Case Studies

AUGUST 01, 2008
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.


AG is a 59-year-old white man with no medical history who comes in for his yearly physical at an ambulatory care clinic. He has no known drug allergies and is taking no medication. He has no family history for premature coronary artery disease and does not consume tobacco products. During the physical assessment, his blood pressure is measured at 130/82 mm Hg. The lipid panel comes back with the following: total cholesterol, 285 mg/dL; low-density lipoprotein (LDL) cholesterol, 155 mg/dL; high-density lipoprotein (HDL) cholesterol, 37 mg/dL; and triglycerides, 116 mg/dL. Due to AG's hypercholesterolemia, his physician refers him to a pharmacy-managed lipid clinic. Which of the following is the correct LDL cholesterol goal for AG, and what should the pharmacist recommend to AG to treat his hypercholesterolemia?


AI, a 68-year-old Caucasian woman with a smoking history that included a pack per day for 20 years, is admitted to the hospital for an exacerbation of her chronic obstructive pulmonary disease (COPD). AI complains of increased shortness of breath and sputum production. Upon review of AI's chart, it is found that this is her 4th exacerbation in the past 3 years. AI is currently receiving ipratropium bromide and albuterol sulfate (Combivent), 2 puffs every 4 hours as needed, and salmeterol 50 ?g inhalation twice daily. Spirometry was completed a few weeks prior and shows that AI has a forced expiratory volume/forced vital capacity (FEV1/FVC) ratio of <70 and a FEV1 of 42% of predicted. After 3 days of intravenous antibiotic therapy, AI is discharged with prescriptions for cefpodoxmine proxetil (Vantin) 200 mg twice daily, azithromycin (Zithromax) 250 mg once a day, and 40 mg of prednisone once a day, each for 7 days.

In what stage of COPD would AI be classified, and what changes (if any) should be made to her COPD medications?