A patient with moderate COPD has difficulty generating sufficient inspiratory flow for DPI therapy and struggles with hand‑breath coordination when using an MDI. Which feature of the soft mist inhaler (SMI) makes it the BEST option for this patient?
Read DetailsThe following question pertains to this case: K.G., a happy 8-year old Latino male, is brought to the PMHNP’s outpatient office after his 2nd grade teacher repeatedly called his parents reporting worsening of his behavior in the classroom. The teacher says she likes him a lot, but he is disruptive in class. He listens to her when she redirects him, but he becomes disruptive again shortly thereafter. He hums, makes noises, blurts out comments, and doesn’t wait to be called on to answer questions. She reminds him “constantly” to get back in his seat. During recess or PE, he has “tons” of energy and has “daredevil” behavior. He is friendly with peers but has difficulty maintaining friendships due to his roughhousing, making up his own rules, and disruption of games/activities. He is always chosen last for team sports due to his inability to stay focused, thus making him an unreliable teammate. The teacher reports that he is very bright, but he rarely completes his assignments; thus they are sent home to be finished, but they are not returned. K.G.’s mother was surprised by this because she spends a significant amount of time helping him with his homework. Homework time takes “hours” because of the many needed reminders to stay on track. Instead he would start watching tv or playing with his toys. He is distracted by others’ conversations and interrupts as he tries to join in. He investigates any sound or movement instead of doing his work. He “constantly” forgets his school materials at home, or he forgets to turn things in at school, which later are found crumpled up in his backpack. He started elementary school “loving it” but now complains about the teachers being mean and unfair. At home, his parents say he is “all boy” and “a real handful” but is sweet, lovable, and funny. He is always on the go and makes the house “look like a tornado hit.” He has plenty of games and toys, but he says everything is boring. He plays loudly and avoids quiet activities. He “goes full steam all day until he runs out of energy at night.” He has few chores to do but is easily distracted while completing them so they rarely are completed. He is not overtly defiant, but rather he has difficulty following even simple instructions. He can occasionally get “fixated” while watching a movie or show, but otherwise he bounces from one activity to another. When he enters the PMHNP’s office he appears healthy with several scrapes and bruises on his arms and legs. His medical history was no significant except for a fractured wrist at age 3 years from falling off a high wall he was able to climb. He met all developmental milestones WNL or early. During toddlerhood, he was loving but very active with a very short attention span. He has always been an early riser in the morning. She has worried about being able to raise him well due to his tendency to do dangerous or destructive things without learning from past mistakes. K.G. attends the session with his mother only. His father is a salesman who travels out of town often and works late most nights when he is in town. K.G.’s mother says that his father minimizes the problems and says that she and the teacher are over-reacting, that “he is just an active boy.” She describes the father as restless and disorganized but successful due to his energy and drive. He graduated high school but was an “underachiever.” He cannot balance a checkbook, hates office work, is impatient, and procrastinates.
Read DetailsA Wisconsin patient has recently switched medications due to an insurance formulary change, and the patient has now experienced a bad reaction to the new medication. The patient asks their pharmacist about potential options. What can the pharmacist offer this patient?
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