Learning Objectives. Pharmacological Pearls for Students A Patient-Centered Approach. The Take-Home Message: 9/9/2011. Brian Tessier, MSHS, PA-C

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1 Pharmacological Pearls for Students A Patient-Centered Approach Brian Tessier, MSHS, PA-C Assistant Professor Department of Physician Assistant Education College of Allied Health Professions Western University of Health Sciences Learning Objectives At the end of this presentation, students should be able to: Recognize commonly used pharmacologic agents for conditions frequently seen in the primary care setting. Make a reasonable first choice of an agent for a presenting condition based on a number of factors. Have a reasonable second choice in the event of allergy or other contraindications for the first choice. The Take-Home Message: Current Medications/Conditions Age Pregnancy / breastfeeding status Allergies Patient Attributes/Attitudes Compliance issues Rachel, 25y/o female C/O ST, Bilat Ear pain, Productive Cough, and Fever X 3 days. Current Meds: Multi-vitamin Age: young adult Not Pregnant, but breastfeeding a 6 m/o Non-smoker / non-drinker Doesn t like to take pills Image: Michal Marcol / 1

2 Tonsillitis, OM, Bronchitis/PNA PCN, Cephalosporin, Macrolide Sulfa, Tetracycline, Quinolone Multivitamin; young; + breastfeeding; NKDA Doesn t like to take pills Tom, 52y/o male C/O 5 days of low back pain after lifting 50 lb bag of dog food. Current Meds: Metformin, Lisinopril, Atorvastatin, Omeprazole, Albuterol inh (prn) Age: Middle-aged adult Allergies: Sulfa Drinks ~2 glasses of red wine/evening Compliant with above Rx regimen Image: Ambro / Lumbar strain/sprain (R/O Red Flags) NSAIDS Opiods, Muscle relaxants, PT, Chiropractic DM, HTN, Chol, Asthma, PUD; Middle aged; Sulfa allergy Drinks alcohol Compliant with Rxs Doris, 80y/o female BIB daughter for 7 days of Cough, SOB, & Anorexia. Image: graur razvan ionut / Current Meds: Donepezil, Memantine, Lisinopril, Age: Elderly, postmenopausal woman Allergies: Tetanus Minimally verbal. Hx mostly from daughter, with whom patient lives. Daughter works outside the home. 2

3 Bronchitis/PNA (including aspiration); CHF PCN, Cephalosporin, Macrolide, Quinolone Diuretic (if evidence of CHF) Dementia; HTN; Elderly What do you know so far? Allen, 40y/o male C/O increased stress at work. BP is 152/94 today. You note elevated BP on past visits. Current Meds: Multi-vitamin Age: young-middle aged adult Image: Andy Newson / Non-smoker / non-drinker. Drinks 3 energy drinks/day. No known fam Hx cardiac disease Insurance=High deductible PPO Stress reaction; Primary HTN Lifestyle modifications Anxiolytics; Antihypertensives Stressful job, young-middle aged, Af. Am. Active, otherwise healthy Why is his insurance of any concern? 3

4 Christopher, 4y/o male C/O N/V/D and fever for 3 days. Current Meds: Pulmicort, Albuterol prn Age: Child Attends preschool Child puts up a fight when given PO meds Image: Arvind Balaraman / AGE (viral vs. bacterial), Strep throat BRAT(Y) diet; Hydration Antidiarrheals: Loperamide, Lomotil, Pepto Antibiotics: ~3 days of TMP/SMX Asthma; Child; NKDA Preschool any other children with same Sxs? Fights PO meds Liz, 34y/o female C/O headache for 2 days. One episode vomiting today. Current Meds: Paroxetine, Lamotrigine, Ibuprofen Age: Young-middle age Pregnancy: Denies (using IUD) Image: Jeroen van Oostrom / Drove self. Migraines ~3x/yr. Non-smoker/drinker home mom of 3 kids < 10y/o. Headache: Migraine vs. Tension vs. Other Injection of Ketorolac with/ w/o antiemetic Injectable triptan / opiod Send home with narcotic pain med Bipolar disorder; Youngish; Not PG; NKDA Drove self. Needs to care for 3 young children 4

5 Remember CAPA, PA-C References Ernst, D., & Lee, A. (2011). Physician assistant prescribing reference, 18 (1), (Spring, 2011). New York: Prescribing Reference LLC. CAPA Current Meds/Conditions Interactions & Contraind. Age Pregnancy / breastfeeding Allergies PA-C Patient Attributes/Attitudes Compliance issues Gilbert, D. N., Moellering Jr., R. C., Eliopoulus, G. M., & Saag, M. S. (2011). The Sanford guide to antimicrobial therapy (41 st ed.). Sperryville, VA: Antimicrobial Therapy, Inc. Hamilton, R. J. (2011). Tarascon pocket pharmacopoeia. Sudbury, MA: Jones & Bartlett Learning, LLC. Harvey, R. A., Clark, M. A., Finkel, R., Rey, J. A., & Whalen, K. (2012). Lippincott s illustrated reviews: Pharmacology (5 th ed.). Baltimore, MD: Lippincott Williams & Wilkins. McPhee, S. J., & Papadakis, M. A. (2011). Current medical diagnosis and treatment (50 th ed.). New York: McGraw Hill Medical. Rang, H. P., Dale, M. M., Ritter, J. M., Flower, R. J., & Henderson, G. (2012). Rang and Dale s pharmacology (7 th ed.). Edinburgh: Elsevier Churchill Livingstone. Stern, S. D. C., Cifu, A. S., & Altkorn, D. (2010). Symptom to diagnosis: An evidence-based guide (2 nd ed.). New York: McGraw Hill Medical. Questions 5