Richard Evans DOB: 1/12/1952 Ht: 5’10” Address: 634 N Johnson Ada, OH 45810 Wt:
ID: 279613 • Letter: R
Question
Richard Evans DOB: 1/12/1952 Ht: 5’10”
Address: 634 N Johnson Ada, OH 45810 Wt: 215 lbs
CC: RE calls the pharmacy and states, “I am having muscle pain and weakness. I am aching, like when I have the flu ”
HPI: You ask RE further questions, and he indicates that he is urinating less often. Due to the muscle pain and weakness, he has been significantly limiting his physical activity. He does not even have the energy to take his dog on a walk. He is very adherent to her medications. His next follow up with his doctor is in two weeks. He has not discontinued any medications yet but is hoping his muscle aches get better soon.
PMH: Type 2 diabetes, Hypercholesteremia, Hypertension, Headaches
All medications managed by physician Dr. Jefferies
Aspirin 81mg QD (increased to twice a day one month ago)
Simvastatin 80mg QD (increased from 40 mg a few weeks ago)
Metformin 2000mg QD (increased from 1500mg a few weeks ago)
Lisinopril 10mg QD (taking for 20 years)
Toprol XL 25mg QD (taking for 20 years)
Ibuprofen 400mg Q6H PRN for headaches (taking for 20 years)
Please complete the Naranjo Algorithm for your patient and the most likely causative agent
Name of drug you think is causing reaction: _______ Reaction: _________________________
Yes
No
Don’t Know
Previous conclusive reports of rxn?
+1
0
0
Rxn after administration of drug?
+2
-1
0
Rxn improved when drug was discontinued or specific antagonist was given?
+1
0
0
ADR occur with re-administration of drug?
+2
-1
0
Alternative causes for rxn?
-1
+2
0
Did rxn occur with placebo?
-1
+1
0
Was drug in toxic concentrations?
+1
0
0
Was rxn more severe w/increased dose or less severe with decreased dose?
+1
0
0
Similar rxn with previous exposures?
+1
0
0
ADR confirmed with objective evidence?
+1
0
0
Naranjo Score:______
Based on the Naranjo Score how likely is this drug the causative agent?
Definite Probable Possible Doubtful
How would you classify the severity of this ADR based on Lasagna/Karch?
Minor Moderate Severe Lethal
Explain why you classified the severity this way
Below, please write a professional email to the prescriber. See “ADR Evaluation of Email to Prescriber Rubric” posted to Moodle for details on how the email will be graded.
Aspirin 81mg QD (increased to twice a day one month ago)
Simvastatin 80mg QD (increased from 40 mg a few weeks ago)
Metformin 2000mg QD (increased from 1500mg a few weeks ago)
Lisinopril 10mg QD (taking for 20 years)
Toprol XL 25mg QD (taking for 20 years)
Ibuprofen 400mg Q6H PRN for headaches (taking for 20 years)
DOB Richard Evans 1/12/1952 Address: 634 N Johnson Ada, OH 45810 Ht: 5'10" Wt: 215 lbs CC: RE calls the pharmacy and states, "I am having muscle pain and weakness. I am aching, like when I have the flu" HPI: You ask RE further questions, and he indicates that he is urinating less often. Due to the muscle pain and weakness, he has been significantly limiting his physical activity. He does not even have the energy to take his dog on a walk. He is very adherent to her medications. His next follow up with his doctor is in two weeks. He has not discontinued any medications yet but is hoping his muscle aches get better soon. PMH: Type 2 diabetes, Hypercholesteremia, Hypertension, Headaches All medications managed by physician Dr. JefferiesExplanation / Answer
1. Hello Dr Jefferies,
I have done a study for Richard Evans medications prescribed by you, Sir. As per my knowledge the most common causative agent is the overdose of Simvastatin which is increased to 80mg and Metformin which causes weakness and muscle pain. The value obtained in the Naranjo Score is 8 which signifies that it is Probable. The severity of this ADR based on Karch is Severe after the medication assessment done.The prescribed drugs are imposing a severe side effects in the body thereby preventing the body from doing any further physical activity and movement.The dosage of Metformin is exceedingly high for the body as the adult dosage should be 1000mg maximum.
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