Where you are
You are an FY2 in Medicine.Who the Patient is
Miss Maria Smith, aged 80, has been diagnosed in Acute Pyelonephritis. She has a history of rheumatoid arthritis. She has hypertension. Weight 65kg.Other Information you have about the patient
eGFR is 50.Regular Medications
Amlodipine 10mg OD.
Methotrexate 7.5mg once weekly every Tuesday.
Folic acid 5mg once weekly.What you must do
Consultant has requested you to start her on Cefalexin.Special Note
Patient is allergic to clarithromycin. Patient had rash.
Shortcut:
- Antibiotic: CEFALEXINE 500mg PO BD 7 days
Additional information: Review in 48 hours - Hold Regular: METHOTREXATE 7.5 mg PO OW (Tuesday)
Additional information: Hold for one week then resume once a week - Regular: FOLIC ACID 5mg PO OW (Wednesday)
- Regular: AMLODIPINE 10mg PO OD
Explanation:
Antibiotic: Cefalexin 500 mg BD for 7 days, for acute pyelonephritis.
Hold methotrexate for the duration of antibiotics. We need to cross out the days Methotrexate is not given with a X. Its once weekly, in task you would be given the day patient takes methotrexate, apart from the day you would cross out every other day in this task. Similarly, when giving folic acid you would cross it on the day methotrexate is given with a X Dr if it is a daily regimen.
For folic acid we can follow the regimen given to us, and hold it on the day we give methotrexate.