Assignment task:
Barbara Witten, 67 year old female client is taking methotrexate for RA for last 2 years with doses steadily increasing to attempt the therapeutic response. She was taling the maximum weekly dose for 6 weeks and has still experiencing moderate disease activity. The physical examination is normal other than joint pain and swelling. Along with non-pharmacologic interventions, NSAIDs and glucocorticoids, NP considers other pharmacotherapy for RA. Past medical history: RA, Allergies: None, Medications: Methotrexate 30 mg PO once per week, folic acid 5 mg PO once per week.Social history: Nonsmoker, drinks alcohol a few times per year on special occasions. Physical exam : temp 101.4, BMI: 23.8, BP 130/81.NP prescribes etanercept (Enbrel) 50mg/mL prefilled syringe, Administer one 50mg prefilled syringe subcutaneously in the upper thigh or abdomen once per week.
Rationale: The client has been taking the maximum amount of methotrexate without adequate symptom relief. CPGs state that in that case, providers can consider adding a TNF antagonist (biologic DMARD) to methotrexate therapy, in addition to NSAIDs and glucocorticoids for short-term symptom relief. Since the client is not experiencing adverse effects from methotrexate, adding a biologic DMARD to current therapy is indicated. The NP should schedule a follow-up appointment with the client in about six weeks to assess whether the client is experiencing relief and to ensure she is not experiencing adverse effects, which is why no refills are currently prescribed (Fraenkel et al., 2021).
1. Describe your assigned client's situation. Why are they presenting to the clinic? What medications are they currently taking? Want Assignment Help?
2. Assess the applicable clinical practice guideline (CPG) for your assigned client. What treatment is recommended by the CPG for your client's situation?
3. Discuss your personal professional assessment of the client's situation provided in the scenario. What pharmacological treatment is necessary and why?
4. Reflect on additional questions you have about your assigned client that may influence treatment. What else do you need to know? What follow-up assessments, labs, or conversations are required to ensure optimal health outcomes?