Discussion Part One
Cynthia is a 65-year-old African American female who presents to the clinic for a check-up. Her last examination was ~5 years ago. She has no specific, significant, or urgent complaint. She explains that her only issues are thirst, fatigue, and leg numbness and tingling, which is beginning to occur more often. You decide to do a physical exam, as well as draw labs and receive the following results:
Social history: no smoking or alcohol consumption.
GEN: well nourished, slightly obese female
VS: BP 180/103 HR 73 RR 13 T 98.4 Weight 90 kg, Height 5’6”
COR: RRR, NMRG
NEURO: monofilament test shows decreased peripheral sensation
Na 139 mEq/L
K 3.8 mEq/L
ALT 34 U/L
Ca 9.1 mg/dL
CL 102 mmol/L
HCO3 22 mEq/L
AST 39 U/L
TP 6 g/dL
BUN 33 mg/dL
SCr 2.0 mg/dL
Alb 4.1 g/dL
Cholesterol 254 mg/dL
BG 300 mg/dL
TSH 0.12 mU/mL
UA: SG 1.013 mg/24h, pH 6.5, +++ protein
What are the major problems in this patient, and what diagnoses do these values indicate?
Additionally, what is your assessment and pharmacological plan for each of these problems including the medication, dose, and mechanism of action?
Discussion Part Two (graded)
Cynthia has been prescribed a plethora of medications. How will you properly monitor each medication for efficacy and toxicity? Are you concerned with any drug-drug interactions? If so, what are they, and what is the mechanism of the interaction?
Discussion Part Three (graded)
Given Cynthia’s increased creatinine and renal deterioration, metformin is probably not optimal in this case. Therefore, upon subsequent visits, you decide to start her on a sulfonylurea. She reappears in your clinic fairly soon thereafter with complaints of shakiness, sweating, chills, clamminess, lightheadedness, and a moderately severe headache.
• What is the diagnosis given these symptoms and the medications she is currently taking from Parts One and Two, and how would you proceed?
• At this point, please also be sure to also provide an accurate summary of Cynthia’s medication plan.