Advanced pharmacology nsg 533
,1. EP is a 38-year-
old female patient that comes in for diabetes education and management. She was diagnosed 12 yea
ago and states lately she is not able to control her diet although she continues a 1600 calorie diet wi
appropriatedailycarbohydrat eintake(perdietitian prescription) andwalks 40 minutes every day of
the week. She states compliance with all medications. She denies any history of hypogly cemia despi
being able to identify signs and symptoms and describe approp riate treatment strategies.
PMHT2DM, HTN, obesity, depression, s/p thyroidectomydue to thyroid can- cer
,FmHx Noncontributory
SHx () Smoking, alcohol use, past marijuana use while in high school Medicatio ns Metformin 85
g
mg tid, glipizide 20 mg bid, lisinopril 20 mg daily, sertraline 100 mg daily, multivitamin daily
Vitals BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
Laboratory test results Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN 16 mg/dL, SCr 0.89 mg/d
glucose 128 mg/dL; A1C 7.8%
Based on EP's profile above, which of the agents would be able to obtain an A1C goal of lessthan 7
andwouldbeappropriatein the patient? Please pro-
vide an explanation of appropriateness or lack thereof.
Answer> Exenatide -
g
Exenatide (Bydureon) once weekly has been able to demonstrate weight loss and decr ease A1C%
0.7% to 1.2% in clinical trials; however it is contraindicated for EP due to the self-reported history
thyroid cancer.
Dapagliflozin - Dapagliflozin (Farxiga) is contraindicated in this patient due to hy- perkalemia which
could be made worse by this drug.The package insert does not indic ate a specific potassium
g
concentration cut off to no longer use this medication; however, there are better choices in this patien
, Sitagliptin -
,1. EP is a 38-year-
old female patient that comes in for diabetes education and management. She was diagnosed 12 yea
ago and states lately she is not able to control her diet although she continues a 1600 calorie diet wi
appropriatedailycarbohydrat eintake(perdietitian prescription) andwalks 40 minutes every day of
the week. She states compliance with all medications. She denies any history of hypogly cemia despi
being able to identify signs and symptoms and describe approp riate treatment strategies.
PMHT2DM, HTN, obesity, depression, s/p thyroidectomydue to thyroid can- cer
,FmHx Noncontributory
SHx () Smoking, alcohol use, past marijuana use while in high school Medicatio ns Metformin 85
g
mg tid, glipizide 20 mg bid, lisinopril 20 mg daily, sertraline 100 mg daily, multivitamin daily
Vitals BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
Laboratory test results Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN 16 mg/dL, SCr 0.89 mg/d
glucose 128 mg/dL; A1C 7.8%
Based on EP's profile above, which of the agents would be able to obtain an A1C goal of lessthan 7
andwouldbeappropriatein the patient? Please pro-
vide an explanation of appropriateness or lack thereof.
Answer> Exenatide -
g
Exenatide (Bydureon) once weekly has been able to demonstrate weight loss and decr ease A1C%
0.7% to 1.2% in clinical trials; however it is contraindicated for EP due to the self-reported history
thyroid cancer.
Dapagliflozin - Dapagliflozin (Farxiga) is contraindicated in this patient due to hy- perkalemia which
could be made worse by this drug.The package insert does not indic ate a specific potassium
g
concentration cut off to no longer use this medication; however, there are better choices in this patien
, Sitagliptin -
