The endocrine case study is crucial for integrating the concepts of pharmacology to supplement evidence-based prescription drugs to manage various diseases. Case study one presents a scenario requiring selecting an effective intervention plan for patients with diabetes mellitus type 2. Intervention, in this case, requires combined therapeutic and behavioral reform strategies. In case study two, the patient presented with diabetes and Atherosclerotic cardiovascular disease associated with a history of diabetes. Case study three presents an advanced case of diabetes mellitus type two patient. This paper seeks to apply the concepts of pharmacology in supporting evidence-based prescription in managing ASCV, diabetes mellitus type two and a combined case of diabetes mellitus type two and heart failure. From the study, metformin is a commonly prescribed drug.
Case Study #1: John Jones
John’s Diabetes Status and Treatment Plan
The laboratory results show John’s glucose level of 200mg/dl; this is an indication of hyperglycemia. More importantly, the HbA1C of 8.1 %, which shows John’s average blood glucose levels for the last three months, confirms diabetes (A OneCare Media Company). From the diabetes levels in John’s case, the treatment plan should integrate lifestyle modification, diet and medications to reduce high glucose saturation in the blood. Prescription will include prescribing oral metformin as first-line treatment for this type two diabetes.
Behavior to be addressed to Inspire Lifestyle Reforms and Reduce A1C Levels
To reduce the levels of A1C, initiating interventions for behavioral and lifestyle changes is crucial. John’s sedentary lifestyle and poor dietary habits involve fast food, sweet tea, and excessive coffee. In addition, motivation to engage in exercises will reduce highly gained weight and trigger eating behaviors (Arnett et al., 2019). Plan to reform high coffee intake, manage stress and establish a personalized strategy with goals to attain can inspire John to make sustainable lifestyle reforms.
Social History Behaviors Posing Potential Concern with First-Line Pharmacological Treatment for Diabetes
John reports occasional drinking with no physical activities could worsen his health condition due to potential concerns with first-line pharmacological treatment. For instance, prescribing Metformin as the first-line medication may lead to lactic acidosis when type diabetes patients consume alcohol (Arnett et al., 2019). Lactic acidosis, in this case, is associated with elevated levels of lactic acid build-up in the bloodstream, which can be fatal. In addition, combining alcohol with metformin can result in deranged liver function because the drug is metabolized in the liver before expulsion through the kidney (Arnett et al., 2019). However, side effects and pharmacological effects of combining alcohol with Metformin vary among patients. Thus, it is essential to advise John on reducing or avoiding alcohol consumption and monitor liver and kidney functions.
Specific Names of Lab and Intervals to Request and Monitor Safety and efficacy of Metformin
Lab Name
Kidney and Liver Function test lab in Arizona. Blood Sugar tests will also be requested from Arizona laboratories.
Intervals
Repeat Hemoglobin and Comprehensive Metabolic Panel A1C every three months initially, then change the monitoring based on John’s glycemic stability moderation (Arnett et al., 2019). The liver function tests can be done every two years to ensure safety.
Baseline
The comprehensive metabolic panel, haemoglobin A1C, Lipid Panel, and liver function examination tests such as the AST, GGT and ALT are monitored routinely to ensure the safety and efficacy of metformin first-line medication.
Counselling
John is advised to moderate alcohol consumption when using metformin medication.
Regular monitoring of estimated glomerular filtration rate
Routine monitoring of eGFR is essential to detect side effects in John after a metformin prescription every 6 months and then adjust to 6 months based on John’s stability.
Case Study #2: Alfonso Giuliani
ASCVD Risk Factors
Atherosclerotic cardiovascular disease risk factors include age, gender, race, hypertension, cholesterol values, and history of diabetes and use of tobacco. In addition, treatment of hypertension, statin therapy and aspirin treatment predispose patients to ASCVD. Alfonso’s risk factor includes hypertension, dyslipidemia and age and cholesterol levels of 280mg/dl, LDL of 193mg/dl would require statin therapy (Arnett et al., 2019). Thus, I would recommend vegetable-based diets such as legumes and lean vegetables to reduce the severity of ASCVD condition (Shane-McWhorter, 2022). In addition, replacing processed carbohydrates would reduce death associated with stroke. An increase in dietary sodium has a significant impact on hypertension and ASCVD, recommending a reduction in sodium intake is essential to preventing the condition.
Diabetic Drug Classes Considered in addition to Metformin for Alfonso
Alfonso presents with a high glucose level of 220mg/dl, indicating impaired glucose metabolism. Prescribing sulfonylureas drugs such as Glipizide, Glimepiride and Glyburide stimulates the pancreas to produce and release more insulin and complement metformin (Arnett et al., 2019). Sodium-glucose Cotransporter-2 is important to Alfonso’s condition, including drugs such as Dapagliflozin and Canagliflozin to help reduce glucose reabsorption in the kidneys and subsequent elimination through urine. In addition, prescribing dipeptidyl peptidase -4 inhibitor drugs in addition to metformin is considered to facilitate hypoglycemia and enhance heart functions.
Baseline Data to Obtain for Each Drug Prescribed in addition to Metformin
Dipeptidyl-4 inhibitors
Prescribing dipeptidyl-4 inhibitors will require baseline data regarding kidney function tests such as serum creatine. In addition, fasting blood glucose levels and haemoglobin A1C will be required to prescribe dipeptidyl-4 inhibitor drugs with Metformin.
Sodium-Glucose Cotransporter-2
Prescription of this drug, in addition to metformin, will baseline data from fasting blood glucose levels, haemoglobin A1C test results and blood pressure information.
Patient Teachings are required when prescribing a Combination of Liraglutide with Metformin for Alfonso.
