/publications/issue/2009/november2009/CaseStudies-1118

Case Studies

Author: Craig I. Coleman, PharmD


Dr. Coleman is an assistant professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.


 

CASE ONE
Lost in (Glucose) Translation

VT is a pharmacy student on experiential rotation in a diabetes specialty clinic. While sitting in on a patient follow-up visit, the student overhears the endocrinologist tell a patient that her sugars are well-controlled, based upon the patient’s laboratory results depicting an estimated average glucose of <154 mg/dL. Later that day, the student meets with her rotation preceptor and asks, “What is an estimated average glucose? I thought we used hemoglobin A1C to monitor patient diabetes control.”

 

What should the preceptor tell the pharmacy student?


 

CASE ONE
ACE Inhibitors and ARBs in Stable Ischemic Heart Disease

EM, a 57-year-old Hispanic woman, comes for a follow-up visit at her primary care clinic. There she sees her primary care physician (PCP) and a consulting pharmacist. The PCP asks the pharmacist if EM could take any other medications that would improve her chances of a longer life. The pharmacist discerns that EM has a 10-year history of stable angina pectoris, has never had a myocardial infarction, and has a normal ejection fraction at 64%. Her chest pain is well-controlled on metoprolol 50 mg twice daily and amlodipine 10 mg once daily with nitroglycerin tablets for acute angina attacks. She receives aspirin 162.5 mg daily and pravastatin 40 mg daily (low-density lipoprotein cholesterol 72 mg/dL).

Given this information, should another therapy be added to EM’s medical regimen?