View Patient Profiles

Patel, Dahlia

MRN: 298415

Room: Exam #2

DOB: 6/12/1962

Age: 63

Gender: Female

Allergies: Cephalexin (rash)

Admit Notes

Clinical Notes

Vitals

Labs, Cultures, Imaging

Clinical Calculators

MAR

Current Orders

Home Med List

Med Reconciliation

Discharge Planning

Setting	Cancer Center Clinic
Scenario	The attending physician will admit the patient to the inpatient hospital ward for treatment. As the clinical pharmacist, you are seeing the patient for the first time with the attending physician at this time. The attending has stated that she is not considering adding any new therapy for DP’s cancer treatment, but would entertain any recommendations you may have on her current regimen. The attending considerers DP’s diarrhea as grade II, which is defined as an increase of 4-6 stools/day over baseline, not interfering with activities of daily living.
Admission note taken on 10/19/25
CC	diarrhea, SOB, rash (face and back)
HPI	DP presents to the medical oncology clinic today for diarrhea which she describes as 4-6 more stools over baseline, but it does not interfere with her activities of daily living. She also states she has a rash on her face and back. She also complains of progressively worsening shortness of breath. Finally the patient reports increased left arm pain of 7/10 intensity, changed from a baseline 2/10 intensity 3 months ago.
PMH	Metastatic breast cancer (ER /PR negative, Her2Neu positive) treated with left mastectomy, trastuzumab, and FAC (5-flurorouracil, doxorubicin, and cyclophosphamide) as adjuvant chemotherapy. DP is also taking a nutritional supplement called Avemar because she heard it could be useful in the treatment of breast cancer. Avemar has been associated with diarrhea, nausea, flatulence, soft stool, and constipation. She developed metastatic disease (to the liver and bones) 6 months ago and is currently on lapatinib and paclitaxel. She has had some worsening dyspnea since starting that regimen. DP also has a 6 month history of neuropathic pain in the left axillary area associated with her malignancy. The patient has no cardiac history and all cardiac studies prior to her cancer therapy have been within normal limits. She has a history of type II diabetes for the past 15 years. She checks her blood glucose before meals and it is usually between 80-100 mg/dL. Two days ago the patient visited her primary care physician for shortness of breath. The physician prescribed clarithromycin for suspected community acquired pneumonia.
Social History	Tobacco: 1 ppd x 35 years, has not smoked in 2 years ETOH: 1-2 drinks/month Illicit Drugs – None Caffeine: 1-2 cups of coffee/day Occupation: Investment banker Status: Married Children: 2 (1 male 40, 1 female 37) Physical Activity: No regular exercise, limited ADLs Diet: No specifics	Family History	Father: 85, alive, DM, HTN Mother: 84, alive, osteoporosis Sister: 60, alive, pancreatic cancer Brother: 66, alive, HTN
Vaccine History	None	Surgical History	None
Physical Exam	General: Pleasant, slightly obese woman with slight shortness of breath Skin: Warm, left mastectomy scar present; acneiform rash on face and back Neck/LN: Neck supple; no lymphadenopathy, thyromegaly, or masses. No supraclavicular or infraclavicular adenopathy HEENT: PERRLA, EOMI, pink conjunctivae, TMs intact Chest: crackles at both bases CV: RRR, S1, S1 normal; (+) S3; (–) S4; normal carotid pulses without bruits Abdomen: Soft, obese; hyperactive bowel sounds with diarrhea; no rebound tenderness or guarding; no hepatosplenomegaly Genit/Rect: Deferred MS/Ext: 1+ edema in both lower extremities; no clubbing or cyanosis Neuro: A&O x 3; CN II-XII intact; DTRs 2+ throughout; (–) Babinski, Severe allodynia centered in L axillary region extending from the left mid-clavicular line to the left mid-scapular line between the 2nd and 5th ICS

Clinical Laboratory Report

Test Name	10/19/25	07/31/25	Range
Sodium (Na⁺)	138	140	136-145 mEq/L
Potassium (K⁺)	3.7	4.1	3.5-5 mEq/L
Chloride (Cl^-)	104	100	98-106 mEq/L
Bicarbonate (HCO₃^-)	18	22	23-28 mEq/L
Urea nitrogen (BUN)	52	19	8-20 mg/dL
Creatinine	1.6	0.8	0.5-1.3 mg/dL
Glucose	108	94	70-115 mg/dL
Hemoglobin A1c	7.8	7.5	5.3-7.5 %
Calcium,Total	10.5	10.2	8.6-10.2 mg/dL
Phosphate	3.5	3.6	3-4.5 mg/dL
Magnesium	2.0	1.9	1.6-2.6 mEq/L
Protein, total	7.1	7.4	5.5-9 g/dL
Albumin	3.9	4	3.5-5.5 g/dL
Aminotransferase,aspartate (AST)	115	104	10-40 units/L
Aminotransferase,alanine (ALT)	97	88	10-40 units/L
Lactic dehydrogenase (LDH)	155	162	80-225 units/L
Alkaline phosphatase	73	69	30-120 units/L
Bilirubin, Total	0.7	0.6	0.3-1 mg/dL
Leukocytes (WBC)	9.9	5.8	4.5-11 x10³/mcL
Red blood cells (RBC), Female	5.1	4.9	4.3-5.7 x10⁸/mcL
Hemoglobin, Female	12.5	13.0	12-16 g/dL
Hematocrit, Female	33	36	37-47 %
Mean corpuscular hemoglobin (MCH)	29	31	27-33 picogram
Mean corpuscular volume (MCV)	86	81	76-100 mcm³
Platelets	211	242	150-450 x10³/mcL
International normalized ratio (INR)	1.1	1.0	0.8-1.2
Prothrombin time (PT)	10.6	10.2	9.5-11.3 sec
Partial thromboplastin time,activated (aPTT)	33	34	25-35 sec

