[Solved] NURS-6521 Week 7 Assignment: Case Studies

CLASS:

NURS-6521N: Advanced Pharmacology

  1. Mary is a 35-year-old woman that has been diagnosed with hypothyroidism. Her labs today show a TSH of 20, MCV 78, MCHD 26, Ferritin 9, TIBC 418. She has a history of iron deficiency anemia for 2 months. Current medications include Kelp tablets daily, ibuprofen 400 mg daily as needed, and ethinyl estradiol/norgestrel one tablet daily.What medication would you start this patient on for her hypothyroidism? How would you monitor this patient’s response to the medication? What education would you provide regarding her medications and their interactions?
  2. Joe is a 48-year-old male diagnosed with Type II Diabetes Mellitus for a year ago. He has controlled his blood glucose through dietary changes. He has hypertension and is currently on Lisinopril 20 mg po daily. He has no known allergies. His lab work includes these results: fasting BG is 225 mg/dL; HgA1C = 7.5%. Basic Metabolic Profile (BMP) is normal except for a Cr of 2.0 and eGRF of 28. What treatment plan would you implement for Joe? What medications would you prescribe and how would you monitor them? What education would you provide regarding his treatment plan?
  3. Jose is a 55-year-old truck driver being evaluated for his commercial driver’s license. He has a known history of diabetes mellitus type II. Current medications include Metformin 1000 mg Bid, Glipizide 20 mg po daily. Diltiazem 120 mg po BID. He is allergic to sulfa. Lab results show a fasting blood glucose of 325 mg/dL, HgA1C = 10.6%. Basic metabolic Profile is normal. What treatment plan would you implement for Jose? What medications would you prescribe and how would you monitor them? What education would you provide regarding his treatment plan?
  4. Jenny is a 63-year-old woman with complaints of heartburn 4 to 5 times a week over the past 3 months. Her symptoms are worse at night after going to bed. Her heartburn is worse, and she coughs a lot at night. She has tried OTC Prevacid 24 hour once daily for the past 2 weeks. This has helped the symptoms some, but she is still bothered by them. Current medications include Diltiazem CD 120 mg PO once daily, Hydrochlorothiazide 25 mg PO once daily, Metformin 500 mg PO twice daily, Aspirin 81 mg PO daily, Fluticasone/salmeterol DPI 100 mcg/50 mcg one inhalation twice daily. Your working diagnosis for this patient is GERD. What treatment plan would you implement for Jenny? What medications would you prescribe and how would you monitor them? What education would you provide regarding her treatment plan?

 

Solution

  1. Mary is a 35-year-old woman that has been diagnosed with hypothyroidism. Her labs today show a TSH of 20, MCV 78, MCHD 26, Ferritin 9, TIBC 418. She has a history of iron deficiency anemia for 2 months.Current medications include Kelp tablets daily, ibuprofen 400 mg daily as needed, and ethinyl estradiol/norgestrel one tablet daily. What medication would you start this patient on for her hypothyroidism? How would you monitor this patient’s response to the medication? What education would you provide regarding her medications and their interactions?

The problem in this case scenario,  is a high level of TSH and ferritin, which shows that hypothyroidism is uncontrolled and iron deficiency anemia.  The use of kelp tablet daily may also aggravate hypothyroidism. Because daily iodine intake may exceed the daily recommended intake of iodine thereby affecting thyroid function (Gherbon et al., 2019). For hypothyroidism, the patient should start taking Levothyroxine.

  1. RX: Levothyroxine 50 mcg for hypothyroidism

Sig:  Take one tablet (50 mcg) PO daily in the morning on an empty stomach 30 minutes before breakfast

Disp#: 30 tablets

Refill: 0

Signed: O.B., 4/14/2024: Dispense as written. Substitution permitted.

The patient should also be prescribed Ferrous Sulfate for iron deficiency anemia as…………………………….$10