Advanced Pharmacology

You have been following your patient for the past 2 years. You have worked with them to lose weight by changing lifestyle and nutritional habits. They continue to be overweight (body mass index [BMI] of 33) and have tried to cut down carbohydrate and fat intake, but now presents with polyuria, polydipsia, and an elevated random blood sugar of 164. You have ordered anHbA1c test in the past, and the values were less than 6.2%. However, the most recent test indicated an HbA1c greater than 7%. They are not on any medications, but does have a sulfa allergy.

You officially have enough evidence to officially start treating this patient for Type II Diabetes Mellitus.  Their 3 P symptoms, their random  blood sugar (BS), and A1C are all evidence ofT2DM.

Answer the following questions. 

  1. What is the first medication you would prescribe? Discuss how you determined which one to give first and how you based this decision on specific factors.
  2. What education regarding medication management would you need to do?
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Advanced Pharmacology

Week 6 Case Study

 

A patient is followed for several years with heart failure. His case is early at stage A.

 

Answer the following questions. 

  1. Which stage A patients would benefit from adding an angiotensin-converting enzyme inhibitor?
  2. As the patient progresses through the heart disease stages, when are diuretics typically added? Are all heart failure patients candidates for diuretics at this stage?

Submission Details:

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Advanced Pharmacology

Students in their first graduate level pharmacology course are confused with the recommendations for hypertension (HTN) and treatment choices after ST-elevation myocardial infarction (STEMI) and with heart failure (HF). The drugs used several years ago and still seen commonly on the acute care floors the students work are not the ones now assuming a stronger role in cardiac health issues. For one, the primary order of which meds are selected for an initial level of blood pressure control has seemed to change.

Help your fellow students by explaining the following changes.

  1. Which classification of drugs has taken the first-choice role in most patients with early hypertension? Is it wrong to select a thiazide diuretic or a beta blocker as was once done?
  2. Is there another primary choice for African American patients? Why?
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Advanced Pharmacology

Week 3 Case Study

   

A 78-year-old male patient comes to your office complaining of increased left knee pain for the past 3 to 4 months. He has had no history of recent injury. An x-ray done less than 4 months ago showed degenerative osteoarthritic changes. He has full range of motion and denies any recent swelling, pedal edema, or discoloration. He has been a long-distance runner for many years and was diagnosed with osteoarthritis of his left knee more than 10 years ago. He has decreased his weekly running, but the pain is persistent and is affecting his daily activities. He has been using over-the-counter NSAIDs on and off, but states they are no longer working and wants something “stronger.” His vital signs are all normal and he has no history of fever, chills, or rashes. He is otherwise healthy.

  1. Which medications do you feel would be safe and appropriate for this patient’s chronic pain?
  2. What education would you provide when prescribing pain medication for this patient?

Submission Details:

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Advanced Pharmacology

Week 2 Case Study

   

Aubre R. presents as a new patient to your practice having recently relocated from rural Tennessee. She is 68 years old and complains of irritable bowel syndrome (IBS) with abdominal cramping and frequent diarrhea with occasional constipation. She has a history of domestic violence with resultant anxiety requiring inpatient hospitalization 8 years ago. She is also complaining of urinary retention, insomnia, and hip pain since a hip fracture 4 years ago. Her drugs include zolpidem 10 mg hs, bethanechol 25 mg tid, metoclopramide 10 mg tid, amitriptyline 100 mg hs, alprazolam 0.25 mg tid, hydrocodone/APAP 5/500 tid, and dicyclomine 20 mg four times daily.

  1. What are your concerns about this drug regimen?
  2. What recommendations do you have for this patient?
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Advanced Pharmacology

Week 2 Case Study

   

Aubre R. presents as a new patient to your practice having recently relocated from rural Tennessee. She is 68 years old and complains of irritable bowel syndrome (IBS) with abdominal cramping and frequent diarrhea with occasional constipation. She has a history of domestic violence with resultant anxiety requiring inpatient hospitalization 8 years ago. She is also complaining of urinary retention, insomnia, and hip pain since a hip fracture 4 years ago. Her drugs include zolpidem 10 mg hs, bethanechol 25 mg tid, metoclopramide 10 mg tid, amitriptyline 100 mg hs, alprazolam 0.25 mg tid, hydrocodone/APAP 5/500 tid, and dicyclomine 20 mg four times daily.

  1. What are your concerns about this drug regimen?
  2. What recommendations do you have for this patient?
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Advanced Pharmacology

   

You have a 58 year old African American male that is coming in for a follow-up visit after recently having a Myocardial infarction which was successfully treated via angioplasty.  He was started on Metoprolol for his consistently elevated high blood pressure during his hospital stay.  

His primary diagnoses include: 

  • Coronary Artery Disease
  • Type 2 diabetes controlled with Metformin 1,000 mg BID and HgA1C of 6.7.
  • Asthma- Mild Intermittent- with no recent episodes of wheezing. Albuterol INH as needed.
  • All other pertinent labs Within Normal Limits

First consider what clinical guidelines noted below can help us choose the best medication treatment for this patient with diabetes, CAD, Asthma and Hypertension. 

Joint National Committee JNC 8 – https://www.aafp.org/pubs/afp/issues/2014/1001/p503.pdf

National Center for Biotechnology Information – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092891/table/T1/?report=objectonly

American Heart Association – https://www.ahajournals.org/doi/epub/10.1161/HYPERTENSIONAHA.120.15026

IHS Division of Diabetes https://www.ihs.gov/sites/diabetes/themes/responsive2017/display_objects/documents/algorithms/dm_hypertension_algorithm.pdf

Please answer each questions citing your response from evidence based clinical guidelines.  Your response should not be post as “I would recommend”. Example of appropriate reference: The 2020 international Society of Hypertension Global Hypertension Practice Guidelines – recommend the use of selective ß1-receptor agonists in patients diagnosed with coronary heart disease and or heart failure ( Unger, T, et al, 2020). 

Reference:  Unger T;Borghi C;Charchar F;Khan NA;Poulter NR;Prabhakaran D;Ramirez A;Schlaich M;Stergiou GS;Tomaszewski M;Wainford RD;Williams B;Schutte AE; (n.d.). 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension (Dallas, Tex. : 1979). Retrieved August 1, 2022, from https://pubmed.ncbi.nlm.nih.gov/32370572/  

  1. Metoprolol is selective for which adrenoceptor? ( pharmacodynamics)
  2. What effects do agents such as metoprolol have on the cardiovascular system? ( pharmacodynamics)
  3. In which organ is metoprolol primarily metabolized? (Pharmacokinetics)
  4. Why would a provider be cautious when ordering a Beta Blocker in a patient with Asthma?

Submission Details:

  • Name your file W1_CaseStudy_LastName_FirstName
  • Submit this assignment to the Submission Area by the due date assigned.
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