:
1. What non-pharmacological recommendations would you recommend for Brian?
2. What pharmacologic therapy, if any, would you recommend for Brian and why? Which counseling points would be pertinent for the medication(s)?
3. Are you concerned about any drug interactions with adding the new pharmacotherapy?
4. What monitoring plan would you recommend for Brian's pharmacotherapy?