NURS90075 Applications Of Clinical Pharmacology

Question:

Patient scenario

Mrs. Martha Vella is a 55-year-old public servant of Maltese background with a past medical history of generalised anxiety disorder, hypertension, and osteoarthritis. Her medications include: Efexor-XR (venlafaxine, 75 mg controlled release, once daily), Zestril (lisinopril, 10 mg, once daily), Panadol Osteo (paracetamol, 665 mg controlled release, two tablets BD), and Nurofen (ibuprofen, 200 mg, TDS when required). Martha is overweight (BMI = 28) and has a history of smoking one pack of cigarettes per day for 25 years (31 pack years).

She had elevated blood sugar and cholesterol levels 12 months ago but did not follow up with a clinical diagnostic work-up. Until recently, Martha has felt fine. Today, she presents to the general practitioner (GP), Dr. Hosu, complaining that her left foot has been weak and numb for nearly two weeks, and that the foot is difficult to flex. Furthermore, she reports that she has been very thirsty lately and gets up more often at night to urinate.

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Martha’s physical examination including random plasma glucose level revealed the following: blood pressure of 165/100 mmHg, pulse rate of 96 bpm, and random plasma glucose of 13.1 mmol/L. Dr. Hosu suspects type 2-diabetes, and orders additional tests that need to be done after an overnight fast. Some of Martha’s results of additional tests are presented in the table below.

Blood test results

Urinalysis

BGL: 8.3 mmol/L

Ketones: negative

HbA1c = 7.5

Protein: negative

Total cholesterol: 6.9 mmol/L

Glucose: positive

HDL: 1.2 mmol/L

Microscopy: negative for microbes, red blood cells and white blood cells

LDL: 4.7 mmol/L

 

Dr. Hosu initiates pharmacological therapy consisting of  :  Caduet (amlodipine 10 mg and atorvastatin 20mg, once daily),   metformin (500 mg controlled release, once daily) and cessation of lisinopril. Martha is now referred for education in relation to her medication management.

Aim:

The assignment assesses the ability of the student to critically analyse the patient scenario presented, and apply the principles of the Quality use of Medicines to develop an education session that covers medication management plan for the patient. You are expected to integrate evidence from a variety of information sources including the peer reviewed literature, clinical practice guidelines and the Australian Quality Use of Medicines Framework.

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