Case Studies

FEBRUARY 15, 2013
Craig I. Coleman, PharmD, and Brendan Limone, PharmD
Case 1
EW is a 58-year-old woman with a past history of hypertension and type 2 diabetes who presents to the emergency department complaining of nausea, shortness of breath, and chest discomfort radiating down her left arm. EW is determined to be suffering an acute coronary syndrome (ACS) and is treated with primary percutaneous coronary intervention (PCI). After PCI, her interventional cardiologist starts her on aspirin 325 mg/day and clopidogrel 75 mg/day. Two days later, the pharmacist recommends EW undergo “on-P2Y12 (clopidogrel)” platelet reactivity testing. The test comes back with a platelet reaction unit (PRU) value of 245. EW is not taking any medications that could potentially interact with her antiplatelet therapy.
What is the significance of this result and how might the pharmacist use it to optimize EW’s care?

Case 2
AQ is an otherwise healthy 23-year-old woman who comes to the outpatient clinic complaining of painful urination and flank pain for the past 2 days. During her visit, AQ’s temperature is found to be elevated at 101.6° F. A urine dipstick test is performed and comes back positive for pyuria (white blood cells in the urine) and leukocyte esterase. AQ is diagnosed with having an uncomplicated pyelonephritis. Her treating physician determines she does not need to be admitted, but orders her urine be cultured and bacterial susceptibility tests be performed.
What is the recommended treatment course for AQ?

Dr. Coleman is associate professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy. Dr. Limone is a pharmacy fellow in the HOPE Collaborative Group at the University of Connecticut School of Pharmacy and Hartford Hospital.

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