final questions

Question 1

what are the possible diagnosis? 
Linezolid 600 mg IV now, then q12 hours x 14 days
Bisoprolol 7.5mg po daily
Nifedipine 60mg po daily
Ramipril 10mg po daily
Insulin glargine (Lantus) 30 units subcutaneous (sc) at HS
Insulin lispo (HumaLOG) 3 units subcutaneous (sc) with breakfast, lunch, and dinner
Albuterol 2.5mg/3mL (0.083%) nebulizer solution 2.5mg q 4-6h
Budesonide 0.125mg 2x/day per nebulizer
Paroxetine 20 mg orally at HS
Ibuprophen 400mg po BID
Celecoxib 100mg po daily
Ducosate 1 cap at HS
Cholecalciferol 3000 IU po daily
Folic Acid 1mg po daily
Ascorbic acid 1000mg po daily

Answer 1

What are the possible diagnoses for this patient based on her medication?
Her open red area is likely infected – Linezolid is an antibiotic (Dx 1: Infection)
Prinzmetal’s angina or HTN – Nifedipine (dec smooth muscle contractility), Ramipril, bisoprolol
Diabetic (type 1 or 2) – Insulin (lantus and HumaLOG)
Depression or anxiety – Paroxetine is an SSRI (for depression, anxiety, OCD, PTSD)
COPD – budesonide is an inhaled corticosteroid (dec inflm in airways) & Albuterol is a bronchoD to relax smooth muscle in airways
Some form of inflammatory problem/pain somewhere – taking Ibuprofen and celecoxib (both anti-inflm’s)
Docusate to keep her bowels regular on the daily - constipation
Vitamin D deficiency – taking vitamin D supplement
Folic acid deficiency – or just a preventative measure – helps produce and maintain new cells
Ascorbic acid (aka vitamin C) – it’s healthy 😊

Question 2

Because Mrs. Xander is 78 years old, what special concerns would you have for her regarding her medication?

Answer 2

Drug-drug interactions with all the medications she is taking (not to do with age but still a concern)
Liver degeneration with age à dec enzyme prod and dec blood flow à dec drug metabolism
Drugs distributed by blood are carried by proteins, specifically albumin.
Due to dec liver fx, dec protein intake, and poor GI absorption, protein-binding sites are reduced and drugs aren’t distributed as well, leaving higher levels of unbound drugs in the blood (that are active) (effects of highly protein bound drugs may be enhanced)
Kidney degeneration à dec blood flow, dec fx, dec GFR à dec drug excretion
GI - inc pH (alters absorption).
GI - dec peristalsis à dec gastric emptying