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A case study of pharmacological aspects of patient care.
Typology: Assignments
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sodium excretion and clearance, and decrease glomerular filtration rate (Olsen et al., 1999). b. We are going to continue his furosemide; however, we will change the route to IV furosemide. The initial course of treatment recommended is a bolus dose up to 2. times the patient’s oral dose. As CM is taking 20mg at home we could do an initial dose of 50mg IV and then titrate to as needed to produce the therapeutic response necessary to stabilize CM (Lexicomp). We can titrate to effect by doubling dose until we reach diuresis that will reduce his fluid volume overload. This can be done at greater than or equal to Q2 hour intervals. Once our effective dose is identified we can reduce the frequency to once or twice a day depending on clinical course. c. Depending on his O2 saturation we should also begin him on oxygen therapy via nasal cannula again titrating to effect to reduce his work of breathing and to ease his shortness of breath. d. We could consider treatment with an IV vasodilator, like nitroglycerin or nitroprusside to reduce his afterload volume and relieve some of his symptoms. The recommended starting range for nitroprusside is 0.1 to 0.3 mcg/kg/minute, titrating every 5-15 minutes to reach desired effect. In a patient that weighs 80 kg the maximum dose recommended is 5mcg/kg/minute (Lexicomp).
Case Study Two: Part One SA is a 70 y/o female with a PMH significant for a previous myocardial infarction and HTN. She has been walking 10,000 + steps a day but is unable to drop her blood pressure. She presents to the doctor’s office with a BP 138/85. Home medications : atorvastatin 20mg daily, acetaminophen 500mg every 6 hours for headaches, Phenylephrine nasal spray for sinuses,