Pharmacology d Diabetes d case d study d guide d complete d and d verified d 100%(fall d 2024)

Pharmacology d Diabetes d case d study d guide d complete d and d verified d 100%(fall d 2024) Mrs. d Franklin d aged d 75 d lives d alone. d Recently d she d has d experienced d episodes d of d extreme d lethargy, d thirst d and d an d increased d need d to d urinate. d Mrs d Franklin's d daughter d encouraged d her d to d visit d the d doctor d for d a d check-up. d Mrs. d Franklin d is d a d smoker d with d mild d hypertension, d osteoarthritis d and d elevated d cholesterol. Following d consultation d it d is d apparent d that d Mrs d Franklin d has d gained d 3 d kg d since d her d last d visit d 6 d months d ago. d Mrs d Franklin d says d she d finds d it d difficult d to d stand d long d enough d to d prepare d healthy d meals d and d usually d snacks d on d ready-made d meals. BMI: d 26 d kg/m2 LDL d cholesterol d 2.8 d mmol/l HDL d cholesterol d 1.2 d mmol/l Triglycerides d 1.3 d mmol/l BP d 150/89 d mmHg HBA1c d 58 d mmol/mol Mrs. d Franklin d is d diagnosed d with d type d 2 d diabetes d mellitus. d What d initial d (non-pharmacological) d treatment d is d indicated d for d Mrs d Franklin? d Provide d some d detail d here d and d explain d the d rationale d behind d your d answers. d - d correct d answers- Initial d non-pharma d logical d interventions d should d include d - d correct d answers-Diet d management d healthy d eating d plan d with d low d GI d foods, d low d fat, d low d salt, d high d protein. Need d to d consider d access d to d healthy d foods, d could d look d at d home d help d etc. Increasing d physical d activity d with d consideration d of d her d decreased d mobility d due d to d osteoarthritis. d Consider d small d achievable d goals d and d working d up d slowly. At d a d follow-up d visit d 3 d months d later d Mrs. d Franklin's d blood d glucose d and d HBA1c d remain d elevated. d She d is d commenced d on d Metformin d 500 d mg d bd. d Briefly d outline d the d mechanism d of d action d (MOA) d of d Metformin. d - d correct d answers-Increase d glucose d uptake d and d utilisation d in d skeletal d muscle d (reduces d insulin d resistance) Reduce d glucose d production d in d the d liver d (gluconeogenesis) Increase d insulin d sensitivity Reduces d low d and d very d low d density d lipoproteins What d is d the d rationale d for d the d prescriber d selecting d Metformin d over d another d oral d hypoglycaemic d agent? d - d correct d answers-Is d effective d for d individual's d that d are d overweight d and d have d high d lipid d profile d due d to d increasing d effectiveness d of d available d insulin d and d reducing d the d LDL d and d VLDL Has d the d benefit d of d not d causing d weight d gain As d it d does d not d affect d beta d cells d it d does d not d increase d insulin d production d and d therefor d does d not d have d the d risk d of d hypoglycaemia List d four d contraindications d for d prescribing d Metformin d and d explain d reasons d for d each. d - d correct d answers-Poor d renal d or d liver d function d - d increased d risk d of d lactic d acidosis d due d to d not d being d able d to d clear d the d drug d effectively GI d disturbances d which d can d cause d diarrhoea d resulting d in d dehydration d and d potential d for d lactic d acidosis Any d condition d causing d reduced d tissue d oxygenation d that d may d result d in d lactic d acidosis d eg d hypoxic d pulmonary d disease, d cardiac d disease, d dehydration, d severe d burns. Pregnancy d as d it d crosses d the d placenta d resulting d in d fetal d serum d levels d being d equivalent d to d maternal d serum d levels Establishing d glycaemic d control d is d a d priority d for d a d person d newly d diagnosed d with d type d 2 d diabetes. d However d other d medications d need d to d be d considered d as d part d of d the d risk d reduction d framework. d Considering d Mrs d Franklin's d profile d discuss d other d medications d that d Mrs d Franklin d may d also d be d commenced d on d and d provide d rationale. d - d correct d answers-Due d to d her d diabetes d and d smoking d she d is d at d risk d of d CD Need d to d consider d smoking d cessation d strategies d to d prevent d risk d of d CD Her d high d lipid d profile d may d suggest d commencing d on d a d statin d to d reduce d cholesterol d levels d and d reduce d CD d risk Low d dose d aspirin d to d help d prevent d thrombosis d formation d due d to d CD d risk d and d decreased d mobility BP d control d may d be d considered d - d for d diabetes d ACEI d would d be d preferred d over d beta d blockers d as d thus d might d mask d any d potential d hypo d events d and d inhibiting d the d sympathetic d response d to d a d hypo List d four d key d points d you d would d include d in d an d education d plan d for d a d client d commencing d on d Metformin. d - d correct d answers-Metformin d should d only d ever d be d taken d with d food. d If d taken d on d empty d stomach d it d can d cause d diarrhoea/ d vomiting d resulting d in d dehydration d and d then d potential d risk d of d lactic d acidosis Start d at d a d lower d dose d then d gradually d build d up d to d the d dose d needed d over d a d few d weeks. d This d can d help d reduce d incidence d of d GI d ADR'S If d you d are d on d metformin d and d you d get d an d illness d that d causes d you d to d have d vomiting d you d should d stop d taking d until d you d are d well d again Stop d prior d to d surgery d due d to d risk d of d lactic d acidosis Hine, d is d 19 d years d old d and d has d type d one d diabetes. d Hine d was d first d diagnosed d with d Diabetes d 2 d years d ago. d With d the d support d of d her d whanau d Hine d has d been d adapting d to d and d managing d her d diabetes d well. d Her d HbA1c d is d within d her d target d and d her d BGL's d within d the d normal d range. d Hine's d insulin d regime d is d as d follows. Apidra d at d meal d times d and d Humulin d NPH d at d bed d time d (10:00 d pm) Hine d has d made d an d appointment d to d see d you d (the d practice d nurse) d to d learn d more d about d her d Insulin d therapy. d - d correct d answers- What d type d of d insulin d is d Humulin d NPH d and d Apidra? d - d correct d answers-Humulin d - d intermediate d acting Apidra d - d fast d acting What d is d the d rationale d for d a d basal- d bolus d regime d such d as d the d one d Hine d has d been d prescribed? d - d correct d answers-It d mimics d the d body's d natural d rhythms d of d insulin d release Short d acting d before d eating d and d the d intermediate d insulin d before d bed What d advice d would d you d give d regarding