PGY1 Community - Based Pharmacy Residency Oral Case Presentation (NTX) Instructions: You have 15 minutes to prepare for the case presentation. You will NOT have access to any resources, please do not utilize the internet while answering the case, in order to fully assess your clinical knowledge and skillset. You will be given 5 minutes in length to present the primary problem(s) to the panel and the remaining 10 minutes will be the question and answer session. Be prepared to identify and prioritize the patient’s medical and drug therapy problem(s). You must have evidence - based recommendations for interventions, evide nce - based therapeutic goals, provide monitoring parameters, and pertinent patient education. HPI : C.M., a 58 - year - old African American male, who presents to the diabetes clinic for follow - up . Patient reports adherence to his current medication regimen. Patient did bring his meter to the visit. Patient denies hypoglycemic episodes. Gluco meter blood sugars Before breakfast: 200 - 220s 2 hour after meals: 250 - 300s Self - reported blood pressu re readings 140s - 150s/80s mm Hg (checks at least 2 hours after taking HTN medications) PMH Hypertension Diabetes Hyperlipidemia MI (2015) Heart Failure (Reduced Ejection Fraction) NYHA Class II I Social Hx ( - ) tobacco use ( - ) alcohol Walks 30 minutes daily Family Hx * Mother significant for HLD and diabetes * Father significant for DM, CKD, and HTN Diet * 3 meals daily * Lean meat * Fruit * Vegetables ROS (+) fatigue (+) polyuria (+) polydipsia (+)polyphagia ( - ) fluid overload / hyp er volemia Immunizations * Influenza 10/ 20 20 * Tdap: 2015 * PPSV23 10/2017 * PPSV13 8/2015 Allergies: NKDA Medication Dose Directions Amlodipine 10 mg 1 po qd Aspirin 325 mg 1 po qd Vitals @ visit: BP 145/94 mmHg Commented [HK1]: Do we add covid perhaps 1 st dose or 1 st and second to see if they recommend booster or leave off to see if they recommend the first dose ? Commented [VCH2R1]: I think that’s a great idea to either add 1 st dose or leave off to see if they recommend the first dose since patient also needs Hep B HR 76 bpm Ht 5’9” Wt: 210 lbs BMI: 31 kg/m2 Ibuprofen 800 mg 1 po qd prn back pain Simvastatin 40 mg 1 po qd Metformin 1000 mg 1 po bid Entresto 97/103mg 1 po bid Carvedilol 25mg 1 po bid Lab Values @ visit: ( labs not significantly changed from 1 year ago ) Na 140 mEq/L K 3 mEq/L Cl 104 mEq/L CO 2 26 mmol/L BUN 22 mg/dL SCr 0.9 mg/dL ALT 26 IU/L AST 24 IU/L EF - 30% CBC wnl Lipid panel TC 200 mg/dL TG 123 mg/dL LDL 130 mg/dL HDL 36 mg/dL A1C 9.4% Albu min - to - creatinine ratio (ACR) 315 mg/g eGFR 75 mL/min/1.73m 2