Pharmaceutical Care Plans for Case Analyses
Case 1: Mr. Jude Santos (75 y/o male)
Medication-Related Problems:
- Polypharmacy and potential drug-drug interactions (warfarin + ibuprofen
→ increased bleeding risk).
- Potential digoxin toxicity (elderly, polypharmacy, symptoms of
fatigue/dizziness).
- Uncontrolled arthritis pain management (NSAID use risky with warfarin,
HF, and CKD risk).
- Potential adverse effects from multiple antihypertensives
(hypotension/dizziness).
Desired Outcomes:
- Prevent bleeding complications.
- Maintain therapeutic digoxin levels within safe range (0.5–0.9 ng/mL).
- Achieve safe pain control without exacerbating comorbidities.
- Maintain stable BP and HR within target.
Pharmacist Interventions:
- Discontinue ibuprofen; suggest acetaminophen or topical analgesics.
- Request digoxin level monitoring, adjust if necessary.
- Review antihypertensive regimen for duplication and dizziness causes.
- Counsel on medication adherence and fall risk prevention.
Recommendations:
Coordinate with cardiologist to reassess digoxin and warfarin therapy.
Replace ibuprofen with safer alternatives. Monitor INR closely.
Case 2: Mr. Rey Alonzo (70 y/o male)
Medication-Related Problems:
- Metformin use in CKD (eGFR 35 mL/min/1.73 m2 → risk of lactic acidosis).
- Ramipril contributing to renal impairment.
- Baclofen accumulation risk in renal impairment causing grogginess.
