Question 1

Adam is an active, healthy 5'10" 34 year-old man weighing 145 pounds. He presents to your clinic with complaints of wheezing, dyspnea, cough, and sputum production, especially when running. He informs you that he is an avid marathon runner competing in one to two 5 or 10K runs per month. He tells you that he is symptomatic more than 2 times per week, but less that 1 times per day, and nighttime symptoms hardly ever occur. He also adds that his symptoms can get worse after and sometimes during his runs, especially when the outside temperature drops below 50°F.

Please provide a list of differential diagnoses, as well as indication of your primary diagnosis.

What is your pharmacological plan for your primary diagnosis including the medication, dose, and mechanism of action?

Question 2

Your patient returns to your office 4 weeks following his initial appointment in Part One with only moderate reduction in symptomology and an increase in nightly symptoms to 1 time per week. Upon closer inspection of his medical records you notice that he has also been prescribed metoprolol (25 mg/day extended release) for uncontrolled familial hypertension.

What is the mechanism of action of metoprolol, and why is this an important issue in this patient? Be sure to contrast the differences between your prescribed/discussed medication in Parts One and Two and the metoprolol discovered in Part Three. Also, include your new patient plan with medication changes and details of dose and mechanism of action.