Question 1 (8-2)

J. L., a 27-year-old African-American female account executive, presents to the Family Medicine office for her annual checkup with her CNP. She has no significant past medical history. Her medications include calcium carbonate 500 mg orally twice a day and a multivitamin daily. She exercises regularly. Her family history is significant for cardiovascular disease (her father had an MI at age 54 and died of a further MI at age 63). She notes that she has been dating her current partner for approximately 5 months. She is interested in a reliable form of contraception. After discussing the various contraceptive options, she decides that an oral contraceptive (OC) would best fit her needs.

In this discussion forum:

1. Discuss what tests or examinations the CNP would likely perform before prescribing an OC regimen, and why.

2. Discuss two different OC regimens that could be chosen for J. L. Discuss their differences and why you chose them.

3. Discuss the potential side effects of each OC regimen that need to be relayed to J. L. Discuss especially those effects for which she should seek immediate medical care.

4. Discuss health promotion recommendations you would consider for J. L.

5. What ethical issues should be considered?

6. Include two references.

Question 2 (7-2)

G. P., a 76-year-old white male, seeks treatment for swelling and decreased range of motion in the right knee. He tells you he retired at age 69 after 40 years of assembly-line work. He reports that his physical activity has decreased and his weight has increased over 20 pounds since retiring. His hobbies include woodworking and playing cards and playing with his two grandchildren. He denies tobacco use and alcohol use. Although he describes several years of joint pain that gradually worsened, his activities were not limited until approximately 6 months ago, when he noted an insidious onset of swelling in the right knee. Over the years, he has sporadically taken acetaminophen, aspirin, and ibuprofen to control the pain. He reports that none of the drugs provided better relief than the others. His medical history is remarkable for hypertension and three episodes of gout.

Diagnosis: Osteoarthritis

If your last name begins with A-L, please focus your initial post on Questions 5-9, and your classmate replies on Questions 1-4. If your last name ends with M-Z, please focus your initial post on Questions 1-4 and your classmate replies on Questions 5-9.

In this discussion forum:

1. List specific goals of treatment for G. P.

2. What drug therapy would you prescribe, and why?

3. What are the parameters for monitoring success of the therapy?

4. Discuss specific patient education based on the prescribed therapy.

5. List one or two adverse reactions for the selected agent that would cause you to change therapy?

6. What would be the choice for second-line therapy?

7. What over-the-counter and/or alternative therapies would be appropriate for G. P.?

8. What lifestyle changes should be recommended for G. P.?

9. Describe one or two drug-food or drug-drug interactions for the selected agent(s).

Include two references