A 63 years old obese female presents with 4 to 5 months history of mid-epigastric pain that is worse after eating. She is unable to identify any specific foods that may be triggering the symptoms. She denies excessive gas, denies regurgitation of food or a water brash. She has normal daily bowel movements but states that sometimes her stools are very dark. She denies nausea and vomiting. She has no previous history of these symptoms and they are becoming disruptive in her daily life. She has been taking TUMs, “like they are candy.”
Past Medical History: surgical menopause at age 35 secondary to endometriosis, hypertension (HTN), diabetes mellitus Type II, morbid obesity, dyslipidemia. Surgical History: T&A as child, total abdominal hysterectomy with bilateral salpingo-oophorectomy, appendectomy, cholecystectomy. Her medication regimen includesPremarin 0.625mg q day, lisinopril 10mg q day, metformin 500mg bid, and atorvastatin 40mg q HS. VS: BP 145/94, P 90, R 18, T 98.2. The patient’s height is 5’4” and her weight is 225lbs., consequently her BMI is 38.6. Physical examination is within normal limits.
Questions for response:
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1. What additional history would you like for this patient?
2. If you plan to start drug treatment today
a. what is your choice, the dose, and the duration of the treatment?
b. what are some alternatives to this choice
c. what is your rationale for this choice
3. What risk factors for this patient will guide your choice?
4. Are there any major drug-to-drug interactions, side effects or adverse reactions to this drug?
5. Provide patient education regarding the use of this drug. Besides drug therapy, are there any other interventions you would consider or recommend?
References less than 5 years and at least 6. no less than 2 pages