Description

Case Scenario:

Trina Pullman is a 24-year old female with a history of hypothyroidism, with a 3-month history of persistent vomiting, followed by the gastroenterology service, thought to have gastritis based on the upper endoscopy report. She continued to have vomiting and weight loss, presented to the emergency department, found to be hypotensive, tachycardic and thin. Her serum labs demonstrated hyponatremia, normal potassium levels, and a random cortisol level that was very low. Thyroid stimulating hormone was normal. CBC was unremarkable, UA normal, negative pregnancy test. Serum glucose, liver function tests and renal function were normal. She was thought to have Addison’s disease, with a plan to admit to the hospital for further workup and treatment. You are the hospitalist AGACNP admitting the patient. What one medication would you initiate on this admission to treat the Addison’s disease? Click on each category below to learn more about Trina.

Past Medical, Surgical, Social & Family History:

• Hypothyroid
• Gastritis
• Social History
• Smoker 2-3 cigarettes socially on weekends
• Recreational drug use-none
• ETOH-none
• Single, no children
• Employed as hairdresser

Medications/Allergies:

• Hypothyroid
• Gastritis
• Social History
• Smoker 2-3 cigarettes socially on weekends
• Recreational drug use-none
• ETOH-none
• Single, no children
• Employed as hairdresser

Physical Exam:

• Vitals: Pulse 104; Resp 18; BP 96/50; SpO2 98%; Temp 37 °C (98.6 °F);

65kg; Ht. 5’6″.

• Constitutional: Alert, no acute Thin.
• HEENT: Head is normocephalic and atraumatic. Eyes without icterus or Mucous membranes pink and dry. Neck is supple, nontender without adenopathy. No JVD. No meningismus.
• Resp: Lungs clear to auscultation bilaterally without wheezes, rales or No increased work of breathing.
• Cardiovasc: S1S2 without murmur, rub or Regular rate and regular rhythm. Pedal pulses 2+ and equal. No edema.
• Abd/GI: Soft, non-tender, No masses.
• Skin: Pink, warm, No rashes or bruising.
• Ext: Movement all extremities without
• Back: Normal Nontender.
• Psych: Affect Appropriate attention, cooperation.
• Neuro: Alert and oriented x 4. No focal motor or sensory deficits.

Complete the Following Questions for Each Category

Addison’s Disease Medication

1. Write out the order including the pharmaceutical agent, dose, route and when it should be
2. Justify the rationale on why this medication was selected in this particular
3. Discuss the class/schedule of medication
4. Discuss the pharmacodynamic action of the

Side Effects/Adverse Reactions/Interactions

1. Discuss the potential side effects and/or adverse drug reactions for the first line treatment in THIS patient (not generically).
2. Discuss reasons/indications why not to give this medication in THIS
3. Discuss the side effects that THIS patient might encounter after receiving this medication, as well as what to do should they
4. Discuss any potential drug interactions for the initial medication option for THIS patient and what the management should be if there was a concern about a drug interaction. (Note: This answer may be )

Cost & Efficacy

1. Document the cost of this initial medication with reference for where that information was
2. Discuss how the cost compares to other options available for this
3. Discuss whether the cost of this medication chosen is the best option based on cost, effectiveness and indication for this particular
4. Discuss any diagnostics tests or other information that might need to be obtained to show that medication is efficacious

Special Considerations

1. Discuss how would the treatment chosen should change IF the patient was
2. Discuss specifically the pregnancy category for this medication
3. Discuss specific approaches to this medication or alternatives with a pregnant
4. Discuss how the treatment chosen should change IF the patient was a 75-year-old