PL is a 64-year-old female with hypertension, chronic kidney…

PL is a 64-year-old female with hypertension, chronic kidney disease, and degenerative joint disease. She is 5’3”, weighs 135 lbs, and has a serum creatinine of 2.5 mg/dL at the time of admission for hip replacement surgery. The provider orders enoxaparin 30 mg SC every 12 hours for deep vein thrombosis prophylaxis to start post-operatively. Which of the following actions is most appropriate for the pharmacist to take?

A 52-year-old African American female is referred to pharmac…

A 52-year-old African American female is referred to pharmacy for hypertension management. She has no other medical conditions, and her current medications include a daily multivitamin. All labs are within normal limits. Her blood pressure today is 135/82 mmHg (was 132/79 mmHg at last clinic visit). Which drug regimen would be most appropriate in addition to lifestyle modifications?

A 68-year-old female is started on opioid therapy for pain c…

A 68-year-old female is started on opioid therapy for pain control after admission for an automobile accident. Her pain was well controlled until the last 2 days when she developed increased somnolence and decreased respiratory rate, leading to intubation. There were no changes in her medication therapy. Current labs include Na: 135 meq/L; K 5.2 meq/L; Cl: 119 meq/L; BUN: 40; and SCr: 4.5 mg/dL, total bilirubin = 2.4. Which opioid would be the most appropriate to use in this patient?

A patient with a 5-year history of bipolar disorder was rece…

A patient with a 5-year history of bipolar disorder was recently discharged from an inpatient hospital stay. She was admitted in a manic episode with a decreased need for sleep, flight of ideas, rapid speech, increased impulsive behavior, and delusional thinking. She was previously stabilized on lithium 900 mg PO at bedtime. Her lithium serum concentration 4 weeks ago was 0.8 mEq/L but was 0.2 mEq/L on admission. During hospitalization, lithium was restarted and olanzapine 10 mg PO at bedtime was added which stabilized her symptoms. Four weeks after discharge, she returns to clinic with a complaint of 30 pound weight gain. Today’s lithium level is 0.9 mEq/L and she has no manic or psychotic symptoms. The psychiatrist would like your opinion regarding her continued drug therapy. What is your most appropriate recommendation?