Case Study For Primary Care Medication Management Assignment

Post your answers to the 6 questions corresponding to this week’s content on primary care medication management. Provide your responses and rationales. Support your rationales with high-level evidence. (See Post Expectations).

An obese patient, age 45, comes to your office. She recently moved from another state three weeks ago and told you that her FNP diagnosed her with type 2 diabetes mellitus. She is currently not on any medicine for her diabetes, and she wishes to avoid insulin, if possible. She is a non-smoker. Her blood pressure is 138/74 mmHg. Labs from 3-weeks ago was hemoglobin A1C = 8.4%; total cholesterol = 260 mg/dL, triglycerides = 290 mg/dL, HDL = 49 mg/dL, LDL = 170 mg/dL (calculated 10-year ASCVD risk = 6.2%)Case Study For Primary Care Medication Management Assignment. You discuss current treatment goal recommendations endorsed by the ADA regarding glycemic control, blood pressure control, and lipid management. She agrees to start any medications that you recommend with lifestyle modification and a DASH diet to treat hypertension.

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Q1. Which classes of diabetes medications are either weight neutral or cause weight loss? Please give one (1) example of a drug’s generic and trade name in that class.

Q2. Based on the current guidelines of the ADA, it would be appropriate to treat her with monotherapy since the patient is hesitant to take any injections. What agent would you recommend? Please provide the trade name, generic name, the dose you would start the patient with frequency, and route.

Q3. What are the contraindications of your selected diabetic therapy?

The patient returns to your office six months later complaining of fatigue for the past two months, constipation, and heavy, irregular menses. Upon examination, you note that her skin is dry, and her fingernails are brittle. You suspect she has hypothyroidism.

Q4. What lab workup should you obtain? What sort of results will you see in patients who have hypothyroidism and hyperthyroidism?

Q5. What is the treatment of choice for hypothyroidism? What is the mechanism of action? Please provide the initial dose, trade, and generic name of the drug, route, and frequency.

Q6. What are the adverse effects, and what important teaching will you provide this patient on thyroid replacement therapy?

A minimum of 500 words, not including references
Citations: At least three high-level scholarly references in APA from within the last 5 years Case Study For Primary Care Medication Management Assignment

Which classes of diabetes medications are either weight neutral or cause weight loss? Please give one (1) example of a drug’s generic and trade name in that class

Diabetes is a disease that develops as a result of the body’s inability to produce or control the levels of insulin hormone thereby leading to too much or too little amounts of sugar in the blood. Diabetes medications considered as weight neutral are those that do not make an individual to either loose or gain weight. Weight neutral diabetes medication include Dipeptidyl peptidase-4 (DPP-4) inhibitors. An example of such medications is Vildagliptin which is its generic name and commercially sold as Galvus (Brown et al., 2017)Case Study For Primary Care Medication Management Assignment. Weight loss medications on the other hand include Biguanides medications effective for type 2 diabetes treatment. An example of such medications include Metformin which is its generic name and commercially sold as Glucophage.

Based on the current guidelines of the ADA, it would be appropriate to treat her with monotherapy since the patient is hesitant to take any injections. What agent would you recommend? Please provide the trade name, generic name, the dose you would start the patient with frequency, and route.

According to the American Diabetes Association, metformin is the first drug therapy that should be recommended to patients with Type 2 DM (Marx et al., 2021)Case Study For Primary Care Medication Management Assignment. I would therefore recommend Glucophage tablets, 500mg once in 24hours to be taken orally. Unless the patient has any other implications, Glucophage should begin immediately after diagnosis of type 2 diabetes. It will therefore be a monotherapy but such patients should be encouraged to incorporate lifestyle modifications that discourage diabetes.

What are the contraindications of your selected diabetic therapy?

