Case Study – Patient with Complaints of Fatigue, Urinary Frequency, and Epigastric Discomfort
Medication Recommendations
The first medication will be Levothyroxine which is a synthetic hormone. The generic name is Synthroid. The starting dose is patient-specific. The patient has had goiter for ten years, and hence the dosage will be 25 mcg/kg/day (Davis, 2020). The labs for this patient will be checked every four weeks. This patient has high TSH levels due to the negative feedback mechanism with low T4 levels. The common side effects of Levothyroxine are symptoms related to hyperthyroidism due to overdose, insomnia, irritability, dyspnea, heat intolerance, skin rash, and weight loss (Davis, 2020). Grapefruit juice, antacids, and calcium delay Synthroid absorption, reducing bioavailability (Davis, 2020)
The second drug is Omeprazole, whose generic name is Prilosec. This drug is a proton pump inhibitor. The starting dose will be 20mg per day. This drug has been chosen since it does not interact with Levothyroxine. It also lowers the stomach pH and is, hence, valuable for treating GERD (Cunha, 2017). The common side effects include diarrhea, headache, dizziness, bloating, and nausea (Cunha, 2017). This drug interacts with Aspirin 81mg and Cymbalta (Cunha, 2017).
The third drug is Metformin, which is a Biguanide. The brand names include Glucophage and Glumetza. The starting dose will be 500mg orally twice daily. This patient has a high A1c, and metformin will help manage diabetes (Cunha, 2017). The side effects of metformin include heartburn, bloating, vomiting, weight loss, and constipation (Cunha, 2017). This drug interacts with Crestor, Januvia, and fish oil (Cunha, 2017). The final drug that will be given to this patient is Doxycycline which is a Tetracycline. It has the following brands, Adoxa and Doxy. The starting dose is 100mg twice daily for seven days. This patient has a wound that is infected with Staph aureus. Doxycycline is effective in managing MRSA (Durbin, 2020). The common side effects of doxycycline include teeth darkening and vaginal yeast infection (Durbin, 2020). The common drug interactions include Lexapro and Lyrica (Durbin, 2020)
Non-Pharmacologic Interventions
The major non-pharmacologic intervention for this patient will be developing a dietary plan for her that will help control her blood sugar levels. The dietary plan will include meal schedules, meals to eat, and the quantity that she should eat. A nutritionist will also be included in the formulation of this intervention to ensure the patient receives the highest quality of care available. The patient will also be advised on how to moderate to vigorous exercise to help lose weight and burn excess fats.
Patient Education
As a healthcare professional, it is critical to educate the patient on how to use her drugs. This patient is taking Omeprazole and Synthroid; hence the timing of taking these drugs is critical. The patient will be advised that Synthroid is taken on an empty stomach 30 minutes to one hour before meals (Davis, 2020). She will also be educated that Synthroid should not be taken with a PPI since it will reduce the drug’s effectiveness.
The patient needs to be educated on the importance of personal hygiene and wound hygiene, which will aid in proper wound healing. The patient will also be educated on the dangers of developing yeast infections due to the drugs and her high sugar levels. The patient will also be educated on the importance of exercise, lifestyle modifications, and dietary changes in controlling blood sugar levels.
References
Cunha, J. P. (2017, April 03). Omeprazole (Prilosec): Side effects, Dosages, TREATMENT, INTERACTIONS, WARNINGS. Retrieved February 04, 2021, from https://www.rxlist.com/consumer_omeprazole_prilosec/drugs-condition.htm
Cunha, J. P. (2017, April 14). Metformin: Side effects, dosages, treatment, interactions, warnings.Retrieved February 04, 2021, from https://www.rxlist.com/consumer_metformin/drugscondition.htm
Davis, C. P. (2020, October 26). Synthroid (Levothyroxine Sodium), Warnings, Uses. Retrieved February 04, 2021, from https://www.rxlist.com/synthroid-side-effects-drugcenter.htm#overview
Durbin, K. (2020, December 1). Doxycycline: Uses, side effects & dosage guide. Retrieved February 04, 2021, from https://www.drugs.com/doxycycline.html
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Case Study – Patient with Complaints of Fatigue, Urinary Frequency, and Epigastric Discomfort
Mrs. Anderson is a 40-year-old female. She presents to your office with complaints of fatigue, urinary frequency, and epigastric discomfort. She states she takes Tums with minimal relief. She states she has had a goiter for 10 years and has complaints. You notice a quarter-open sore on her left calf. She states she thinks it is a bug bite, but it has not healed yet. Lab results are HbA1c- 10, TSH-11, UA-positive for nitrites and glucose, and wound culture-positive for staph aureus. Diagnoses – DM Type 2, Hypothyroidism, GERD, Staph infection.
Advanced Pharmacology-Endocrine Disorder
- What medication recommendations will you make? Include the drug class, generic and trade name, and starting dose range. Provide a rationale for your choices.
- Discuss any potential side effects and drug interactions for this patient.
- What non-pharmacological interventions would you suggest?
- What patient education would you provide?
Expectations
- Length: A minimum of 500 words, not including references
- Citations: At least two high-level scholarly references in APA from within the last 5 year
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