Case: VTE and antiplatelets Name: Khafra HermanAge: 75Gender…
Case: VTE and antiplatelets Name: Khafra HermanAge: 75Gender: MaleMedical History: Hypertension, Hyperlipidemia, Depression, arthritis in R hipChief Complaint: “I’m here for my pre-op appointment. I’m having my right hip replaced in 2 weeks.” HPI: KH has been having right hip pain due to arthritis for the last few years. After meeting with an orthopedic surgeon, it was decided that he should have a hip replacement, which is currently scheduled for 2 weeks from now. Today, the patient is meeting with the pharmacist in clinic to complete the pre-op medication history. KH states that he has been taking his lisinopril and amlodipine for high blood pressure for the past 15 years. He has been on cholesterol medications for awhile and he was changed to his current atorvastatin dose about 8 years ago after the guidelines changed. He has been on sertraline for his mood for many years and his mood has been stable. He has been taking aspirin for a ‘long time’ and his PCP recommended that he start taking it to prevent a heart attack many years ago. He takes his acetaminophen at least once a day for his hip pain, sometimes more if he has an active day. Current Medications: Lisinopril 40mg daily Amlodipine 5mg daily Atorvastatin 80mg daily Sertraline 50mg daily Aspirin 81mg daily Acetaminophen 500mg 1-2 tablets q6 hrs prn hip pain Social history: 1-2 beers in the evening after work, walks the dog at least once a day for ~10-15 minutes when he’s able to tolerate the pain Labs: Serum creatinine: 1.0 mg/dLCalculated CrCL (Cockcroft-Gault, actual body weight): 81 mL/min Vitals: BP: 122/78 mmHg 10-year ASCVD risk: 26.6%
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