What are your treatment goals for Maria?
According to the examination report, Maria has BP of 120/70 mm Hg, a pulse of 76, the temperature of 98.7, respirations of 18, fasting plasma glucose of 179mg/dl, TSH of 5.6 and HgbA1C is 7.4%. The results show Maria has BP, temperature, pulse and respiration rate of a normal person but the level of fasting plasma glucose, TSH and HgbA1C is above that of a normal person. A healthy person has fasting plasma glucose of 65-110 ml/dl, TSH level of 0.4-4 and HgbA1C of less than 5.9 %. Maria has a BMI of 26.0 kg/M2 which is considered as grade 2 overweight. If an individual has HgbA1C has more 6.5 %, he is considered to have type 2 diabetes. The high TSH indicates that Maria has hypothyroid. The results show that she has two chronic conditions; diabetes and an underactive thyroid. My main treatment goals are to implement lifestyle modifications, control blood sugars, control thyroid levels and control the weight. The main motive is to provide pharmacologic treatment.
What is your plan for drug therapy?
My plan for drug therapy would begin with Metformin 500 mg. This is the most preferred initial pharmacologic agent for the treatment of type 2 diabetes. My second drug therapy would be synthetic thyroid hormone levothyroxine. The final drug therapy will be the physical activity of 30-40 mins every day for at least 5 weeks. I would also recommend a low-fat diet with adequate fiber.
What is the mechanism of action for each drug?
Mechanism action of Metformin
Metformin is an antihyperglycemic agent which improves glucose tolerance in individuals with type 2 diabetes. Metformin treats type 2 diabetes by decreasing hepatic glucose production, reducing the intestinal absorption of glucose and increasing insulin sensitivity. When using metformin, the insulin secretion remains the same but fasting insulin levels and plasma insulin response decrease gradually to achieve the normal blood sugar level.
Mechanism action of levothyroxine
Levothyroxine is used to treat hypothyroidism by releasing thyroxine (T4) and triiodothyronine (T3) hormones which improves the metabolic rates of the tissues all over the body. This drug replaces these hormones which an individual lack when suffering from underactive hypothyroidism.
Mechanism action of Physical activity
Physical activity reduces body weight by increasing energy expenditure. This increases the absorption of fat mass which causes obesity and overweight. It can also treat type 2 diabetes by reducing the level of fasting plasma glucose.
5 teaching point for Metformin
Maria should know that metformin is used to control blood sugar which improves her A1C level. She should also know that she must follow the prescribed diet, and medication to prevent hypoglycemic incidences. I will educate Maria about the signs and symptoms. She should report any side effects of the drug. Lastly, Maria should have regular tests of blood sugar levels.
5 teaching points for levothyroxine
Maria will be instructed that levothyroxine is used to treat hypothyroidism. She should know the allergic reaction of levothyroxine. She should be aware that the drug is not taken if an individual has another medication condition. She should also know the side effects of the levothyroxine.
If Maria’s initial HgbA1C was 10.2 Mg/dl
(haha) suggests that if the HgbA1C exceeds 9.0 mg/dl, Insulin should be the most preferred drug therapy. If Maria was 10.2 mg/dl I would use insulin as the treatment choice for her hyperglycemia level which is above 300 mg/dl.
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