Dennis is a delightful older gentleman who normally lives at home with his wife, Helen, who he has been married to for 50 years. Helen had a stroke a few months ago and since then, she has relied heavily on Dennis for help around the house and with her activities of daily living. Dennis isn’t much of a cook so most of the food he prepares for himself and Helen are instant pre-packaged meals. Dennis is very keen to get home to Helen as soon as possible because he knows she has a hard time coping without him. Dennis was diagnosed COPD in 2003, but since Helen’s stroke he has been feeling increasingly anxious and has a low mood. Two weeks ago his doctor saw him and suggested he start on a new medication to help manage his mood. After a week, he went back to the doctor to tell her that the new medication wasn’t working, and instead of ‘doing something about it’, the doctor added a new blood pressure tablet.
Dennis was a little annoyed by this and a few days ago, he decided to take matters into his own hands and
start taking the mood tablet morning and night. Today, he has been admitted to the short stay ward with an
infective exacerbation of COPD. On examination, Dennis reported that over the last few months he has been
feeling increasingly short of breath when he is helping around the house and is annoyed that his inhalers have
‘stopped working’. While Dennis’ infective exacerbation of COPD is mild, the medical team are concerned
about the other symptoms he has presented with and are unsure of what is causing them. They have decided
to keep him in hospital for a few days to investigate. Dennis is asking if you will make sure the doctors in
hospital have charted him for his dose of the “mood medication” twice a day. Also, Dennis is telling you that
he is thinking of stopping his inhalers because he doesn’t think they are doing him any good.
Patient details Presentation
Mr Dennis Vale
22 Stretton St
Weight: 98 kg
Presenting Complaint: Infective exacerbation of COPD
Presenting symptoms: Increased shortness of breath, cough, and sputum.
Nausea, dizziness, constipation, and weakness over last few days.
Depression and anxiety (several months ago)
COPD (since 2003)
Hypertension (Since 2000)
Smoking: Yes, smokes 1-2 packs per day since he was 20. Increased
use in the last few months.
Alcohol consumption: No
Lab Tests/Diagnostic tests Medication History
BP: 165/100 mmHg (Dennis
states up until 1 week ago his
blood pressure was
CrCl = 28mL/minute (baseline
Amoxicillin 1g twice a day (starting tonight, has not yet taken a dose)
Hydrochlorothiazide 12.5mg daily (started 1 week ago)
Venlafaxine 150mg, 1 dose daily (started 2 weeks ago)
Salbutamol 100mcg MDI, 2 puffs PRN (since 2003)
Tiotropium 18mcg, 1 dose daily (since 2005)
Symbicort 400/12, 1 dose twice a day (since 2015)
Amlodipine 5mg 1 daily (since 2000)
Allergies/previous Adverse Drug Reactions:
Penicillin – anaphylaxis (as a young man; not re-challenged)
Ramipril – cough (in 2000)
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You are required to present the following in the provided ASE-C-POP template:
Identify all actual and potential therapeutic problems in this case, focussing on
Quality Use of Medicines approaches (drug & non-drug strategies or concerns);
Outline & discuss available options to resolve the issues identified (in order of
Explain your team’s therapeutic plan as solutions to the therapeutic problems
Outline other healthcare professionals that Dennis could be referred to.
Refer to the Assignment Instructions for further information.
Is there an indication for each medication?
Do they Comply with QUM?
Is there a clear contribution?
Re any doses too high?
Are there any interactions? (Medication and/or condition)
Is the patent experiencing side effects?
Effective Is the expected outcome being achieved?
Are the doses adequate?
Are there compliance/adherence issues?
Conditions and comorbidities – all being treated? Any
Are they taking complementary/ Alternative therapy?
Problem list Create a complete problem list for the patient: Actual Vs.
For each problem create a range of possible treatment
options – are there any opportunities to collaborate with
other Health Care professionals to get the best outcome for
From problem list and a monitor plan to evaluate the
outcomes of your plan, including any other health
professional that should be involved in their care and their
role in your patient case. (E.g. what would be the
contribution of a psychologist? etc.)
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