Assignment
Margarita Voulos is a 68-year-old woman who has recently complained of continuous breathlessness to her GP, despite taking her inhalers. Margarita was first diagnosed with asthma when she was 11. Her regular medications include inhaled Beclometasone dipropionate 100mcg 2 puffs BD via a metered dose inhaler (MDI) and salbutamol prn.
Mrs Voulos has been referred by her GP to a specialist respiratory service for assessment and management of her continuous breathlessness. The patient referral also states that she has never smoked but previously worked in a pub and lived with a husband who was a heavy smoker. Margarita finds it increasingly difficult to do her daily activities and can only manage to walk short distances outdoors, after shopping for groceries she finds she is breathless and exhausted.
When taking a history from Margarita she tells you that she is not sure if she has any allergies and that she has not been using her spacer device because she is unsure how to use it and has always used her MDI without any issue and that her symptoms are worse at night. Margarita was diagnosed with atrial fibrillation one month ago and commenced on metoprolol and aspirin.
• Past medical history:
1) Hypertension,
2) Asthma,
3) High cholesterol and
4) Atrial Fibrillation
• Medication hx:
1) Beclometasonedipropionate 100mcg MDI 2 puffs BD
2) Salbutamol100mcg MDI prn
3) Simvastatin20mg nocte
4) Metoprolol25mg BD
5) Aspirin 100mg daily
• The following investigations were carried out:
1) Chest X-ray - showed bilateral hyperinflation
2) Arterial blood gases - PH 7.37, PCO2 4.8 kpa, PaO2 11kpa, SaO2 99%, HCO3 23, BE -2
3) Blood test - CRP 3mg/l, Na+ 138mmol/l, K+ 4.2mmol/l, Hb 12.5g/dL, BNP 30pg/ml, WCC 7 x 109/l, INR 0.9, Troponin 10
4) No chest pain, ECG shows Atrial Fibrillation
5) Pulse oximetry - SpO2 96% HR 92 b/min
6) Spirometry - result showed FEV1 40% predicted, FEV1/FVC ratio 45%, with the usual concave shape of the flow volume curve
7) MRC 4Frequency of exacerbation: 3-4 in 12 months.
Task: Medications
Choose at least two medications that your patient has been prescribed and discuss the following:
• How does the medication work?
• Why has your patient been prescribed this medication?
• Discuss any side effects that could affect the patient.