Dosage and Administration
Alfonso presents with mild distress and is 68 years of age. Determines the type of teaching to be given regarding the administration of Liraglutide alongside metformin (Shane-McWhorter, 2022). Teaching on dosage and administration is essential to help Alfonso administer Liraglutide precisely. The drug is injected subcutaneously in the abdomen, upper arm or thigh at the correct dosage and intervals.
Injection Timing
Liraglutide is given at the same time daily, with or without food.
Blood Glucose Monitoring
Alfonso will need routine monitoring of blood glucose levels to ensure efficacy in this drug combination.
Lifestyle and Diet
Scrutinize the need to maintain a healthy diet and routine body exercises in addition to the two drugs.
Side Effects
Teach the patient about the potential adverse effects of using Liraglutide with metformin, such as vomiting, nausea, diarrhoea and constipation (Standards of medical care in Diabetes—2020 abridged for primary care providers, 2020). These insights will help Alfonso report any persistent and severe adverse effects to the healthcare provider.
Hypoglycemia Sensitization
Although Liraglutide exhibits low threats of causing hypoglycemia, enlighten Alfonso about symptoms of reduced blood glucose and appropriate response.
Injection Route site Rotation
Teach Alfonso to change injection sites to prevent lipoatrophy using appropriate demonstration.
Omitted Doses
Provide insight on what to do if she misses the dose and avoid taking the doable dose to cover the missed injection.
Storage and Travel
Teach the patient the need to warm the drug at room temperature prior to administration and proper storage when travelling. Follow-up appointments are essential to monitor the efficacy of the prescribed therapy and adjust the medication regime if necessary (Arnett et al., 2019). Teaching Alfonso about the interaction of the drugs with other medications is crucial. All teachings will focus on Alfonso’s needs and inspire transparency to solve their concerns.
Case Study #3: Helen Smith
Caution with Metformin Prescription
Caution is indicated if metformin was prescribed for Helen due to its contraindication associated with congested heart failure indicated by prominent S3 heart sounds (A OneCare Media Company, 2023). In addition to her condition of decreased ejection fraction, caution is required when giving metformin to prevent deteriorating her condition. Heart failure can cause elevated lactic acidosis due to impaired perfusion and oxygenation of tissues. Metformin is primarily eliminated by the kidneys, caution should be taken to prevent deranged renal and heart functions. Prescription of the drug to Helen, who has heart failure, needs precautions to prevent life-threatening events associated with congested heart failure (Wang et al., 2021). Administration of this drug will be influenced by Helen’s health condition, including the severity of congested heart failure.
Correct Levothyroxine Dose for Helen
With the standard starting dose of levothyroxine being 1.6 mcg/kg, if her weight was calculated in kilograms, this is the correct dose prescribed to her. However, the correct initial dose can differ based on Helen’s age, risk of heart attack, and comorbidities (A OneCare Media Company, 2023).In the presented Helen Case, a lower dose of 1.2 mcg/kg would be appropriate to prevent contraindications associated with her age and cardiovascular threats indicated by prominent S3 sounds. In addition, Helen presents with increased TSH levels of 24mU/L, an indication of hyperthyroidism requiring urgent therapy with levothyroxine, hence, the dosage is correct (The American Thyroid Association, 2019). The HbA1C level is 9.2 %, indicating undermined glycemic management, hence the need for a diabetic management strategy.
Helen’s Lab Values that Require Considerations for Possible Treatment and Lab Name
Glucose value of 189mg/dl is elevated showing possible diabetes management considerations. TSH value of 24mU/L is above lab reference value of 0.4-4.1mU/L, this indicates elevated thyroxin, hence consideration for thyroid hormone replacement therapy (Testing.com, 2022). Total cholesterol levels of from California clinics of 2540mg/dl are borderline elevated HDL:35mh/dl is low with triglycerides values are high at 260mg/dl. In addition, the HbA1c test value of 9.2 % is elevated,an indicative of diabetes (A OneCare Media Company,2023). California laboratory provides reference values of <5.7 % in the case of Helen, elevated HbA1C levels of 9.2 depict poor long-term blood sugar management, hence the need to adjust her diabetes management strategies (Testing.com, 2022). These indicate Helen requires improvement to her diabetes interventions, thyroid hormone replacement therapy and management of dyslipidemia.
DM Drug Class Contraindicated in Patients with Heart Failure
Thiazolidinedione is a class of drugs prescribed as second-line medications for diabetes mellitus type 2. The drug target and activate PPAR-gamma, which is a core receptor found in adipose tissue, liver cells and muscles (Rosenthal & Burchum, 2020). Drugs in this category are pioglitazone and rosiglitazone, these drugs are contraindicated in patients with heart failure due to underlying risks associated with its prescription without caution (Hurren & Dunham, 2020). First, this class of drugs cause increased fluid retention that may intensify heart failure symptoms. Fluid retention is a concern because it can cause elevated preload on the heart, hence exacerbating heart failure. Secondly, the use of this drug has the potential of elevating cardiovascular events and is not recommended for patients with heart failure (Giglio et al., 2022).In addition, the use of Thiazolidinedione is contraindicated in patients with established heart failure like Helen since it causes decreased heart function. Therefore, it is essential to evaluate the heart risk profile of the patient and factor in alternative diabetes management plans, especially in patients with heart failure.
Conclusion
Laboratory results are crucial in providing an effective treatment plan for various diseases. In cases of diabetes, conducting systemic examination in patient provide essential results for effective treatment planning. In case one, the patient’s medical and social results from systemic body evaluation provide insights into planning combination treatment interventions, including behavioral and therapeutic approaches. In case study two, the medical intervention plan for ASCVD patients requires understanding of medical history and risk factors associated with this cardiovascular condition. Case study three is essential for the effective management of diabetes mellitus.
References
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