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 feel tired still, 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 219 pounds. Urine dip + glucose, fasting plasma glucose 179 mg/dl, HgbA1C is 7.4%, TSH 5.6. Physical Exam reveals notable for acanthosis nigricans at the neck but otherwise is normal.

What are your treatment goals for Maria?
What is your plan for drug therapy? What is the mechanism of action for each drug?
Please give five teaching points for each drug prescribed.
How would you change the plan if her initial HbgA1C was 10.2mg/dL and her fasting blood glucose was 305mg/dL? Provide a detailed alternative plan with the rationale

Solution:

What are your treatment goals for Maria?

Based on Maria’s current health condition as well as her medical background, below are the treatment goals that need to be taken into account:

To reduce and control her weight. Based on her weight and weight, her BMI is 35.3, which is considered obese (American Diabetes Association, 2017).
To control her blood sugar. Normal fasting plasma glucose should be less than 100 mg/dL (Forslund et al., 2015).

What is your plan for drug therapy? What is the mechanism of action for each drug?

A fasting plasma glucose of 126 mg/dL and higher implies that the patient has diabetes. Therefore, the high plasma glucose of 179 mg/dl is an indication that Maria has type 2 diabetes. Taking this into consideration, drug therapy for Maria entails treating type 2 diabetes and obesity. In relation to type 2 diabetes, the most suitable drug for Maria is Metformin. As asserted by Forslund et al. (2015), Metformin usually works by making the body cells more sensitive to insulin. It also works through slowing the release of glucose stored in the liver and absorption of glucose from food in the gut (Marín-Peñalver, Martín-Timón Sevillano-Collantes, & del Cañizo-Gómez, 2016). On the other hand, when it comes to diabetes, the best drug therapy of Maria is Orlistat. This drug….Please click the Paypal icon below to purchase full solution for only $10