Week 5: Discussion Question

Q1. Which classes of diabetes medications are either weight neutral or cause weight loss? Please

give one (1) example of a drug’s generic and trade name in that class.

Weight loss is a side effect of a different class of diabetic drugs known as sodium-glucose

cotransporter 2 (SGLT2) inhibitors. Through urine, SGLT2 inhibitors eliminate sugar from the

blood. Less blood sugar equals less sugar available to be converted to fat. While taking SGLT2

inhibitors, some people may lose between 4 and 6 pounds. After using these drugs for six weeks,

you can start to notice weight loss (Le, 2021).

 SGLT2 inhibitors

- Generic Name: Canagliflozin, Dapagliflozin, Empagliflozin

- Trade Name: Invokana, Farxiga, Jardiance

- Initial Starting Dose: 100 mg once daily

Q2. Based on the current guidelines of the ADA, it would be appropriate to treat her with

monotherapy since the patient is hesitant to take any injections. What agent would you

recommend? Please provide the trade name, generic name, the dose you would start the patient

with frequency, and route.

One of the frequent injection-related side effects is pain. That is why with a patient who’s

hesitant in taking injections, I must recommend an oral tablet if any advises wouldn’t work for

her and left me no choice. The best oral medication I might recommend is Metformin because it

is best known as a first-line treatment for Type 2 Diabetes Mellitus. It works well both on its

own and in combination with other drugs that decrease blood sugar. It costs little, normally has
few adverse effects, and is well tolerated. Although metformin’s efficacy and safety are widely

known, there is debate over whether it should always be the primary treatment option because

alternative anti-hyperglycemic drugs have shown to be more beneficial in some populations

(Baker et al., 2021).

 Biguanides

- Trade Name: Glumetza, Riomet, Fortamet

- Generic Name: Metformin

- Initial Starting Dose: Metformin’s standard beginning dose is either 850 mg once

daily or 500 mg twice daily. Depending on how well it works, the dosage can be

raised to a daily maximum of 2,550 mg by mouth, spread out across a few doses

during the day.

Q3. What are the contraindications of your selected diabetic therapy?

Renal illness or renal failure are two medical conditions that might make taking metformin

dangerous or even impossible. If you have significant renal impairment, metformin can cause

lactic acidosis. Because it is eliminated by the kidneys, this risk grows as the severity of renal

disease increases. The next issue is liver disease. Metformin can make it harder for the liver to

absorb lactate, causing blood lactate levels to rise. Due to an elevated risk of lactic acidosis,

metformin should not be taken by people who have liver impairment. History of a stroke, serious

illness, or heart attack. Each of them raises the possibility of lactic acidosis. Sensitivities or

recognized allergies. If patient is known to be sensitive to metformin, avoid taking Glucophage.

Pregnant women and also breastfeeding moms were also contraindicated. There is a chance that

metformin will pass into breast milk and cause low blood sugar in nursing infants (Cervoni,

2021).
Q4. What lab work up should you obtain? What sort of results will you see in patients who have

hypothyroidism and hyperthyroidism?

The diagnostic tests I might perform include Free T4, T4, and T3 level tests. Thyroid

hormone (T4 and T3) levels in the blood are measured by these tests. Thyroid ultrasound is also

included. The entire thyroid gland, as well as any tumors on or inside of it (such nodules), can be

measured using ultrasound technology. The solidity or cysticity of a mass can also be determined

by using ultrasounds (Lights & Collins, 2023). A high T4 level denotes hyperthyroidism, or an

overactive thyroid. Anxiety, unintended weight loss, tremors, and diarrhea are symptoms. The

majority of the T4 in the body is protein-bound. Free T4 is the name for the tiny fraction of T4

that is not bound. The body can use free T4 because it is the most readily available type. Along

with the T4 test, a free T4 level is occasionally also measured. Between 0.4 and 4.0

milliinternational units of hormone per liter of blood (mIU/L) is the usual test range for the TSH.

You run the risk of developing hypothyroidism if you have symptoms of hypothyroidism and a

TSH level that is higher than 4.5 mIU/L. Weight gain, exhaustion, melancholy, and brittle

fingernails and hair are just a few symptoms. In both hyperthyroidism and hypothyroidism, the

thyroid gland enlarges into a goiter, which can be symmetrical or one-sided. A goiter, which is

an enlargement of the gland, can frequently be seen as a lump or puffiness near the base of the

neck. Iodine deficiency is the main reason for goiters (Stang, 2023).

