Case NR508 WEEK5 TD Advanced Pharmacology Fundamentals (2Version)

Maria is a 46-year-old woman who presents for her yearly physical examination. Her medical history is notable for mild depression and moderate obesity. Six months ago her fasting lipid profile was normal. Maria report that her mother and brother have diabetes and hypertension. She reports that she knows she should be on a low calorie, low fat diet and exercising but with her full-time job and four children, she finds it difficult to exercise, and she eats out most of the time. She is 67" tall and weighs 225lbs today, no current medication. She does report taking a multivitamin daily but still feels tired, biotin Vit-C when she remembers. She is a nonsmoker, only drinks sweet tea with each meal, 3-4 cups of coffee per day. Today: BP 120/70 mm Hg, pulse 76, temperature 98.7, respirations 18, weight 225 pounds. Urine dip + glucose, fasting plasma glucose 179 mg/dl, HgbA1C is 7.4%, TSH 5.6. The physical exam is notable for acanthosis nigricans at the neck but otherwise is normal. Acanthosis nigricans is a skin condition characterized by areas of dark, velvety discoloration in body folds and creases. The affected skin can become thickened. Most often, acanthosis nigricans affects your armpits, groin and neck. The skin changes of acanthosis nigricans (ak-an-THOE-sis NIE-grih-kuns) typically occur in people who are obese or have diabetes BS 179 AIC 7.4% TSH 5.6 Primary hypothyroidism? ADA recommends one of following: AIC > 6.5% or Fasting BG > 126 GOAL: weight and glucose control. Decrease macrovascular (stroke, MI, peripheral vascular disease) and microvascular (retinopathy and neuropathy) complications. Aic level <7% Monotherapy ok for pts with aic <7.5% Metformin first line tx (improves cardiac outcomes) Dr. Moscu and class,