(Q) pharm week8

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Chief Complaint“Iâ€

m up four to five times a night feeling that I have to urinate, and then when I get to the bathroom all I do is dribble. Iâ€

m very lightheaded when I stand up, and sometimes I donâ€

t make it to the bathroom in time. I have a girlfriend now, but I am finding it difficult to be intimate with her. Also, going to the bathroom all night is really impacting my love life.”
HPIJimmy McCracken is a 65-year-old man with a long-standing history of UTIs. He has a history of urosepsis requiring hospitalization. He is being evaluated because of complaints of worsening urinary hesitancy, nocturia, and dribbling. He also has a new complaint of ED. He would like information on prescription medications to treat his urinary symptoms but is not opposed to using natural products.
PMHHTN
Laminectomy 10 years ago
BPH
Chronic UTIs
Type 2 DM
ED
Obesity
Osteoarthritis (new onset)
Cat allergy (new onset)
FHEducated through the 12th grade. Father died of massive MI at age 78; mother died of natural causes at age 91.
SHWorked for 35 years in a grocery store; retired 7 years ago. Married once. Wife deceased 6 months ago (stroke); one daughter, two granddaughters. Lives alone but is starting to become more socially active. He recently joined a senior dating website and has started dating a 60-year-old woman. He also just adopted a 3-year-old cat from the humane society. Although he reports being allergic to cat dander, he feels that she has added happiness back in to his life and uses medications to keep his allergies under control because he doesnâ€

t want to give up the cat. Used smokeless tobacco × 35 years (quit 10 years ago); heavy ETOH in the past, occasional glass of wine now.
ROSIn conversation, he is alert, friendly, and courteous. He has no c/o dyspepsia, dysphagia, abdominal pain, hematemesis, urinary incontinence, or visible blood in the stool.
MedsMetformin 1000 mg PO BID
Rosuvastatin 20 mg PO once daily
Terazosin 10 mg PO once daily
Amitriptyline 25 mg PO at bedtime (insomnia)
Metoprolol succinate 50 mg PO once daily
Ibuprofen 800 mg PO BID
Claritin-D 24-hour one tablet PO daily (allergy to cats)
AllNKDA; allergic to cat dander
Physical ExaminationGenWhite male in NAD; well-kept appearance; A&O × 3
VSBP 110/60 mm Hg, P 65 bpm, RR 18, T 37°C; Wt 115.2 kg, Ht 6′0″
SkinVertical scars on neck and lower back from laminectomies
HEENTPERRLA; EOMI; TMs intact; nose and throat clear w/o exudate or lesions
Neck/Lymph NodesSupple w/o LAD or masses; thyroid in midline
Lungs/ThoraxCTA, distant sounds
CVRRR w/o murmurs
AbdSoft, NTND w/o masses or scars; (+) BS
Genit/RectTestes ↓↓, penis circumcised w/o DC; guaiac (+) stool
MS/ExtDistal pulses 1–2+, knees appear to be inflamed with decreased range of motion and tenderness on palpation.
NeuroDTRs 2+; CNs II–XII grossly intact
LabsSee Table 98-1.
TABLE 98-1Laboratory ValuesView Table|Favorite Table|Download (.pdf)UAColor straw; appearance clear; SG 1.010; pH 6.5; glucose (–); bilirubin (–); ketones (–); blood (–); urobilinogen 0.2 mg/dL; nitrite (–); leukocyte esterases (–); epithelial cells—occasional per hpf; WBC—occasional per hpf; RBC—none seen; bacteria—trace; amorphous—none seen; crystals—1+ calcium oxalate; mucus—none seen. Culture not indicated.
GU ConsultPatient treated for UTI 2 weeks ago with Cipro 250 mg PO Q 12 H × 3 days. Urine clear; negative for glucose. Bladder examination with ultrasound revealed postvoid residual estimate of 300 mL. Prostate approximately 35 g, benign. AUA Symptom Score = 20. Uroflowmetry (Qmax) = 8 mL/sec. A 3-day urine frequency volume chart was completed and showed no polyuria.
AssessmentBPH
ED
Symptomatic hypotension
Microcytic anemia possibly secondary to ulceration from ibuprofen use
HTN
Type 2 DM
Obesity
OA
Cat allergy (recent onset with adoption of new cat)
3.a. What are the goals of pharmacotherapy in this case?
3.b. What nondrug therapies might be useful for this patient?
3.c. What feasible pharmacotherapeutic alternatives are available for treating BPH?
Provide patient educational material to assist with adherence to treatment and/or non-pharmacologic management of BPH
pharm week8 My perfect tutors.
 
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