Discussion # 13: Discuss the FDA approach for liver safety for new drugs. Support discussion with 1 journal no older than 5 years. Discussion Question #14 Discuss an advantage and one disadvantage of one non-narcotic drug used for chronic pain syndrome. Discussion week 15: (Worth 1 point) Discuss a current issue on a pharmacological agent and your opinion. Support with 1 peer reviewed journals no older than 5 years. Discussion #12 CARDIOVASCULAR CASE STUDY ACC/AHA Guidelines Chief complaint: medication refill " I ran out of medicines" HPI: E.D a 65-year-old AA male presents to the clinic for prescription refills. The patient also indicates that she has noticed shortness of breath which started about 4 months ago. The SOB gets worse with exertion, especially when she is walking fast and it is resolved when he is resting. He reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. His symptoms of shortness of breath resolve after sitting upright on 3 pillows. He also has lower leg edema pitting 1+ which started 2 weeks ago. He also indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight stairs, but it resolves after sitting down to rest. He has not tried any over the counter medications at home. He never filled her prescriptions that he received at her checkup 6 months ago, she did not think it was important. PMH: Primary Hypertension Previous history of MI 1 year ago Surgeries: 1 year ago-Left Anterior Descending (LAD) cardiac stent placement Allergies: Penicillin Vaccination History: He receives an annual flu shot. Last flu shot was this year Has not had a Td in over 10 years Has not had the herpes zoster vaccine Social history: High school graduate, married and no children. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago. Family history: Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52. ROS: Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea Cardiovascular: + 2 pitting leg edema for 3 weeks. Psychiatric: Pt sated not taking medications for 6 months - "ran out and did not get refills" Physical examination: Vital Signs Height: 5 feet 1 inches Weight: 163 pounds BMI: 31 obesity, BP 157/87 T 98.0 po P 110 R 22, non-labored HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase no clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without ra.