[Answered]: Case summary Patient Details · 76yo male, from…

Case summary Patient Details · 76yo male, from Edinburgh, Scotland. Lives with wife – no services. · Moved to London 6 years ago when fully retired to be closer to family. Current medical history · Chronic lymphocytic leukaemia – Binet stage C – pancytopenia, weight loss, hepatosplenomegaly. · Develops urinary retention · Benign prostatic hypertrophy – awaiting TURP · Hypertension · Atrial fibrillation Results (Blood results etc) FBC · Hb 95g/l · WBC 130 x 10 9/l · Neuts 5.3 x 10 9/L · lymph 121 x 10 9/L · Biochemistry · Na 141 mmol/L · K 4.0 mmol/L · Cl 104 mmol/L · Urea 4 mmol/L · Creatinine 79 umol/L · Albumin 26 g/L · LFTs normal · LDH 380 u/l · CRP 8 mg/L · CT prior to starting treatment (8 weeks earlier) shows splenomegaly of 16cm, mild hepatomegaly only · No significant lymphadenopathy · Bulky prostate · Few small gallstones in otherwise contracted, thin gallbladder · Renal cyst on right side, but otherwise normal Observations: Respirations – 16 breaths/min Spo2 – 97% on air BP – 141/87 HR – 92 bpm Temp. – 36.8 Lifestyle · Normal diet and fluids · Enjoys a daily walk · Retired offshore worker · Non-smoker · Alcohol – only on special occasions · 59 kgs • Penicillin (causes rash) · Normal diet and fluids · Enjoys a daily walk · Retired offshore worker · Non-smoker · Alcohol – only on special occasions · 59 kgs • Penicillin (causes rash) · Current Medication · Obinutuzumab 1000mgs · Venetoclax 50-400mgs (as per protocol) · Digoxin 62.5mcg od · Apixaban 5mg bd · Bisoprolol 2.5mg od · Tamsulosin 400mcg od · Omeprazole 20mg Main complaint/current situation · Noted to have lower abdominal pain, along with reduced/ absent urination · Bladder scan in clinic shows 1400mls post void volume Most Recent Consultations/Follow up · Approach to current medication in terms of immediate management · Approach to chemotherapy both in terms of renal dysfunction, but also with regards to other pre-existing medications – what dose adjustments, drug substitutions should be considered Critically analyse polypharmacy and discuss medicines optimisation for your patient. Discuss the 7 steps to appropriate polypharmacy. Evaluate disease progression and impact of the disease on any co-morbidities. Requirements: Discuss the pathophysiology and link to the signs and symptoms Identify the TWO drugs that are treating the current complaint? Identify what makes the patient complex? Apply the 7 steps of Polypharmacy (as per the Scottish Polypharmacy Realistic Guidelines) to all medications prescribed to the patient.