Diabetic Case Study 1

Diabetic Case Study

Takia Marshall
The University of Texas Arlington
College of Nursing and Health Innovation

In partial fulfillment of the requirements

Of
N5334 Advanced Pharmacology for
APNs
Takia Marshall, FNP, B-C
June 23, 2020
Diabetic Case Study 2

Assessment: My assessment data is of a 55-year-old white female who has frequency

burning and urgency when urinating, which consists of a UTI. “Common symptoms of a UTI

include: strong and frequency urge to urinate, pain or a burning sensation when urinating,

nausea and vomiting, muscle aches and abdominal pains, cloudy bloody or strong-smelling

urine.” (McIntosh, 2018). She was treated for this urinary tract infection in the urgent-care

setting. She has protein in the urine and a high blood glucose level. She also has a

220mg/dL random glucose level, and a HbA1C of 7.5%, which consists of diabetes. A

random glucose test means the level of glucose that is in your blood. “For a random glucose

test of 200mg/dL or above indicates that a person has diabetes.” (Barrel, 2019). She has a

family history of type 2 diabetes with her mother and her aunt. She possibly has type 2

diabetes. Her pulse is normal at 72 beats per minute. She is a nonsmoker. She has a blood

pressure of 150/90mmHg, which consists of stage 2 hypertension. The ideal blood pressure

reading is 120/80mmHg. “If your blood pressure reading shows a top number of 140 or

more, or a bottom number of 90 or more, its considered stage 2 hypertension.” (Madell &

Cherney, 2020). She weighs 180lbs at only 5 feet 5 inches tall.

Plan: Marion will demonstrate how to keep her blood sugar levels within a normal range.

She will demonstrate how to prevent further urinary tract infections. She will also

demonstrate how to control her blood pressure, cholesterol and maintain a healthy weight

through diet, exercise and medication administration.

Pharmacologic:

1. Lisinopril (Zestril) - 10mg daily in the morning with a full glass of water to help lower

hypertension.
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2. Metformin (Glucophage) - 500mg everyday with the evening to help control diabetes.

3. Acetaminophen (Tylenol) - 650mg Q8 for pain

4. Atorvastatin (Lipitor) - 10mg daily in the morning on an empty stomach to help

lower cholesterol levels.

Provide rationale:

1. Lisinopril (Zestril)- which is an ACE inhibitor. “ACE inhibitors are oral medications

that lower blood pressure.” (Ross, 2019). “ACE inhibitors are used to treat hypertension

(high blood pressure) coronary artery disease, and heart failure and to help control the

progression of diabetes and kidney disease.” (Ross, 2019).

2. Metformin (Glucophage)- “There are several studies that showed that metformin can

decrease the long-term complications of diabetes; including cardiovascular events and

cardiovascular mortality, myocardial infarction, heart failure, arterial revascularization,

stroke and death.” (Lawler et al, 2020).

3. Acetaminophen (Tylenol) - “Tylenol is used for short-term pain reliev mild to

moderate pain and to temporarily reduce fever.” (Asher, 2019).

4. Atorvastatin (Lipitor) - “It reduces levels of triglycerides and “bad” LDL cholesterol

in the blood and increases levels of “good” HDL cholesterol.” (Carter, 2019).

Non-Pharmacologic:

1. Low calorie diet: “Eating a healthful, balanced diet can help people with diabetes

manage their condition and reduce their risk of health-related complications.” (Nichols,

2019).
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2. Exercise: “Exercise improves blood glucose control in diabetics, reduces

cardiovascular risk factors, contributes to weight loss, and improves wellbeing.” (Colberg et

al 2016).

3. Blood Sugar Control: “In people with diabetes, achieveing blood glucose targets

stops or reduces the risk of a variety of complications of diabetes including: nerve damage

and neuropathy, eye damage, heart attacks, and stroke and kidney disease sexual

dysfunction.” (Shomo, 2019).

4. Weight reduction: “Improved glycemic control induced by weight loss is associated

with partial corrections of the two major metabolic abnormalities in type 2 diabetes; insulin

resistance and impaired insulin secretions.” (Wexler, 2020).

5. Reduce the risk of another UTI: “UTI’s can’t always be avoided, but its possible to

reduce your risk of getting one by wiping from front to back, drinking plenty of fluids, avoid

holding urine and urinate befor and after intercourse.” (Nunez, 2020).