Q5. What is the treatment of choice for hypothyroidism? What is the mechanism of action?

Please provide the initial dose, trade, and generic name of the drug, route, and frequency.

Lifelong hypothyroidism is a condition. Medication helps many patients by reducing or

eliminating their symptoms. Levothyroxine (Levoxyl, Synthroid) is the drug of choice for

treating hypothyroidism. The thyroid hormone that your body typically produces is mimicked by
this synthetic form of the T4 hormone (Holland, 2023). Thyroxine-4 (T4), a naturally occurring

hormone made by the body, is represented by the synthetic hormone levothyroxine. In a healthy

state, the hypothalamus releases thyrotropin-releasing hormone (TRH), which prompts the

anterior pituitary to release thyroid-stimulating hormone (TSH), which causes the release of T4

(approximately 80% of the body’s output) and triiodothyronine, or T3 (about 20% of the body’s

secretion). Nearly 50% of the thyroxine (T4) is then transformed into the active metabolite L-

triiodothyronine (T3) since there is less triiodothyronine present. The thyroid receptor proteins,

which are found in the cell nucleus, are then bound by the thyroid hormones. The thyroid

hormone affects DNA transcription in the nucleus, which in turn boosts gluconeogenesis, protein

synthesis, and the body’s ability to mobilize glycogen reserves. Levothyroxine operates as a

supplement to perform all the activities when the body’s thyroxine secretion is altered (Singh,

2022).

 Thyroxine (T4)

- Trade Name: Synthroid, Euthyrox, Levoxyl, Tirosint, Unithroid

- Generic Name: Levothyroxine

- Initial Starting Dose, Route, & Frequency: There are several different dosages of

levothyroxine (Synthroid), ranging from 25 mcg to 300 mcg. On an empty

stomach, levothyroxine (Synthroid) is normally administered once day; the first

dose is based on your weight. The dose will then be adjusted based on your lab

results and how your body responds.

Q6. What are the adverse effects, and what important teaching will you provide this patient on

thyroid replacement therapy?

 Levothyroxine side effects include chest pain that radiates to the jaw and shoulders, rapid

or irregular heartbeats with shortness of breath, sweating that is followed by hot flashes and

fever, sleep disturbances that cause fatigue and weakness, the onset of depression, muscle pain,

headaches, and leg cramps, as well as changes in weight and appetite (Singh, 2022). The patient

may occasionally feel fatigued despite taking medicine. What I can advise to the patient is to get

enough sleep every night, eat a diet high in fruits and vegetables, and think about using stress-

relieving techniques like yoga and meditation to assist her manage low energy levels.
 References:

Baker, C., Retzik-Stahr, C., Singh, V., Plomondon, R., Anderson, V., & Rasouli, N. (2021,

January 13). Should Metformin Remain the First-line Therapy for Treatment of Type 2

Diabetes? SAGE Journals. Retrieved May 30, 2023, from

https://journals.sagepub.com/doi/full/10.1177/2042018820980225

Cervoni, B. (2021, December 9). Metformin: An Effective Treatment for Type 2 Diabetes.

Verywell Health. Retrieved May 30, 2023, from

https://www.verywellhealth.com/metformin-how-to-prevent-side-effects-1087301

Holland, K. (2023, February 21). What You Need to Know About Hypothyroidism. Healthline.

Retrieved May 30, 2023, from

https://www.healthline.com/health/hypothyroidism/symptoms-treatments-more

Le, K. (2021, December 1). Why Do Some Diabetes Medications Affect Body Weight? GoodRx

Health. Retrieved May 30, 2023, from

https://www.goodrx.com/conditions/diabetes/diabetes-medications-that-can-cause-

weight-gain

Lights, V., & Collins, D. (2023, February 9). Hyperthyroidism: Causes, Symptoms, Treatment,

Diagnosis & More. Healthline. Retrieved May 30, 2023, from

https://www.healthline.com/health/hyperthyroidism

Singh, R. (2022, July 8). Levothyroxine and Liothyronine – Uses | Mechanism of Action |

Dosage and Side Effects. iCliniq. Retrieved May 30, 2023, from

https://www.icliniq.com/articles/drug-and-supplements/levothyroxine-and-liothyronine
Stang, D. (2023, May 19). Thyroid Function Tests: Procedure, Side Effects, and Results.

Healthline. Retrieved May 30, 2023, from https://www.healthline.com/health/thyroid-

function-tests