M.W. is a 70-year-old white woman with a medical history of hypertension, osteoarthritis, atrial fibrillation, and total hysterectomy who lives by herself in a two-story row home. She visits the primary care clinic with her daughter, who is concerned because M.W. has “bounced” a few checks and can no longer pay her bills without assistance. M.W. admits that she has been forgetful and appears anxious as she describes an incident in which she went shopping and could not remember where she parked her car. Her daughter states that her mother’s memory has progressively worsened over the past year. M.W.’s medications include fosinopril 20 mg PO daily, metoprolol succinate ER 50 mg PO daily, warfarin 5 mg PO daily, vitamin D 1,000 IU PO daily, and acetaminophen 325 mg 2 tablets (650 mg) PO tid. A careful evaluation and workup were ordered. Diagnosis: Mild AD with an MMSE Score of 22

1. List specific goals of treatment for M.W.

2. What drug therapy would you prescribe for M.W.? Why?

3. What are the parameters for monitoring success of therapy?

4. Discuss specific patient education based on prescribed therapy.

5. List one or two adverse reactions for the selected agent that would cause you to change therapy.

6. What would be the choice for second-line therapy?

7. Would there be any over-the-counter and/or alternative agents appropriate for M.W.?

8. What lifestyle changes would you recommend to M.W.?

9. Describe one or two drug–drug or drug–food interactions for the selected agents

M.P. is a 66-year-old man with past medical history of hypertension and hyperlipidemia presenting to the clinic describing problems with balance and gait that have worsened in the past few months. A gait assessment reveals reduced arm swing while walking and a single halt hesitation when turning. During straight walking, he continues smoothly without freezing. The MDS-UPDRS reveals slight impairment related to postural instability and mild impairment related to both gait and freezing. Based on his history and physical exam, he is diagnosed with PD. Following his diagnosis, he mentions that he is considering retirement. Diagnosis: Parkinson Disease

1. Which of the following is not an appropriate goal of therapy for M.P.?

a. Maintain patient independence by alleviating motor symptoms.

b. Preserve patient ability to perform activities of daily living.

c. Reverse disease progression.

d. Maintain patient quality of life by alleviating nonmotor symptoms.

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