Question

Scenario 1

A 38-year-old female patient with a history of corticosteroid use for her autoimmune disorder, presents to the office with a cc of hip pain following a slip and fall the previous week. Examination reveals edema and hematoma in the right lateral femoral region with pain with palpation and manipulation. The doctor orders radiographic testing of the region and blood work.

The blood work comes back with the following results:

Chloride: 100 mEq/L

Potassium: 4.6 mEq/L

Sodium: 138 mEq/L

Calcium: 7.2 mg/dl

Magnesium: 1.9 mg/dl

Phosphorus: 3.0 mg/dl

Blood results also reported very low levels of VitaminD. The radiograph reported decreased bone density in the imaged femur and ilium. There was no evidence of fracture. The doctor diagnosed this patient with contusion of the gluteal region and osteopenia.

Based on the information provide above in Scenario 1 -

1.What is this patient’s lab results is consistent with the development of osteopenia?

2. Based on the information provide above in Scenario 1 -

How does the prolonged use corticosteroids impact the bone?

3. Based on the information provide above in Scenario 1 -

Following the diagnosis, the doctor prescribed additional medications to the patient. Below is updated list of the patient’s medications. For each medication, give the drug class and, based on this patient’s history, briefly explain why the patient is taking the medication.

Tylenol

Drug Class:

Reasoning:

4. Based on the information provide above in Scenario 1 -

Following the diagnosis, the doctor prescribed additional medications to the patient. Below is updated list of the patient’s medications. For each medication, give the drug class and, based on this patient’s history, briefly explain why the patient is taking the medication.

Citracal + D

Drug Class:

Reasoning:

5. Based on the information provide above in Scenario 1 -

Following the diagnosis, the doctor prescribed additional medications to the patient. Below is updated list of the patient’s medications. For each medication, give the drug class and, based on this patient’s history, briefly explain why the patient is taking the medication.

Prednisone

Drug Class:

Reasoning:

Answer 1

Answers:

1). Patient has decreased calcium level.Normal value of serum calcium in adult is 8.6 - 10.3 mg/dL. Low calcium levels increase the risk of osteopenia.

2).Long term use of corticosteroids affects the metabolism of calcium and vitamin D and results in broken bones, decreased bone mass and osteoporosis. Prolonged use of steroids causes lose bone and high dose of drug increase the speed of lose bone.The rate of lose bone vary from one person to another. The major side effect of steroids is fracture especially in spine and ribs.

3). Tylenol

Drug class: Analgesic

Reason: Tylenol (acetaminophen) is used to relieve pain in soft tissue injury. It provides analgesic effect for patient in gluteal contusion.

4).Citracal +D

Drug class: Calcium +vitamin D

Reason: Citracal +D is used to treat and prevent calcium deficiency. Vitamin D help in calcium absorption. Patient has osteopenia and citracal +D is a drug of choice for it.

5).Prednisone

Drug class: Corticosteroids

Reason: Patient has autoimmune disorder. Corticosteroids is used to treat autoimmune disorder.