Additional Labs:

Other (today)

B-type natriuretic peptide (pg/mL) Pending

Cultures:

Stool for ova and parasites (today): negative
Clostridium difficile toxin (today): negative

Imaging Studies:

Chest X-ray (today)

Radiologist preliminary report: Bilateral fluid in bases of lungs, inconsistent with pneumonia.

Multigated acquisition (MUGA) scan (today)

Cardiologist preliminary report: EF of 35% (7 months ago previous MUGA reported 55%)

Vital Sign	10/19/25 09:12	07/31/25 07:27
Height (cm)	168	168
Weight (kg)	79.5	73.9
Body Temperature (°C)	37.9	36.7
Blood Pressure (mmHg)	110 / 75	128/90
Heart Rate (bpm)	110	67
Respiratory Rate (bpm)	20	12
Oxygen Saturation (%)	92	97

Current Orders

Medication
History

The patient reports that she takes all her medications regularly.
The patient has not missed any doses of paclitaxel in the clinic and has had consistent refills of lapatinib.
All pain medications have been filled regularly, except the controlled release oxycodone has not been filled in the last 2 weeks.
She continues to take the oxycodone CR, although she does not take the oxycodone IR since it does not seem to help the pain much. She is not currently comfortable on her current pain regimen.
Prior to this clinic visit she was having bowel movements regularly every other day.
The herbal product (Avemar) compliance cannot be confirmed, since the patient’s pharmacy does not stock this product. There is no compliance history for the over the counter medication(s).

Home Medication List: verified by pharmacy on admit (10/19/25)

Patient Name: Patel, Dahlia Date of Birth: 6/12/1962 Room#: Exam #2	Allergies:	Immunization History:
Community Rx Info: Rx Insurance:	Social History:
Additional Notes:

DRUG STRENGTH DF	STRENGTH ROUTE FREQ	PRN?	LAST DOSE (date/time)	ADVERSE EFFECTS	ADHERENCE	NOTES	MED REC ACTION
Wheat Germ Extract (Avemar) 17 g granules	1 packet PO QD	no	8:00 10/18/25	none	never misses
Clarithromycin 500 mg tablet	1 PO BID	no	17:00 10/18/25	none	never misses	on day 3 of treatment
Duloxetine 30 mg capsule	1 PO QD	no	8:00 10/18/25	none	never misses
Pregabalin 50 mg capsule	1 PO TID	no	21:00 10/18/25	none	never misses
Oxycodone CR 40 mg ER tablet	1 PO BID	no	21:00 10/18/25	none	never misses	pain controller
Oxycodone IR 10 mg tablet	1 PO q3H	yes, pain		none	not taking for past couple of days (not effective)	takes for breakthrough pain
Senna 8.6 mg tablet	1 PO BID	no	21:00 10/18/25	none	never misses
Pioglitazone 30 mg tablet	1 PO QD	no	8:00 10/18/25	none	never misses
Pamidronate	90 mg IV every month	no		none	never misses
Paclitaxel	175 mg/m2 IV every 3 weeks	no		none	never misses
Lapatinib 250 mg tablet	5 tabs PO QD	no	8:00 10/18/25	none	never misses
							Action Key: C = Continue, D = Discontinue^, H = Hold^, M = Modify^* ^*must provide reason

Medication

10/19/25

Clinical Notes

Medication Discharge Orders

Hospital Medications
Medication	Instructions	Comments	Continue	Modify	Discontinue	New Rx sent

Previous Home Medications
Medication	Instructions	Comments	Continue	Modify	Discontinue	New Rx sent

Discharge Planning - Medication List and Instructions

Patient Name:
Admission Date:	Discharge Date:	Service:
Principle Diagnosis on Admission:
Secondary Diagnosis:
Allergies:

Medications ADDED this visit: (begin taking these)	Medications CHANGED this visit: (modify what you were taking)	Medications STOPPED this visit: (stop taking these)

Final Discharge Medication List
Medication/Route/Dosage/Frequency/Duration	Comments	Morning	Afternoon	Evening	Bedtime










As Needed Medications

Medication Reconciliation - Finalized Medication List

Patient Name: Patel, Dahlia

Date of Birth: 6/12/1962

Room: Exam #2

Medication (name/strength)	Dose	Route	Frequency	Notes

Height	168 cm
Actual Body Weight (ABW)	79.5 kg
Ideal Body Weight (IBW)	59.3 kg
ABW % of IBW	134 %
Adjusted Body Weight (AjBW)	67.4 kg
Body Surface Area (BSA)	1.93 m²
Body Mass Index (BMI)	28.2 kg/m²