Prescribing Cases Module Five Case One: I.G. Complaint: “My.
Prescribing Cases Module Five Case One: I.G. Complaint: “My… Prescribing Cases Module Five Case One:I.G.Complaint: “My heartburn has been waking me up at night.”History:I.G is a 47-year-old male patient presenting to the clinic with complaints of intermittent nocturnal gastroesophageal reflux. History reveals that he awakens experiencing burning pain substernally and in the back of his throat. This results in “my larynx closing down” and his being “almost unable to breathe.” As soon as he can breathe effectively, he swallows “a lot” of antacid and flushes it down with water. The entire episode is very frightening, and he is often afraid to go back to sleep. Because he already has a problem with mild sleep apnea, he is becoming increasingly tired and unable to function at work due to lack of sleep. He now sleeps only in his recliner. He is also concerned about the substernal pain because his father had a myocardial infarction at age 49 and required coronary artery bypass surgery.I.G. is obese with much of his excess weight carried in his abdomen. He is not a smoker, “occasionally” has three or four beers with friends, and “often” has pizza or submarine sandwiches for lunch with a “diet cola.” He takes no drugs other than the antacid after a reflux episode.Assessment:A chest x-ray and electrocardiogram are negative for cardiopulmonary disease, and Greg is diagnosed by history with gastroesophageal reflux disease (GERD).1. What is the initial pharmacologic management plan for GERD?2. What education does he need for this treatment?3. Do you need baseline lab(s)? If so, what do you need to draw?Case Two: H.W.H.W. is a 55-year-old patient with type II diabetes mellitus (DM). He has been taking medications for this issue since his late 40s along with statins for his cholesterol issues, Lisinopril for his hypertension, and steroid cream for his intermittent eczema on his arms and legs. He is on metformin at the maximum dose but does complain from time to time about some gastrointestinal (GI) issues with this medication.He still has normal renal function and has not been hospitalized for any wound or glucose control issues. His HgA1C readings are always “on the high side.” His liver function tests, other complete metabolic panel (CMP) results, and complete blood count (CBC) are normal.Though he reports adherence to a “good” diet he has gained 30 pounds in the last 10 years with a body mass index (BMI) of 35. He knows that some of that is associated with his use of basal insulin and occasional rapid acting insulin at meal times when he remembers to take his premeal blood sugars.He has a plan in his record to start adding additional medications if his previous goals of weight loss and HbA1C control are not met.1. Which families of antidiabetic medications might be considered for him as adjunctive medications? How do they basically work?2. Mr. Wilson agrees that more medications are required. However, he refuses to take any more medications that require needles and he refuses an increase in frequent glucose checks. He hates needles. Which of the medications noted above are no longer a first choice for him?3. Because Mr. Wilson has intermittent GI issues with his metformin, are any of the family groups originally considered of potential concern? Why?Health Science Science Nursing NURS 730
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