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Relevant Evaluation Criteria Scenario/Model Outcome
Information Gathering
1. Gather essential information about the patient’s symptoms, including:
a. description of symptom(s) (i.e., nature, onset, duration, severity, associated symptoms) Patient has battled overweight and obesity his entire adult life. He has never been severely obese but tends to gain 10 to 15 pounds per decade. His obesity does not affect his ability to perform activities of daily living.
b. description of any factors that seem to precipitate, exacerbate, and/or relieve the patient’s symptom(s) Patient is a stress eater: he tends to snack on unhealthy foods at work and late at night.
c. description of the patient’s efforts to relieve the symptoms Various diets and exercise programs have been tried over the past 2 decades. Patient is usually able to lose a few pounds but gains it back when stresses of life contribute to declining compliance with diet and exercise regimens.
2. Gather essential patient history information:
a. patient’s identity John Coughlin
b. patient’s age, sex, height, and weight 45-year-old male, 5 ft 10 in, 220 lb
c. patient’s occupation Computer software engineer
d. patient’s dietary habits Typically skips breakfast and eats a sweet roll with his coffee mid-morning on workdays. Eats healthy lunch in workplace cafeteria. Wife fixes large dinner in evenings. He often gets pretzels and chips from snack machine at work and likes to eat candy and popcorn when working on home computer late at night.
e. patient’s sleep habits Goes to bed late, gets up early in morning: averages about 6 hours of sleep per night
f. concurrent medical conditions, prescription and nonprescription medications, and dietary supplements Simvastatin 20 mg daily forhyperlipidemia: lisinopril 10 mg daily for hypertension
g. allergies NKA
h. history of other adverse reactions to medications None
i. other (describe) N/A
Assessment and Triage
3. Differentiate the patient’s signs/symptoms and correctly identify the patient’s primary problem(s). Patient’s body mass index is 32, placing him in the obese category. Lack of exercise and poor dietary habits are probably contributory.
4. Identify exclusions for self-treatment. On the basis of the patient’s age and weight, he should see a primary care provider for medical clearance before beginning an exercise program.
5. Formulate a comprehensive list of therapeutic alternatives for the primary problem to determine if triage to a medical practitioner

is required, and share this information with the patient.

Options include:
(1) Refer John to a dietitian and/or personal trainer for diet and exercise advice, respectively.
(2)  Refer John to a primary care provider for prescription medication for obesity.
(3) Counsel John on diet and exercise.
(4)  Recommend nonprescription orlistat.
(5) Recommend a dietary supplement for weight loss.
(6)  Take no action.
Plan
6. Select an optimal therapeutic alternative to address the patient’s problem, taking into account patient preferences. Because of previous failures with diet and exercise alone, the patient chooses to try orlistat while again trying to diet.
7. Describe the recommended therapeutic approach to the patient. Take orlistat up to 3 times a day before meals that contain fat, as described in the text.
8. Explain to the patient the rationale for selecting the recommended therapeutic approach from the considered therapeutic alternatives. You can anticipate that weight loss may be slightly easier to achieve when combining orlistat with diet and exercise, compared with diet and exercise alone.
Patient Education
9. When recommending self-care with non-prescription medications and/or nondrug therapy, convey accurate information to the patient:
a. appropriate dose and frequency of administration 60 mg up to 3 times a day
b. maximum number of days the therapy should be employed Greatest benefit is usually seen within first 6 months of therapy.
c.product administration procedures Take before meals containing fat. Minimizing dietary fat and spreading it out between all meals should help to minimize the gastrointestinal side effects such as flatus and oily discharge associated with orlistat. Taking a multivitamin supplement at bedtime is wise in case fat-soluble vitamin malabsorption occurs with orlistat.
d. expected time to onset of relief Weight loss should be detected with the first 2 weeks of initiating orlistat therapy along with diet and exercise regimen.
e. degree of relief that can be reasonably expected Many patients lose 5 to 10 pounds during the first 6 months of therapy.
f. most common side effects Flatulence, oily spotting, loose and frequent stools, fatty stools, fecal urgency, fecal incontinence
g. side effects that warrant medical intervention should they occur None
h. patient options in the event that condition worsens or persists Consult a dietitian or personal trainer for diet and exercise advice, respectively, or see a primary care provider for prescription medication for weight loss.
i. product storage requirements No special requirements
j. specific nondrug measures Continue diet and exercise measures. Find exercise that is enjoyable and thus sustainable. Attempt to reduce stress and thus stress eating. Too little sleep has been associated with increased body weight, so sleep hygiene measures may be helpful.
10. Solicit follow-up questions from patient. Can I double the dose of medication if weight loss slows?
11. Answer patient’s questions. Dosage above 60 mg up to 3 times a day should be attempted only under the supervision of a primary care provider.

Spanish And French Translations Of Common Medication Words:

English Spanish French
Medications Medicamentos Médicaments
Tablets Comprimidos Comprimés
Capsules Cápsulas Gélules
Pharmacies in the United States
Top 10 Pharmacy chains in the U. S. ranked by the number of pharmacists:
1 Walgreens 2 CVS 3 Walmart 4 Rite Aid 5 Kroger
6 Target 7 Kaiser Permanente 8 Sears 9 Cardinal Health 10 Dominick's
Pharmacy-led chains in the United Kingdom
Alliance Boots The Co-operative Lloyds Pharmacy
Numark Rowlands Pharmacy Superdrug

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Name, Strength, Form, Route
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(The World's Largest Pharmaceutical Companies: Abbott, Amgen, AstraZeneca, Baxter, Bayer, Bristol-Myers Squibb, Boots, CSL, Eli Lilly, Forest, GlaxoSmithKline, Hoffmann - La Roche, Johnson & Johnson, Merck & Co., Mylan, Novartis, Pfizer (with Wyeth), Sanofi - Aventis, Sandoz, Solvay, Takeda, Teva, UCB, Watson)
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