Click click  to download the sample files.

​

PT is a 69 year old male with osteoarthritis, type II DM, hypertension, and insomnia in addition to long-standing pain after a disc fusion in his lower back years ago. Patient also has signs and symptoms consistent with BPH, although he lacks an official BPH diagnosis or any related therapies. You review all of the medications and ask the patient how and why he is taking each. The patient is already on med sync, and a review of the fill history indicates that he is mostly adherent to all of his medications. PT knows why he is taking each of the medications except for omeprazole. He says he was started on that during a hospital stay a year or so ago and has stayed on it ever since. Per the patient, his blood sugars have been stable on metformin for some time, with no issues related to hypoglycemia. The patient reports checking his blood sugar only once per week, which is less often than the once daily monitoring recommended by his physician. He is willing to increase the frequency of blood glucose checks to 3-5 times per week. His hemoglobin A1c recently rose to 7.2, which was the first time it rose above 7 since the patient’s initial diagnosis of type II DM 5 years ago. The patient is willing to begin walking, especially since he understands that even mild exercise has potential to improve his blood sugar and blood pressure. Upon the most recent visit to your pharmacy, the patient’s blood pressure was 146/80. He says his blood pressure was “normal” upon his most recent visit to the physician, so you plan to re-check it the next time he’s in the pharmacy. His pain is well-controlled on his current regimen. He has been taking lorazepam for some time to help his insomnia, which it does, but during the patient encounter you learn that patient’s physician is referring him for a sleep study due to concerns about sleep apnea. Additionally, PT reports taking the lorazepam every night. You send a recommendation to the physician to consider a different medication for insomnia because of the increased risk of respiratory depression when opioids and benzodiazepines are taken together. The recommendation is to slowly taper the lorazepam and begin ramelteon 8 mg QHS. You ask the patient some questions about social determinants of health and found out that he regularly experiences food shortages toward the end of each month, which is particularly challenging given his diabetes. You make a referral to the health plan care manager to connect the patient with a local food bank. The patient has a 20 pack-year history of cigarette use, and while he is willing to try to quit at some point in the future, he’s not ready yet. He recently lost his wife and says he is not ready for another stressor in his life.

​