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Med Pharm Diss - Diabetes Melitus (Case Study: Mrs ET (Case study 2)…
Med Pharm Diss - Diabetes Melitus
Aims of treatment
Case Study: Mrs ET (Case study 2)
Symptoms:
BP: 160/95 mmHg
Fasting blood glucose: 6mmol/L
Total cholesterol: 4.0 mmol/L
BP above what NICE consider to be diagnostic for hypertension (140/90mmHg)
This is a random BP measurement - need ABPM and HBPM to truly diagnose hypertension
BP of 160/95 suggests stage 1 hypertension
Hypertension despite normal blood cholesterol levels? COPD?
Cholesterol levels: NICE suggests blood cholesterol levels of 7.5 mmol/L are suggestive of familial hypercholesteremia
Heart.uk.org: Any blood cholesterol below 5.0mmol/L is normal
Mrs ET is over 60 and is taking statins - higher risk of hypercholesterolemia, statin prescription will lower her blood cholesterol levels
diabetes.co.uk: fasting blood glucose of 6.0mmol/L is indicative of being non-diabetic
Reduced blood glucose due to Metformin prescription - previously diagnosed with T2DM
Current treatment: Simvastatin 40mg daily o.n
Metformin 500mg 3 x a day
Simvastatin:
Statin drug - HMG CoA reductase inhibitor
Inhibits the 1st committed step of cholesterol synthesis
Reduces plasma cholesterol
Increases hepatic LDL receptors and therefore promotes LDL-C uptake
Hepatoselective drug
Taken at night (cholesterol synthesis highest at night)
#
Metformin:
Treatment for Type 2 Diabetes Melitus
Mechanism of action not clear?
May
activate AMP kinase
This would lead to decrease in gluconeogenesis and increase glucose uptake
Drugbank mechanism of action
:
Activates AMP kinase
Inhibits gluconeogenesis in liver
This increase peripheral utilization of glucose - this may be due to increased insulin binding strength to insulin receptors
#
Suggested treatment:
Metformin 500mg 3 x a day
Simvastatin 40mg every night
Glyceryl trinitrate spray 400µg when needed
Isosorbide mononitrate 20mg 2 x a day
Aspirin 75mg 2 x a day
Glycerol trinitrate spray:
Used to treat angina - second stage of treatment for chest pains/angina
Isosorbide mononitrate:
Used to prevent angina attacks
Dilates blood vessels via activation of Gs GPCRs
Aspirin:
First stage of treatment for angina sufferers -
Info: 60 years old
1.6m
76kg
Admitted for chest pain observations
Explain what each of the drugs is for and their mechanisms of action
#
What might you deduce regarding her previous state of health? Explain your reasoning
Comment on her blood glucose and cholesterol levels
Why was she prescribed a statin
Why were the changes made to her therapy
Symptoms
Literature to read
NICE guidelines on diagnosing and treating hypertension:
https://www.nice.org.uk/guidance/cg127/chapter/1-Guidance#diagnosing-hypertension-2
NICE guidelines on diagnosing and treating hypercholesterolemia:
https://www.nice.org.uk/guidance/cg71/chapter/1-Guidance
