Case Stem

You are the ward pharmacist. You are now at the bedside table of Sam Wong, with Dr Melody present in the room. The doctor has a drug query for you. You have access to inpatient progress notes. If necessary, you may ask the doctor and/or the carer to gather information. When you are ready to make a recommendation, please communicate your recommendation to the both doctor and carer/patient then consult them about your plan.

Inpatient Progress Notes

Today 0800h - General Medicine

78 yo, male, admitted to hospital yesterday after tripping over a stone accidentally when hanging out.

Observations

• BP 132/87 mmHg, HR 78 bpm, Temperature 36.5C
• Weight 64 kg
• Height 176 cm

Investigation

• T-score (hip): -2.6
• T-scores (femur): -2.3
• Z-score: - 1.4
• Vitamin D lv within range.
• eGFR >90

PMHx