Endocrine System Case Study _ Advanced Pharmacology Fundamentals graded A+

Week 5: Endocrine System Case Study Due Mar 31 at 11:59pm Points 100 Questions 51 Time Limit None Instructions Purpose   The purpose of this assignment is to apply the principles of pharmacology to support evidence-based prescribing practices for the management of common diseases of the endocrine system. This assignment allows students to use clinical practice guidelines to guide treatment decisions for common patient scenarios in the clinical setting.   Course Outcomes  This assignment enables the student to meet the following course outcomes:  CO 1: Identify the most commonly prescribed agents in the major drug classes. (POs 1, 2)  CO 2: Make appropriate evidence-based therapeutic treatment decisions for individual patients utilizing drugs from the major drug classes.(POs 1, 2)  CO 3: Apply knowledge of pharmacokinetics, pharmacodynamics and pharmacogenomics in prescribing patient treatment. (POs 1, 2)  CO 4: Distinguish internal and external environment factors affecting drug action, reaction, efficacy, and interaction. (POs 1, 2)  CO 5: Identify client indicators of therapeutic, ineffective, adverse responses and side effects to drug therapy. (POs 1, 2)  Due Date  The Late Assignment Policy applies to this assignment.   The assignment title is due by Wednesday 11:59 p.m. MT of Week 5.   Total Points Possible 100   Preparing the Assignment  Follow these guidelines when completing each component of the assignment. Contact your course faculty if you have questions.  There are three patient cases presented in this assignment.  You are to use the following resources in addition to your textbook to answer the questions.   American Diabetes Association. (2020). Figure 9.1 [Graph]. Standards of Medical Care in Diabetes—2020 Abridged for Primary Care  3/31/2021 Week 5: Endocrine System Case Study : Advanced Pharmacology Fundamentals-Ghaeli Providers.  ( Rosenthal, L., Burchum, J. (2021). Lehne's pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants (2nd ed.). Elsevier. General web search. You will be presented with a patient case and then answer a series of questions.  Questions are worth 2 points each. After each question, you will receive feedback on your answer.  However, this does mean that you will not be able to change your answer so be sure to use the resources listed to locate the answers to the questions. When you are ready to begin this assignment, click the "Take the Quiz" button near the bottom of this page.  3/31/2021 Week 5: Endocrine System Case Study : Advanced Pharmacology Fundamentals-Ghaeli Attempt History Attempt Time Score LATEST Attempt 1 399 minutes 95.1 out of 100 Score for this quiz: 95.1 out of 100 Case Study #1: John Jones Case Study #2: Alfonso Giuliani Case Study # Helen Smit Endocrine Case Studies  3/31/2021 Week 5: Endocrine System Case Study : Advanced Pharmacology Fundamentals-Ghaeli Submitted Mar 31 at 6:38pm This attempt took 399 minutes. Ques 0 / 0 pts tion 1 I understand the value of doing my own work and learning this skill to support my future independent practice as a nurse practitioner. I understand that while there may be opportunities beyond my faculty’s control to collaborate or share answers with peers, that it would not benefit my own personal and professional growth to do so. I agree to do my own work and take personal responsibility for my learning. I do not. I do. Correct! Ques 2 / 2 pts tion 2 Use the John Jones case study to answer the following question. Which glucose level equates with a Hgb A1C of 8.1%? ~183 mg/dl Correct! ~175 mg/dl ~204 mg/dl ~160 mg/dl  3/31/2021 Week 5: Endocrine System Case Study : Advanced Pharmacology Fundamentals-Ghaeli The correct answer is ~183mg/ dl. See page 400, Table 48.4, Hemoglobin A1c levels and their corresponding eAG levels for complete information. Ques 2 / 2 pts tion 3 Use the John Jones case study to answer the following question. John calls the office and reports that he is scheduled for diagnostic testing that requires IV contrast for imaging. He inquires if there are concerns with undergoing this procedure while taking his medications. What instructions should be given to John regarding his metformin regimen? Take the metformin the morning of the procedure but don’t take it for 48 hours afterward. Don’t take the metformin the day of the procedure and for 48 hours afterward. Correct! No special instructions are needed. Don’t take the metformin the day of the procedure but resume the following day.  3/31/2021 Week 5: Endocrine System Case Study : Advanced Pharmacology Fundamentals-Ghaeli Metformin must be withheld on the day of the procedure and for 48 hours afterward. Serum creatinine levels should be normal before resuming metformin. Ques 2 / 2 pts tion 4 Use the John Jones case study to answer the following question. Using the ADA Standards of Medical Care in Diabetes-2020, which of the following medications should be prescribed for John? Canagliflozin Metformin Correct! Dulaglutide Glyburide According to the ADA Standards of Medical Care in Diabetes2020, Metformin is the first-line medication to prescribe for patients with a HgbA1C 6.5%. American Diabetes Association. (2020). Figure 9.1 [Graph]. Standards of Medical Care in Diabetes—2020 Abridged for Primary Care Providers.  