Case Studies (December 2016)

DECEMBER 20, 2016
Albert Zichichi, PharmD Candidate, and Craig I. Coleman, PharmD
CASE 1
JM is a 68-year-old woman who is given a diagnosis of cellulitis on her left calf by a medical resident. JM has a medical history of hypertension, chronic obstruc- tive pulmonary disease, and heart failure, as well as a urinary tract infection (UTI) that was treated with levofloxacin 2 weeks ago. The resident asks you, the infectious diseases stewardship pharmacist, for your advice regarding empiric therapy for JM’s cellulitis, telling you that the cellulitis is associated with purulent drainage and is likely a sebaceous cyst infection. The resident drains the cyst and is considering treating JM with cephalexin 500 mg every 6 hours for 5 days.
As the pharmacist, what antibiotic course would you recommend?

CASE 2
TO is a 54-year-old woman who presents to your prima- ry care clinic for continued management of her insulin regimen. TO was recently given a diagnosis of type 2 diabetes, with a glycated hemoglobin concentration of 10.2%. Her insulin regimen includes insulin lispro 2 units 3 times daily taken 5 minutes before meals and in- sulin NPH 5 units before breakfast and 10 units before bed. TO brings her in glucometer, and on reviewing her finger-stick results, the resident sees all her glucose readings are in the target range except her prefasting breakfast readings, which have been consistently high (198-240 mg/dL) over the past 1 to 2 weeks. TO reports strict adherence to her insulin regimen and has not made any significant changes to her diet. The resident wants to increase TO’s insulin, but is unsure by how much. The resident consults you, the pharmacist, to help manage TO’s insulin regimen.
What would you recommend regarding TO’s insulin therapy?

SEE THE ANSWERS ON PAGE 2.



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