Patient Presentations and Drug Classifications

Patient Presentation 1

• A 65-year-old woman presented with constipation lasting two weeks
• Described stool as hard, bullet-like
• No significant past medical history
• Social drinker, non-smoker
• Blood pressure: 110/70 mmHg
• Pulse rate: 70 bpm
• Temperature: 37.5°C
• Used over-the-counter medication for constipation

Drug Classification

• Docusate sodium is a stool softener
• Classified as a surfactant
• Also available as a suppository
• Often recommended for mild constipation

Teaching Points

• Docusate sodium inhibits fluid secretion in the small bowel
• Acts as a surfactant
• Also available in suppository form
• Demulcents form a protective film over mucous membranes (lasts less than 30 minutes)

Patient Presentation 2

• Patient with right maxillary sinus pain, nasal congestion, and thick yellow secretions
• Used nasal decongestant spray, saline spray, and anti-inflammatories for several days
• 10 days later presents with worsening pain, thick drainage, low-grade fever, and pain around the 2nd maxillary molar
• Requires an antibiotic for sinusitis if no allergies
• First-line treatment: high-dose amoxicillin or amoxicillin/clavulanate for adults/children not using antibiotics in the past 4–6 weeks.

Patient Presentation 3

• 72-year-old female patient with lower-risk myelodysplastic neoplasms (LR-MDS)
• Characterized by symptomatic anemia that is transfusion dependent
• Erythropoietin (EPO) level: 200 mU/mL
• Cytogenetic analysis: deletion on the long arm of chromosome 5 [5q (del(5q))]
• Platelets and neutrophil counts are normal
• Most appropriate treatment: Luspatercept

Patient Presentation 4

• 34-year-old woman
• History of pulmonary embolism and deep venous thrombosis (DVT)
• Chronic liver disease, migraine without aura, coronary artery disease, and polycystic ovarian syndrome (PCOS)
• Smoker, no alcohol or illicit drug use
• Absolute contraindications for oral contraceptive pills: history of venous thromboembolism, smoking if over 35, uncontrolled hypertension, migraine with aura

Medical Conditions

• Myelodysplastic neoplasms (MDS) previously known as myelodysplastic syndromes
• Group of clonal hematopoietic disorders
• Characterized by persistent and unexplained cytopenias, morphologic dysplasia, and inadequate blood cell production
• Annual incidence rate: at least 4.5 per 100,000 people
• Median age at diagnosis: seventh decade
• Can manifest at any age (especially with secondary MDS)
• Pathogenesis involves recurrent genetic alterations and epigenetic dysregulation
• Anemia is prevalent in low-risk myelodysplastic neoplasms (LR-MDS).

Treatment and Considerations

• High-dose amoxicillin or amoxicillin/clavulanate
• Treatment for patients with EPO levels lower than 500 mU/mL: lenalidomide

This quiz focuses on two patient presentations involving constipation and sinus pain. It reviews the use of docusate sodium as a stool softener and highlights key teaching points related to its action and classification. Additionally, it discusses symptoms and management strategies for sinus issues.