Diagnostics:

Follow up:

Referral:

Metformin
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MOA: “Metformin is a biguanide drug that reduces blood glucose levels by decreasing the

production of glucose in the liver, decreasing intestinal absorption, and increasing insulin

sensitivity.” (Corcoran & Jacob, 2020).

Absorption: “Oral bioavailability of metformin is ~50% and is aborbed through the upper

small intestine (duodenum and jejunum and then is delivered to the liver, circulates unbound

essentially, and finally is eliminated by the kidneys.” (Corcoran & Jacob, 2020).

Distribution: “The drug is widely distributed into the tissues including the intestines, liver

and kidneys by organic transporters.” (Corcoran & Jacob, 2020).

Metabolism: “Metformin is not metabolized.” (Corcoran & Jacob, 2020).

Excretion: “Metformin is excreted unchanged in the urine.” (Corcoran & Jacob, 2020)

Side effects: “Gastrointestinal side effects including diarrhea, nause and vomiting.”

(Corcoran & Jacob, 2020).

Pertinent drug/drug interactions: “These include but are not limited to bupropion, carbonic

ethanol and topiramate.” (Corcoran & Jacob, 2020).

Black box warning: “Lactic acidois.” (Corcoran & Jacob, 2020).

Lisinopril

MOA: “Lisinopril is a competitive inhibitor of angiotensin-converting enzyme (ACE) and

prevents the conversion of angiotensin I to angiotensin II which is a potent vasoconstrictor.”

(Lopez et al, 2020).

Absorption: “Lisinopril is absorbed unchanged by food and is excreted unchanged in the

urine.” (Lopez et al 2020).

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Distribution: “Lisinopril does not bind to proteins in the blood.” (Lopez et al 2020).

Metabolism: “Lisinopril is not metabolized; it is excreted unchanged in the urine.” (Lopez et

al 2020).

Excretion: “Excreted unchanged in the urine.” (Lopez et al 2020).

Side effects: “Hyperkalemia, dry coug, angioedema, hypotension, dizziness.” (Lopez et al

2020).

Pertinent drug/drug interaction: “Aspirin, diuretics Lithium and other ACE inhibitors.”

(Lopez et al 2020),

Black box warning: “You shouldn’t take this drug if you’re pregnant or plan to become

pregnant, can cause fetal toxicity.” (Lopez et al 2020).

Atorvastatin

MOA: “By preventing he conversion of HMG-CoA to mevalonate, statins medications

decreases cholesterol production in the liver.” (Melver & Siddique, 2020).

Absorption: “It is rapidly absorbed after oral administration with a peak plasma

concentration at 1 to 2 hrs.” (Melver & Siddique, 2020).

Distribution: “It is highly plasma protein bound (over 98%) and has a volume of distribution

of about 30 liters.” (Mclver & Siddique, 2020).

Metabolism: “It is metabolized by cytochrome P450 3A4 (CYP 3A4) to active ortho and

para-hydroxylated metabolites.” (Mclver & Siddique, 2020).

Excretion: “Eliminated in bile.” (Mclver & Siddique, 2020)

Diabetic Case Study 7

Side effects: “Arthralgia, dyspepsia, diarrhea, nausea and vomiting.” “(Mclver & Siddique,

2020).

Pertinent drug/drug interactions: “The use of atorvastatin with potent CYPSA4 inhibitors

can lead to increased plasma concentrations, which may enhance adverse events, including

myopathies.” (Mclver & Siddique, 2020).

Black box warning: “May cause rhabdomyolysis.” (Mclver & Siddique).

Tylenol

MOA: “Although its exact mechanism of actions remains unclear, it is historically

categorized along with NSAIDs, because it inhibits the cyclooxygenase (cox) pathways.”

(Gerriets et al 2020).

Absorption: “Tylenol is rapidly absorbed from the GI tract with peak plasma levels usually

occurring at 2 hours and almost always by 4 hrs.” (Garriets et al 2020).

Distribution: “It distributes rapidly and evenly throughout most tissues and fluids and has a

volume of distribution of approximately 0.9L/kg.

Metabolism: “By the liver.” (Garriets et al 2020).

Excretion: “Tylenol is broken down / metabolized almost completely by the liver, so the

kidneys hardly do any of the work and are not affected by it.” (Garriets et al 2020).

Side effects: “Skin rash, hypersensitivity and nephrotoxicity.” (Garriets et al 2020).

Pertinent drug/drug interactions: “Warfarin, Carbamazepine and Isoniazid.” (Garriets et al

2020).
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Black box warning: “Hepatotoxicity.” (Garriets et al 2020).

References