Discussion Part One\u00a0\t\u00a0\tCynthia 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:\t\u00a0\t\u00a0Social history: no smoking or alcohol consumption.\tPhysical examination:\tGEN: well nourished, slightly obese female\tVS: BP 180\/103 HR 73 RR 13 T 98.4 Weight 90 kg, Height 5’6″\ufffd\tHEENT: PERRLA\tCOR: RRR, NMRG\tCHEST: CTA\tNEURO: monofilament test shows decreased peripheral sensation\tEXT: normal\tLaboratory (fasting):\tNa 139 mEq\/L\tK 3.8 mEq\/L\tALT 34 U\/L\tCa 9.1 mg\/dL\tCL 102 mmol\/L\tHCO3 22 mEq\/L\tAST 39 U\/L\tTP 6 g\/dL\tBUN 33 mg\/dL\tSCr 2.0 mg\/dL\tAlb 4.1 g\/dL\tCholesterol 254 mg\/dL\tBG 300 mg\/dL\tTSH 0.12 mU\/mL\tUA: SG 1.013 mg\/24h, pH 6.5, +++ protein\tWhat are the major problems in this patient, and what diagnoses do these values indicate?\t\u00a0\tAdditionally, what is your assessment and pharmacological plan for each of these problems including the medication, dose, and mechanism of action?\t\u00a0\tDiscussion Part Two (graded)\t\u00a0\tCynthia 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?\t\u00a0\tDiscussion Part Three (graded)\t\u00a0\tGiven 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.\t\u00a0\t“\ufffd What is the diagnosis given these symptoms and the medications she is currently taking from Parts One and Two, and how would you proceed?\t\u00a0\t“\ufffd At this point, please also be sure to also provide an accurate summary of Cynthia’s medication plan.<\/p>\n","protected":false},"excerpt":{"rendered":"
Discussion Part One\u00a0 \u00a0 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 Read More …<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[],"tags":[],"class_list":["post-230071","post","type-post","status-publish","format-standard","hentry"],"_links":{"self":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/posts\/230071","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/comments?post=230071"}],"version-history":[{"count":0,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/posts\/230071\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/media?parent=230071"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/categories?post=230071"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/tags?post=230071"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}