Hours, was followed by a retrun of appetite and resumption of her normal diet.

At this time,
hr IV was discontinued, including IV ciprofloxacin. Oral ciprofloxacin 250mg Q12h was
started to complete the 14-day course of therapy. Oral potassium supplementation was
restarted at 10mEq PO BID. Oral digoxin 0.125mg QAM and hydrochlorothiazide 50mg
QAM were also started. A repeat CBC revealed the WBC count was down to 8.5 X 103 . The
patient was transferred to her bed in the nursing home, where periodic serum digoxin,
potassium, and creatinine levels were done with all levels within normal limits.

Pharmaceutical Care Process

The level Pharmaceutical care required by this centenarian can be characterized as a

progression from primary to secondary and back to primary. The pharmacotherapeutic risk to
her was moderate, considering the types of drug therapy, her remarkable constitution for a
woman of such advanced years, and her response to pharmacotherapy.

First Pharmaceutical Care Event:

Establish a Pharmacist-Patient Relationship

The consulting pharmacist had known this patient for the previous eight years, which
coincided with the time AAA had been in the nursing home. The relationship was one of
mutual trust, respect, and cooperation.

Second Pharmaceutical Care Event :

Gather and Interpret Patient-Related Information

The pharmacist had a detailed database on AAA which was routinely updated when
the pharmacist made monthly rounds to review pharmacotherapy and more frequently when
AAA had changes in health status. This database consisted of objective patient-specific data,
including relevant physical findings (e.g., vital signs and sensorium status), laboratory data
(e.g., complete blood chemistries, serum digoxin levels, stool occult blood tests, urine and
paired blood specimens for culture and sensitivity, and CBCs),
 Long-Term Pharmaceutical Care

FIGURE 21.2. Ranked Drug-Related Problems

Problem Patient-Specific Factors for AAA

Rangking Drug actual or potential Age Hydration Renal Infection
1 CiproTM GU toxicity ++ ++ ++ +
crystalluria
2 Digoxin Dig. toxicity ++ + ++
3 KCL Hyperkalemia + + ++
cardiac
conduction block
4 Hydrochlorot Dehydration + ++ ++
hiazide
5 Ibuprofen GU and GI + +
toxicity
Rangking: 1 = highest, 5 = lowest
+ = Significant factor
++ = Very significant factor

FIGURE 21.3. Desired Outcomes

Drug Outcomes Desired by AAA and the Pharmacist

Ciprofloxacin No crystalluria
No interstitial nephritis
No reduced renal function

Digoxin No signs and symptoms of digoxin toxicity

Return to/improvement in previous cardiovasculas status
Serum digoxin levels within normal limits for AAA

Potassium chloride Serum potassium levels within normal limits

No evidence of potassium-induced cardiac dysfunction

Hydrochlorothiazide No edema
No hypokalemia
Satisfactory blood pressure for this patient, i.e., (120-140)/(75-90)

Ibuprofen No GI toxicity, e.g., pain, nauses and vomiting, bleeding

Satisfactory relief of joint pain