An obese patient, age 45, comes to your office. She recently moved from another state three weeks ago and told you that her FNP diagnosed her with type 2 diabetes mellitus. She is currently not on any medicine for her diabetes, and she wishes to avoid insulin, if possible. She is a non-smoker. Her blood pressure is 138/74 mmHg. Labs from 3-weeks ago was hemoglobin A1C = 8.4%; total cholesterol = 260 mg/dL, triglycerides = 290 mg/dL, HDL = 49 mg/dL, LDL = 170 mg/dL (calculated 10-year ASCVD risk = 6.2%). You discuss current treatment goal recommendations endorsed by the ADA regarding glycemic control, blood pressure control, and lipid management. She agrees to start any medications that you recommend with lifestyle modification and a DASH diet to treat hypertension.
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.
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.
Q3. What are the contraindications of your selected diabetic therapy?
The patient returns to your office six months later complaining of fatigue for the past two months, constipation, and heavy, irregular menses. Upon examination, you note that her skin is dry, and her fingernails are brittle. You suspect she has hypothyroidism.
Q4. What lab workup should you obtain? What sort of results will you see in patients who have hypothyroidism and hyperthyroidism?
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.
Q6. What are the adverse effects, and what important teaching will you provide this patient on thyroid replacement therapy?
week6 (825 words 9 refereces)
Mrs. William, a 75-year-old patient is with her daughter for a follow-up visit. At her previous office visit, her daughter expressed concerns of her mother’s increasing forgetfulness. You send Mrs. William for neuropsychiatric testing. She is diagnosed with mild dementia, and the patient and family would like to discuss treatment options.
Q1. Name a drug for each of the two classes of medication that is currently available for the treatment of dementia, and their adverse effects. (Trade and generic names).
Q2. Mrs. William’s daughter is concerned about the behavioral disturbances that can be associated with progressive dementia. Discuss at least two disturbances that are associated with progressive dementia and their treatment recommendations. Please provide one medication, trade and generic name for each of the behavioral disturbances you list.
Mr. Lacy is a 65-year-old man diagnosed with Parkinson’s disease (PD) five years ago. His disease has progressed over the years, and it is recommended that he be treated with levodopa.
Q3. What is levodopa, and how is it used in the treatment of Parkinson’s disease? What are the adverse effects of levodopa that might be expected in this patient?
Q4. What drug is most commonly combined with levodopa and why?
Q5. What other drugs can be used for the treatment of PD?
A 50-year-old man has developed depression after the death of his wife. He is prescribed venlafaxine (Effexor XR) 75 mg PO once a day.
Q6. How does venlafaxine differ from tricyclic antidepressants (TCAs)? What adverse effects might this patient expect with venlafaxine?
WEEK7 (825 words 9 references)
A 12-year-old boy has occasional episodes of mild asthma while playing soccer with his friends.
Q1. What treatment should this patient receive to relieve symptoms during an asthma attack?
Q2. If the patient’s asthma attacks occur more frequently, what changes in therapy might be appropriate?
A 19-year-old college student is asking for contraceptives.
Q3. What will you assess to determine if this patient is a good candidate for contraceptives, and what will you prescribe? (Include brand and generic name, route, frequency, and dose). What is the mechanism of action of the contraceptive you prescribed and the adverse effects?
Q4. The patient states she heard a pill can help her acne. What would you prescribe and your rationale? (Include brand and generic name, dose, route, and frequency).
Q5. The patient is concerned because her mother and sister developed fractures in their legs and vertebra after menopause. She wants to know what medication and other advice will prevent osteoporosis. You discuss bisphosphonates. How are they used in the prevention and treatment of osteoporosis?
A 48-year-old man has occasional episodes of gout that are painful and debilitating. He requires drugs to treat the symptoms of acute gout attacks and prevent recurrent attacks.
Q6. How would you treat this patient’s acute gouty attack? Please list the trade and generic name and the dose of therapy. What is the mechanism of action of your choice of prescription?
(825 words 9 references)
A healthy 2-month-old child was brought to your clinic by her parents. The child is a full-term infant with no concerns. Her exam is normal, and she had received her Hep B #1 in the nursery.
Q1. What vaccines does she get? What combinations are available at your clinic?
Q2. The child comes back at 12 months after completing her primary series of vaccines at 2, 4, and 6 months of age. Her vaccines are right on schedule, and her parents have no concerns, she is developing normally, and her exam is normal. What vaccines can she get today?
Q3. Which groups of patients are at higher risk for pneumococcal disease, and need PPSV23 early starting at 2-years old?
A 25-year-old woman comes to your office asking for oral contraceptive refills. She stated that she was feeling depressed and heard about St. John’s wort used in depression which she started taking a week ago.
Q4. How might concomitant administration of St. John’s wort affect the efficacy of drugs this patient is taking such as the oral contraceptives? Discuss another example of a possible drug interaction that might occur with St. John’s wort?
The 25-year-old woman stated that her 4-year-old child has been coughing and sounds congested. She wants to know if echinacea might help her child.
Q5. What is echinacea used for and how is it taken?
Q6. Is it safe for this mother to give her child echinacea?
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