Case 1 Answer:
The patient’s medication profile suggests a history of cardiovascular disease. Studies examining the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in post-MI patients have found that NSAIDs, including ibuprofen, are associated with an increased risk of all-cause mortality, coronary death, and MI for at least 5 years after the index event. Consequently, the pharmacist should consider recommending an alternative therapeutic option for TJ’s osteoarthritis.
In addition to NSAIDs, the 2012 American College of Rheumatology guidelines recommend acetaminophen, tramadol, or corticosteroid injections as first-line therapy options for initial management of OA of the knee. The pharmacist might consider recommending a change in therapy to acetaminophen 1000 mg 2 to 4 times daily. If it is determined that the patient should be initiated on an NSAID despite the associated risks, it may be suggested that naproxen be the NSAID of choice, as it has been shown to have the lowest cardiovascular risk of the studied NSAIDs.
Case 2 Answer:
Infants younger than 6 weeks cannot receive the diphtheria, tetanus, and acellular pertussis (DTaP) vaccine and those younger than 6 months cannot receive the influenza vaccine. Consequently, infants are at greater risk of contracting these illnesses and should be protected through passive immunity by immunizing those who have close contact with them. The CDC recommends that adults who spend time around these children should receive the adult booster version of the diphtheria, tetanus, and acellular pertussis vaccine (Tdap) and the influenza vaccine to minimize the risk of infecting the infant. Due to JR’s age, she should receive the trivalent inactivated influenza vaccine (she could receive the live vaccine if she were under 50). She should also receive the adult Tdap vaccine instead of the simple Td booster as it has added protection against pertussis (whooping cough).
In addition to these vaccines that are meant to help protect the newborn, there are others she may consider due to her age. JR should consider getting the pneumococcal polysaccharide vaccine if she has not yet, since she is older than 65 years, as well as the herpes zoster vaccine, since she is older than 60 years.