That's so unfair they made everyone do the same case. The afternoon ones would've had an advantage. I did:there was only i case i think. there wasn't enough time so i only put the following
- macrodantin CI with low crcl, and lower limb sensory loss
- implement methotrexate due to poor management of RA
- change NSAID to paracetamola adn fish oil
- delay sulfasalazine (stupid)
i missed the big sulfur allergy which was pretty stupid, and the finasteride one.
what did you get?
- replace macrodantin with amoxycillin + clavulanic acid. So glad I used the 2009 AMH not 2008, because 2008 doesn't say it's CIed. Even though I wasted so much time getting used to the electronic format (I'm a hardcore hardcopy person)
- keep on hydroxychloroquine because even though I forgot to ask if this flare up has happened before, it says on the table it's been effective till now. I actually didn't put two and two together that sulfasalazine had sulfur in it (how stupid!) but I reasoned there was no point starting them on a new drug that had more side effects if it had been effective till now. So net conclusion = didn't start sulfasalazine, remained on hydroxychloroquine at same dose
- I didn't put methotrexate as it has a lot of side effects associated with it and it's indicated for moderate rather than mild RA.
- increased fish oil. but not to the correct amount as I misread. misread it as prescribing 2.7g which is right, but only of the active amount. argh!
- I thought about paracetamol, but RA is inflammatory and I thought an NSAID would be better (haha probably is better actually, now that my fish oil amount is still not high enough). So I replaced piroxicam with meloxicam, since celecoxib has sulfur in it.
BPH I didn't address--apparently everyone had different answers depending on the interviewer. Mine said Flomaxtra was too expensive, yeah I admit I didn't ask about BPH but mine emphasised the pins and needles and RA were really bothering her. I forgot to address smoking as well. And I used two versions of the AMH bcos I simply lost patience with eAMH 09 so used my hardcopy 08.