Please review and answer each discussion with a long paragraph.Support your responses with scholarly academic references using APA style format. Assigned course reading and online library resources are preferred. Weekly lecture notes are designed as overviews to the topic for the respective week and should not serve as a citation or reference. In your discussion question response, provide a substantive response that illustrates a well-reasoned and thoughtful response; is factually correct with relevant scholarly citations, references, and examples; demonstrates a clear connection to the readings In your participation responses to your peers, comments must demonstrate thorough analysis of postings and extend meaningful discussion by building on previous postings.
Discussion 1
Is there any additional subjective or objective information you need for this client? Explain.
Yes, there would be a need for additional subjective and objective information to assess the patients current state. For instance, surgical, family, and social history are crucial to determining the memory loss at just 48 y/0. For instance, familial history can help establish if there is any family member who has experienced dementia. Additionally, objective data can help indicate the functionality of bodily functions and critical organs.
What would be your position on Ms. GM’s use of alternative supplements for her diabetes and memory? Explain and include contraindications, if any.
I would highlight the importance of alternative supplements and therapy in response to her conditions. As envisaged in practice protocols, I have to support her decision to use alternative supplements; however, I would need to explain to the patient the dangers associated with the therapy. Perhaps more important is letting them know that alternatives can often be used at the patients discretion; however, they are not certified by the FDA to provide therapeutic effects as approved drugs. Ms. Gami will have to be informed about contraindicationssuch as the moderate interactions between the two drugs (ginseng and coumadin)reducing the efficacy of coumadin. I would underscore the essential of considering other medications.
Are there any additional tests/assessments you would complete for this patient given this list of medications? Explain.
Brain imaging would be crucial to evaluate the causes of memory loss at that young age. I would recommend tests such as computerized tomography, magnetic resonance imaging. Additional tests would include Hemologic A1C tests to evaluate the efficacy of the drugs on her diabetes type II.
How might your treatment plan, in terms of medications, differ for this patient? Include the class of the medication, mechanism of action, route, the half-life; how it is metabolized in and eliminated from the body; contraindications, and black box warnings.
The patient would be advised to stop taking supplements immediately and put on a biguanidemetformin. The lattermetforminworks by regulating the amount of sugar released from the liver to the bloodstream. The drug further increases the bodily response to insulin. The drug has a half-life of approximately 6.2 hrs, no metabolism. The drug is removed from the body through urine excretion.
What health maintenance or preventive education is important for this client based on your choice of medication/treatment?
The patient should be advised to consider more vegetables in her diet (Albarrak et al., 2018). Additionally, postprandial blood glucose and hemoglobin A1C will be evaluated after every three months.
Reference
Albarrak, A. I., Mohammed, R., Assery, B., Allam, D., Al Morit, S., Al Saleh, R., & Zarea, R. (2018). Evaluation of diabetes care management in primary clinics based on the guidelines of the American Diabetes Association. International journal of health sciences, 12(1), 40. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5870309/
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Discussion 2
Additional Subjective or Objective Information
Additional subjective information would be the level of compliance with prescribed medication as well as any side effects experienced from the medication. She will be asked if the current medication has been helpful in relieving her symptoms. It will be important to obtain her family as well as social health history to understand history of certain diseases and social lifestyle contributing to illnesses. Memory capacity results and blood glucose levels would be obtained as part of the subjective information.
Use of alternative Supplements
I would be hesitant on continuation of the alternative supplements since there lacks enough evidence on the use of these supplements to manage diseases. Although cassia cinnamon has been used to manage type 2 diabetes by some patients, it may be risky to prescribe its continuation since the side effects may cause serious health problems (Radler, 2020). I would also not recommend continuation with usage of ginseng for memory as it is found to have possible interactions with other drugs. Since the patient has been prescribed with Coumadin and Aricept, the use of alternative supplements would not be necessary. Additionally, the alternative supplements have not been approved by FDA, and there are no approved dosages for the supplements, therefore its safety for use is not guaranteed.
Additional Tests/Assessments
Additional tests would include a blood sugar test to obtain her blood sugar levels, and a prothrombin time test to determine bleeding risks due to the intake of Coumadin (Chatterjee et al., 2017). A Mini-Mental State Exam is also required for assessment of the patients cognitive function due to her memory problems.
Treatment Plan
The treatment for the patient may differ by discontinuation of the current medication and prescribing new medication. For type 2 diabetes, the patient will be prescribed with Metformin which is effective in regulation of blood sugar levels (Aroda et al., 2017).
Metformin- 500mg PO once daily
Mechanism of Action- Improves insulin response to reduce the level of blood sugar.
Half-life- 6.2 hours
Metabolism-Metformin is not metabolized and is excreted unchanged in the urine (Aroda et al., 2017).
Elimination- Through the urine
Contraindications- Patients with CHF, renal diseases, hypersensitivity and myocardial infarction
Black box warning- high risk for metabolic acidosis and heart diseases.
Aricept will be continued to help improve the patients memory function.
Aricept- 23mg PO once daily
Mechanism of Action- It inhibits acetylcholine hydrolysis to help transmit cholinergic for improvement of memory function (Hara & Kawabe, 2019).
Half-life- 70 hours
Metabolism- Liver
Elimination- Through the urine
Contraindications- Patients with chronic heart diseases and hypersensitivity
Black box warning- increased risk of heart problems
Coumadin would also be discontinued due to increased risk of abnormal bleeding.
Health Maintenance and Preventive Education
Patient education would involve adherence to prescribed medication for improved health outcomes. Medication should also be taken as prescribed to avoid adverse effects from the medication. Health maintenance education include healthy lifestyle including healthy eating and physical exercises which will help with management of her diabetes as well as memory function (Chatterjee et al., 2017).
References
Aroda, V. R., Knowler, W. C., Crandall, J. P., Perreault, L., Edelstein, S. L., Jeffries, S. L., Molitch, M. E., Pi-Sunyer, X., Darwin, C., Heckman-Stoddard, B. M., Temprosa, M., Kahn, S. E., & Nathan, D. M. (2017). Metformin for diabetes prevention: Insights gained from the diabetes prevention program/Diabetes prevention program outcomes study. Diabetologia, 60(9), 1601-1611. https://doi.org/10.1007/s00125-017-4361-9
Chatterjee, S., Khunti, K., & Davies, M. J. (2017). Type 2 diabetes. The Lancet, 389(10085), 2239-2251. https://doi.org/10.1016/s0140-6736(17)30058-2
Hara, Y., & Kawabe, H. (2019). Donepezil (Aricept). Drug Discovery in Japan, 183-205. https://doi.org/10.1007/978-981-13-8906-1_11
Radler, D. R. (2020). Herbal and other natural dietary supplements. Nutrition in Kidney Disease, 599-605. https://doi.org/10.1007/978-3-030-44858-5_32
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