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Patient Case #1

LT is a 31-year-old patient. She was assigned the male gender at birth and is completing the steps in order to undergo gender reassignment surgery. She has been a regular patient to your pharmacy to pick up her prescription for estrogen, but today she is getting spironolactone 100 mg po daily. Practice counseling her over this new prescription.

Questions

  1. What is the indication for spironolactone for this patient if she does not have heart failure or hypertension?

  2. When will the effects be noticed?

  3. When can gender reassignment surgery occur after the start of hormone therapy?

  4. Practice addressing a patient using their preferred pronouns when it does not necessarily match the gender assigned at birth. For example, if your patient appears female, practice referring to the patient as “him” and avoiding the terms “ma’am,” etc.

  5. Examine your own thoughts and biases regarding trans persons. In what way can you express empathy and support for what the patient is experiencing?

Patient Case #2

VR is a 71-year-old male Vietnam War veteran patient that was recently started on amlodipine 10 mg po daily, which is his third antihypertensive medication (in addition to lisinopril 20 mg po daily and hydrochlorothiazide 25 mg po daily) due to continued elevated blood pressure. VR often speaks ill of his physician and does not believe he is respected as a true veteran. After his exposure to Agent Orange during his time overseas, he is skeptical that the government has his best interests in mind. How would you counsel VR over his new prescription today?

Questions

  1. What questions will help you assess a patient’s medication adherence?

  2. What should be addressed to emphasize the importance of proper medication adherence?

  3. What is the concern with the patient starting to take his medications as prescribed after being effectively counseled over proper medication adherence?

  4. What is Agent Orange and what are its effects on Vietnam veterans?

  5. What is the effect of mistrust and perceived discrimination on medication adherence?

  6. What other screenings and/or lifestyle recommendations should be considered?

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