Summary of evaluation

Present materials: two H&Ps, ten pharm cards and one article

In the mid-rotation evaluation site visit, I present a patient with adverse side effect of drug. Patient is in her 20s, and reports feels down, depressed, crying almost every day, fatigue, nausea, abdominal cramps, hot flashes, and difficulty falling asleep or staying asleep after getting injection of Depo-Provera. This case allows me to explore the side effects other than weight gain for the birth control. Typically, most patients will report with weight gain as side effect, but will have other side effects, like in this case, depression. I find an article that talks about side effect of Depo-Provera shot, which find out that patients have higher risk of fracture with use of depo shot or combined contraception, because exposure may have negative effects on bone metabolism, resulting in impaired bone mineral acquisition. We need to pay attention to those patients who having Depo shot, and inform the patients with side effects. Furthermore, as healthcare provider, we should inform medication indication and side effects whenever we start a new medication or adjust medication and make sure patient understand these changes as well.

In the final evaluation site visit, I write up for migraine case. Patient is a 28 years old female with no significant past medical history c/o headache for 2 days. The pain starts abruptly, located in the back of left eye and frontal part of the head, constant, throbbing and tightness, 10/10, no radiation, no particular pattern. Reports photophobia, dizziness, and darken room relieve the pain. From the HPI, the patient has all typical presentations of migraine, and we start patient on Excedrin Migraine tablet, and patient mentioned Erenumab, which is new to both my preceptor and me. Erenumab was approved in 2018 by FDA, and we find some articles concludes that Erenumab works for prevention of episodic migraine. However, we persuaded patient that we will start on traditional way, Excedrin Migraine, because Erenumab is a relatively new drug, we do not know the long-term effects yet.

Feedback received

Mrs. Stephens gave feedback for my H&P, which helps a lot. For description of pain, it should be more concise and in chronological order, and she also provided an example how it should be written, which I find extremely helpful.

Need to improve:

• Will need to work on patient education part, every time initiate a new medication or make adjustments of medications, need to explain to patient and also discuss the side effects as well
• Diagnosis imaging/labs for specific presentations patient have

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