Case Synopses
 

Case #12 (RMMR)

 This RMMR is of an unfortunate diabetic man who is a resident of a nursing home. He has significant diabetic complications with retinopathy, nephropathy and foot ulcers and neuropathic pain.

  • How important is diabetic control in this setting?
  • He's already on Lyrica, what more can we do for his pain relief?
  • He has anaemia, is this playing a part?
  • Which of his drugs should be reduced because of his renal dysfunction?
Review these and other issues with Peter Tenni, then see the report that was submitted to the Doctor.

Medscope CPD is accredited for PSA and AACP CE/CPD points.

Case #11 (HMR)

 This case studies an HMR for a woman who is a very effusive historian. She is more than happy to expand on her symptoms and tells long stories about the background to each of her questions.

  • How do you (re)direct patients that want to share information that may not be relevant to the question (She even mentions the operation record of her daughter's birth 53 years ago!)?
  • She has multiple complaints- how do you prioritise?
  • She is due to have surgery in a few days time, and you discover something that would cause significant problems- how do you handle this?
See what issues you identify and how you deal with them. Compare your findings and recommendations with those made by Peter Tenni. Watch Peter try(!) to re-direct the lady to answer his questions.

Medscope CPD is accredited for PSA and AACP CE/CPD points.

Case #10 (HMR)

 This case involves an HMR for a woman who the doctor (rather cheekily) informs you "… has lost her adrenals due to Sheehan's Syndrome".

  • What is Sheehan's Syndrome?
  • She has an un-recordable TSH level, why?
  • How much cortisone is enough- and how much is too much?
  • She also has a high parathyroid hormone level- how does this fit in to the picture?
See what issues you identify and how you deal with them. Compare your findings and recommendations with those made by Peter Tenni.

Medscope CPD is accredited for PSA and AACP CE/CPD points.

Case #9 (HMR)

 An HMR for a delightful elderly female. She has a daughter who is a registered nurse and the daughter is sitting in on the interview.

  • She has a pacemaker- how does this change the way you consider her medications?
  • Her daughter works at an acute care hospital- are you intimidated?
  • She has had some difficulties with her dose of warfarin- is it her compliance or is something else going on?
  • She can only walk bout 20 metres before getting short of breath- can you help?
See what issues you identify and how you deal with them. Compare your findings and recommendations with those made by Peter Tenni.

Medscope CPD is accredited for PSA and AACP CE/CPD points.

Case #8 (HMR)

 This case involves a home medicine review that is conducted in the doctor's surgery at the patient's request. The patient is an elderly female with significant chronic cardiac conditions (AF, heart failure) as well as a history of shingles and listed medical warnings to 16 drugs. At the interview, this lady outlines an interesting symptom that may be drug induced. In addition, she has some laboratory test abnormalities that require interpretation and action.

  • Her pain is poorly controlled- what are the options?
  • Why are her liver function tests abnormal? And does it matter?
  • What about this unusual symptom, what is the most likely drug cause?
  • She has lots of allergies- does that mean she's at increased risk of ADRs?
  • She has been seen by a cardiologist- how do you get the GP to make changes?
Compare your findings against those identified by Dr. Peter Tenni.

Medscope CPD is accredited for PSA and AACP CE/CPD points.

Case #7 (RMMR)

 A pharmacist initiated annual medication review for an elderly female resident of a nursing home. She has long-standing rheumatoid and osteoarthritis as well as ulcerative colitis and hypertension. She is taking 19 regular medications and is prescribed an additional 6 agents for prn use (!). Despite her complex regimen, she still has significant problems with pain management, and also has some laboratory test abnormalities that require interpretation and action.

  • She's already taking Norspan, Tramadol, Paracetamol and Mobic- what else can be done?
  • What are the possible causes of low sodium and how should this case be managed?
  • When is iron supplementation no longer required?
  • What is the relevance of her elevated uric acid?
  • Why are her liver function tests so abnormal? And does it matter?
Compare your findings against those identified by Dr. Peter Tenni.

Case #6 (HMR)

 This HMR case studies a 60 year old man with morbid obesity (150kg) and gastric banding. He has several obesity related complications and although not taking a great number of medications at the moment, is at risk of multiple additional co-morbidities.

Your role in this case will be to prevent additional morbidity while encouraging his weight loss by outlining the benefits of losing weight.
  • What are the complications of morbid obesity?
  • When should pharmacotherapy be introduced for obesity?
  • What is the evidence for improvement in complications with weight loss?
  • Can the metabolic syndrome be treated?
He is a knowledgeable patient, so you will need to be on your toes.

Compare your findings against those identified by Dr. Peter Tenni.

Case #5 (HMR)

 Case #5 concerns a 62 year old female living at home with her husband. Like many HMR patients, she has complex medical conditions including Sjogren's syndrome, gastrointestinal problems, uncontrolled pain and psychiatric issues.

You will be provided with a referral and also with a video of the HMR interview and photos of her medications. There are a range of possible drug related problems and this month's challenge is about prioritization of issues (because there are so many!).
  • How do you decide which issues should be directed to the doctor first?
  • There are no lab tests, which ones do you need to determine if problems are present?
  • How do you resolve issues without affecting other conditions?
  • How can you make a one page report from someone with this many problems?
There is also one interesting rare possibility that may be worth exploring!!

Compare your findings against those identified by Dr. Peter Tenni.

Case #4 (RMMR)

 Case concerns a 63 year old female nursing home resident. Our resident has complex medical conditions including rheumatoid arthritis, cardiovascular disease and diabetes.

To assist in her management you are provided with her medication chart, doctors and nursing progress notes, pathology, Webster profile, routine observations and notes from the nurse interview with the accredited pharmacist.

You are asked to perform a RMMR and make recommendations on how best manage her current and long term quality of life.
  • What disease management recommendations will you discuss with her GP?
  • Are there any drug related problems that the GP must be alerted to?
  • What recommendations would you include in a RMMR report?
Compare your findings against those identified by Sandy Travers.

Case #3 (RMMR)

 An 89 year old female nursing home resident with complex pain management issues. Her particulars are detailed in the GP referral, nurse and GP patient notes, drug chart and pathology results.

The patient has recently been discharged from hospital and, being unable to care for herself at home, was admitted to an aged care facility. She has a number of health conditions, including severe uncontrolled pain.

You are asked to perform her initial medication review in collaboration with her new GP.
  • How will you assist her in pain management?
  • Are there any drug related problems that the GP must be alerted to?
  • What recommendations would you include in a RMMR report?
Compare your findings against those identified by Dr. Peter Tenni.

Case #2 (HMR)

 John has suffered indigestion, tight chest pains, dry breathing, coughing issues and high blood pressure since a bladder operation. John is being administered multiple drugs for blood pressure, his chest pains and his leg. Some of the medications have had no effect on his current pain.
  • What medication will solve his pain on his right leg?
  • Currently he is on glucosamine, but it has made no difference, does he need another solution?
  • He was a smoker until six months ago, but is that why he has difficulty in breathing?
  • What recommendations will you include in his Home Medication Review?
Compare your findings against those identified by Dr. Peter Tenni.

Case #1 (RMMR)

 An 87 year old nursing home patient is suffering from oesophageal reflux, ventricular premature beats, asthma, depression, DVT (since 2002) and anaemia. She is currently on over 15 medications. She has been suffering from pains in her right foot whilst walking and a UTI.
  • Is she on too many medications?
  • How will you assist in her pain management?
  • Are there any drug related problems that the GP must be alerted to?
  • What recommendations would you include in the RMMR report?
Compare your findings against those identified by Dr. Peter Tenni.