Bob Barkley is a 92 y.o. Caucasian male with PMH of HTN, diastolic heart failure, Type 2 Diabetes, Constipation, Hypothyroidism, asthma, chronic kidney
disease (CKD) IV, benign prostatic hypertrophy with urinary retention, hyperlipidemia, insomnia, eczema, and depression.
He is widowed and lives on his own, with minimal assistance from adult children who live next door.
In the past year, he has hospitalized for a UTI and once for a broken hip requiring surgical repair.
VS: T 98.4, HR 94, BP 129/76. SpO2 94%. His weight is 176lbs. Height = 64 inches.
Lab values are:
Complete Blood Count: WBC 7.6, Hgb 13.5, HCT 42, Plt 290,
Comprehensive Metabolic Profile: Na 141, K 4.0, Cl 95, CO2 31, UN 30, Cr 1.8, Glu 101, Ca 8.4, TP 6.4, Alb 4.0, AST 22, AP 44, ALT 16, Tbili 0.5, Mg 1.3, GFR
(calculated) 25ml/minute
Lipid panel: Chol 164, TG 148, LDL 66, HDL 48,
TSH: 2 Hemoglobin A1C: 6%
He denies sore throat, fevers, chills, chest pain, dizziness, nausea, dysuria or fatigue.
Your exam shows:
General: A&O x 3, appears comfortable.
Resp: respirations slightly labored. Lungs have expiratory wheezes bilateral that clears with cough
CV: no jugular venous distention, S1S2 regular.
Abd- soft, NT, ND, +BS x 4.
Ext- trace edema.
Skin: eczematic patches flexure surfaces of elbows.
He is concerned about the number of medications he takes and about his ability to afford them. He can afford $70 dollars per month. His prescriiptions are
filled at Walmart Pharmacy, as they have a discount program. (See the price list in BB). Any other meds (whether OTC or Rx) cost copays $10. RXs may only
be written for 30-day supply, with refills as appropriate
** No medication substitutions allowed. You may order a combo tablet when available to save money**
This is a list of his medications:
Docusate sodium (colace)
Lisinopril (Zestril)
Metoprolol
Budesonide / Formoterol (Symbicort)
Furosemide (Lasix)
Aspirin
Tiotropium (Spiriva)
Albuterol
Alendronate (Fosamax)
Tamsulosin (Flomax)
Calcium/ Vitamin D3
Hydrocortisone topical
Fluoxetine
Atorvastatin
Metformin
Levothyroxine
Diphenhydramine
20 points: Review his listed medications. Given his chronic conditions, kidney function, age/ Beer’s criteria, and cost, choose the meds that you are going to
renew. Remember, he cannot afford more than $70 per month.
Provide rationale for keeping the meds you are prescribing.
Provide rationale for why you decided to discontinue other meds.
Medication to Rx Rationale Medication to stop Rationale