3/31/2021 Week 5: Endocrine System Case Study : Advanced Pharmacology Fundamentals-Ghaeli Ques 2 / 2 pts tion 5 Use the John Jones case study to answer the following question. What is the recommended interval for monitoring John’s HgbA1C? 6-months 1-month 6-weeks 3-months Correct! The HgbA1C is a 3-month average of glucose; therefore, it should be re-checked in 3 months after starting treatment. Checking this lab value beforehand will provide a mixed result of glucose before and after treatment. Monitoring blood sugar between the beginning of treatment with metformin and a 3 month follow up, fasting finger stick blood sugars should be done. Ques 2 / 2 pts tion 6 Use the John Jones case study to answer the following question. Which of the following lab test should be evaluated before prescribing metformin? Complete metabolic profile (CMP) Correct!  3/31/2021 Week 5: Endocrine System Case Study : Advanced Pharmacology Fundamentals-Ghaeli Lipid Panel Urinalysis Complete blood count (CBC) CMP provides a baseline evaluation for both hepatic and renal function which should be evaluated throughout treatment with metformin. Ques 2 / 2 pts tion 7 Use the John Jones case study to answer the following question. Which of John’s behaviors should be addressed to encourage lifestyle changes and decrease A1C levels? Select all that apply. Sits at a desk several hours a day. Correct! His diet largely consists of fast-food meals. He drinks sweet tea with every meal. Correct! Weight 235lbs Correct! He drinks 3-4 cups of coffee per day. BP 130/90 Correct! Family history is significant for diabetes.  3/31/2021 Week 5: Endocrine System Case Study : Advanced Pharmacology Fundamentals-Ghaeli The combination of moderate exercise and weight loss reduces the risk for the development of type 2 diabetes and improves outcomes for patients with type 2 diabetes (Rosenthal & Burchum, 2021). Ques 2 / 2 pts tion 8 Use the John Jones case study to answer the following question. Which behavior in John’s social history poses a potential concern with initiating metformin? His diet largely consists of fast-food meals. He drinks sweet tea with every meal. He reports drinking “a few beers on the weekend during football season”. Correct! He drinks 3-4 cups of coffee per day. No answer text provided.  3/31/2021 Week 5: Endocrine System Case Study : Advanced Pharmacology Fundamentals-Ghaeli Metformin is contraindicated in alcoholics. Although it does not sound as if John is an alcoholic, further questioning is needed, and the discussion should be documented. Metformin taken by alcoholics increases the risk of lactic acidosis so John should be educated on this risk along with signs and symptoms of lactic acidosis. Ques 2 / 2 pts tion 9 Use the John Jones case study to answer the following question. Metformin works by decreasing ____________ and _____________. glucogenesis; insulin resistance Correct! incretin secretion; insulin production glucogenesis; incretin secretion insulin resistance; incretin secretion Metformin decreases glucogenesis and insulin resistance. Ques 2 / 2 pts tion 10 Use the John Jones case study to answer the following question.  3/31/2021 Week 5: Endocrine System Case Study : Advanced Pharmacology Fundamentals-Ghaeli John’s triglycerides are 260 mg/dl and his HDL is 35mg/dl. Referring to the ADA Standards of Medical Care in Diabetes-2020, what is the correct action to take at this time? Stop John’s atorvastatin since he is now being treated for diabetes. Leave John’s atorvastatin as is and re-check lipids when A1C is rechecked. Increase John’s atorvastatin to 20mg per day. Correct! Increase John’s atorvastatin to 40 mg per day. According to the ADA Standards of Medical Care in Diabetes2020, the correct action is to intensify lifestyle therapy and optimize glycemic control for patients with elevated triglyceride levels (≥150 mg/dL [1.7 mmol/L]) and/or low HDL cholesterol (40 mg/dL [1.0 mmol/L] for men, 50 mg/dL [1.3 mmol/L] for women). John's treatment includes lifestyle changes as well as metformin which aligns with practice guidelines. John’s atorvastatin should remain as currently prescribed with monitoring of lipid profile and A1C.