Case 1
 

A 47-year-old male asks the AOK pharmacist what he recommends to relieve recurring belching, heartburn, nausea, difficulty swallowing, and hoarseness. He states that antacids haven’t been very helpful.  He reports a past medical history of DM (type 1), COPD, CAD with exertional angina, MI (2003) and CHF.  His current medications are salmeterol/fluticasone 50/250 2 puffs BID, ipratropium 2 puffs QID, ASA 325 mg QD, lisinopril 20 mg QD, furosemide 40 mg QD, KCl 10 mEq QD, digoxin 0.125 mg QD and isosorbide mononitrate 120 mg QD. 

Social history: 30-pack-year smoker; occasional EtOH use. 

The pharmacist recommends ranitidine 75 mg twice daily.

What is your assessment?  What would you have recommended (if different from above)?

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Case 2

72-year-old female with c/o of weakness, fatigue, cough, dizziness, occasional chest pain

PMH:  diabetes (type 2), anemia, osteoporosis, HTN, mild memory loss, involuntary weight loss

Social Hx: Lives alone, smokes 1 pack per week, red wine to help with sleep and with socializing

Meds: Takes glipizide, ferrous sulfate, alendronate, calcium, vitamin D, trazodone, vitamin E, HCTZ, Tylenol PM, antacids

Questions?

Recommendations?

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Case 3

VK, a 70-year-old male salesman

PMH: HTN, hypercholesterolemia, recurrent gastroesophageal reflux

PE: 5’9”, 185 lb.

SH: smokes 10 cigarettes daily, 8-10 caffeinated beverages daily (coffee, cola), 2 glasses red wine every other day

Labs: endoscopic finding of erosive esophagitis consistent with reflux

Medications: diltiazem XR 120 mg QD, magnesium oxide 64 mg QD, simvastatin 20 mg QD, ranitidine 300 mg BID, alginic acid PRN (used approximately 8 times daily)

GERD sx: recurrent reflux

Provoking factors: advanced age, possibly some excessive weight, smokes, caffeinated beverages, alcohol, diltiazem

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Case 4

72 yo female with c/o of weakness, fatigue, cough, dizziness, occasional chest pain

PMH:  GERD, diabetes (type 2), anemia, osteoporosis, HTN, mild memory loss, involuntary, unexplained weight loss

Lives alone, smokes 1 pack per week

Takes glipizide, ferrous sulfate, alendronate, calcium, vitamin D, trazodone, vitamin E, HCTZ, Benadryl PM, antacids

Red wine to help sleep

Is GERD is well controlled?  If not, Why not?

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