Patient Medication Profile
Analyze the following case:
D. M. is a sixty-nine-year-old black male patient who was admitted with the chief complaint of “dizziness and difficulty walking up stairs.”
History of present illness: Patient states that he has been feeling “weak and dizzy” for the last two weeks and has fallen four times during that period. He states that he did not lose consciousness but became lightheaded and lost strength before he had fallen down.
Past medical history:
• Diabetes mellitus type 2, noninsulin requiring X nine years
• Hypertension X twenty-two years
• Hyperlipidemia
• Cerebrovascular accident (CVA) in 1999
• Pneumonia in 2000
• Osteoarthritis of lumbosacral spine and hip
Past surgical history: None
Social and family history: Four to five beers per day, no other alcohol reported; no nicotine; retired salesman; wife deceased; four children alive and well in other states
Allergies: No known drug allergies
Current Medications:
• Glyburide 10 mg po qAM, 5 mg PM
• Metformin 1000 mg po qAM and pm
• Pravachol 40 mg po qhs
• Hctz 25 mg po qAM
• Atenolol 100 mg po qAM
• Naproxen 500 mg po bid
• ASA E.C.325 mg po qAM
New Medications:
• Ferrous sulfate 325 mg by mouth three times a day with food #90
Physical Examination:
• Pertinent positive findings only.
• Elderly male in no apparent distress.
• Temperature: 98.6 oF; Resp: 14; Pulse: 92; BP sitting: 164/96 78 mmHg; BP standing: 152/88 mmHg; Wt: 172#
Head, eyes, ears, nose, and throat (HEENT): Pale conjunctivae and gums
Resp: None
Cardiovascular: II/VI systolic ejection murmur
GI: Stool guaic—for occult blood
GU: Prostate enlarged to palpation
Neuro: Slow verbal response to questions
Extremities/Peripheral Vascular: 1+ pedal edema, capillary refill > 3 sec
ECG: RRR, tachycardic
Laboratory:
Tests Observed Values Normal Values
Sodium (Na) 139 mEq/L 136–142 mEq/L
Potassium (K) 3.8 mmol/L 3.5–5.5 mmol/L
Chloride (Cl) 105 mmol/L 101–111 mmol/L
Bicarbonate (CO2) 26 mmol/L 21–31 mmol/L
Blood urea nitrogen (BUN) 17 mg/dL 5–24 mg/dL
Glucose (Glu) 189 mg/dL 70–110 mg/dL
Creatinine 1 mg/dL 0.6–1.2 mg/dL
Magnesium (Mg) 1.4 mg/dL 1.4–1.8 mg/dL
Calcium (Ca) 9.6 mg/dL 8.6–10.4 mg/dL
Protein Total (Pro. T) 6.2 g/dL 6–9 g/dL
Albumin (Alb) 4.9 g/dL 3.5–5.5 g/dL
Alanine aminotransferase (ALT) 26 U/L 0–60 U/L
AST 22 U/L 0–60 U/L
Bilirubin direct (Billi D) 1.3 mg/dL 0–0.3 mg/dL
Bilirubin total (Bili T) 0.2 mg/dL 0.1–1.5 mg/dL
Coagulant response time (INR) 1.1 1
Total cholesterol 267 mg/dL < 200 mg/dL
Thyroid stimulating hormone (TSH) 12.3 mIU/L 2–5 mIU/L
White blood cells (WBC) 4.7 K/µL 4–10 K/µL
Hemoglobin (Hb) 7.2 g/dL Males: 14–17 g/dL
Females: 12–15 g/dL
Hematocrit (Hct) 24 percent Males: 40–54 percent
Females: 37–47 percent
Platelets (Plt) 238 K/µL 150–400 K/µL
Mean corpuscular volume (MCV) 79 fL 80–100 fL
Reticulocyte (Retics) 1.5 percent 0.3–2 percent
RDW 17 fL 11.5–14.5 fL
You decide to investigate further and recommend iron studies. They yield the following result:
Tests Observed Values Normal Values
Serum iron 19 µg/dL 45–182 µg/dL
Ferritin 12 µg/dL 22–322 µg/dL
TIBC 516 µg/dL 250–420 µg/dL