There are many contraindications associated with metformin drug therapy. The medication is usually contraindicated with people suffering from congestive heart failure and therefore practitioners should be very cautious when selecting the medications to recommend (Siavash et al., 2017)Case Study For Primary Care Medication Management Assignment. Metformin is also contraindicated to people suffering from kidney impairments such as renal insufficiencies as a result of issues with lactic acidosis. Since Metformin is excreted by the kidneys, it may also accumulate as a result of renal problems thereby resulting to production of more lactic acidosis which may be fatal.

What lab workup should you obtain? What sort of results will you see in patients who have hypothyroidism and hyperthyroidism?

Thyroid gland occurs at the lower front of the neck as a very tiny gland. The blood tests used to check the functionality of a person’s thyroid include the T3, T4 and TSH. The thyroid helps the body to regulate several functions including generation of energy, mood and metabolism. The thyroid gland T4 is responsible for producing thyroxine and Triiodothyronine (T3) hormones. If these hormones are not produced in the correct amount, a person may experience various symptoms such as depression, fatigue and weight gain, a condition known as hypothyroidism characterized by High TSH, Low T4 and T3 (Ylli, Klubo-Gwiezdzinska & Wartofsky, 2019)Case Study For Primary Care Medication Management Assignment. However, if there is overproduction of these hormones, one may experience, high anxiety levels, sense of being high, tremors and weight loss resulting to hyperthyroidism condition characterized by low TSH, High T4 and T3.

What is the treatment of choice for hypothyroidism? What is the mechanism of action? Please provide the initial dose, trade, and generic name of the drug, route, and frequency.

My choice of hypothyroidism treatment is levothyroxine. It is a form of synthetic thyroid hormone that is synthesized and released by thyroid gland. The mechanism of action of levothyroxine is increasing the rate of metabolism of cells of every tissue in the body (Ylli, Klubo-Gwiezdzinska & Wartofsky, 2019). To prescribe levothyroxine which is its generic name but sold under the name synthroid, I would start the patient with 50mcg tablets, taken orally once in 24hours.

What are the adverse effects, and what important teaching will you provide this patient on thyroid replacement therapy?

The adverse effects depend on the patient’s conditions such as in the contraindications mentioned above. The side effects therefore mostly depend on the health condition of the kidney of the patient. For instance, recommending metformin to patients with kidney impairments may result to renal failure which is associated with production of the fatal lactic acidosis (Siavash et al., 2017). The dosage therefore requires a thorough consideration of the patient’s age, medical condition, weight and the patient response to the medication. Some of the important teaching that I would provide to the patient include taking levothyroxine the first thing in the morning, preferably one hour before eating anything. This will help in consistency maintenance when taking the medication thus helping to avoid any levels of thyroid swings. I would also inform the patient that the medication depends on their weight, age, response to medication and their medical condition Case Study For Primary Care Medication Management Assignment.

References

Brown, A., Guess, N., Dornhorst, A., Taheri, S., & Frost, G. (2017). Insulin‐associated weight

gain in obese type 2 diabetes mellitus patients: what can be done?. Diabetes, Obesity and

Metabolism, 19(12), 1655-1668. https://doi.org/10.1111/dom.13009

Marx, N., Davies, M. J., Grant, P. J., Mathieu, C., Petrie, J. R., Cosentino, F., & Buse, J. B.

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(2021). Guideline recommendations and the positioning of newer drugs in type 2 diabetes

care. The lancet Diabetes & endocrinology, 9(1), 46-52.

https://doi.org/10.1016/S2213-8587(20)30343-0

Siavash, M., Tabbakhian, M., Sabzghabaee, A. M., & Razavi, N. (2017). Severity of

gastrointestinal side effects of metformin tablet compared to metformin capsule in type 2

diabetes mellitus patients. Journal of research in pharmacy practice, 6(2), 73.

https://DOI: 10.4103/jrpp.JRPP_17_2

Ylli, D., Klubo-Gwiezdzinska, J., & Wartofsky, L. (2019). Thyroid emergencies. Polish archives

of internal medicine, 129(7-8), 526. doi: 10.20452/pamw.14876 Case Study For Primary Care Medication Management Assignment