What medication recommendations will you make?

What medication recommendations will you make? Include the drug class, generic and trade name and starting dose range. Provide rationale for your choices.
Diabetic medication: As hemoglobin is >10% it is recommended that 2-3 agents are utilized with therapy initiation; TDD of 0.2-0.3 U/kg is recommended. Since she is newly diagnosed I would begin with the 0.2U/kg dose/ We would need her weight to calculate dose. Starting Lantus dose 20 units PM. Metformin is gold standard so I would begin with 500mg PO one daily w/ food – If blood sugars still remain elevated >200 then reevaluate increasing metformin dose. (Brock, 2020).
GERD: Proton Pump Inhibitor Omeprazole (Prilosec) 20mg Daily
Hypothyroid: Levothyroxine (Levothyrox) 100 ug Daily PO (Levothyroxine 1.7 mcg/kg/day we don’t know weight). In general, thyroid hormone replacement therapy in non-pregnant adults ≤ 70 years is clearly indicated if the TSH concentration is >10 mU/l (Koehler et al., 2018).
Staph infection: (not resistant) – Cephalosporin antibiotics. Ceftriaxone (Rocephin) 500 mg PO once a day
(Rosenthal & Burchum, 2021).
Discuss any potential side effects and drug interactions for this patient.
Metformin side effects of metformin are diarrhea, flatulence, nausea/vomiting, hypoglycemia. The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics, estrogens, gonadotropin-releasing hormone agonists, human growth hormone, phenothiazines, progestins, protease inhibitors, sympathomimetic amines, thyroid hormones, L-asparaginase, alpelisib, copanlisib, danazol, diazoxide, isoniazid, megestrol, omacetaxine, phenytoin, tagraxofusp, temsirolimus, as well as pharmacologic dosages of nicotinic acid and adrenocorticotropic agents. These drugs may interfere with blood glucose control because they can cause hyperglycemia, glucose intolerance, new-onset diabetes mellitus, and/or exacerbation of preexisting diabetes.
** Alcohol can potentiate the effect of metformin on lactate metabolism and increase the risk of lactic acidosis. **
Omeprazole side effects: headache, abdominal pain, diarrhea, nausea, vomiting, gas or flatulence, dizziness, and upper respiratory infection.
Ceftriaxone side effects: rash, diarrhea, nausea, vomiting, upset stomach, blood clots, dizziness, and headache
PPI + Synthroid Concurrent administration of proton pump inhibitors (PPI) may decrease the oral bioavailability of levothyroxine. It is recommend separating administration of PPI and levothyroxine by several hours.
Synthroid: Levothyroxine should be taken on a consistent schedule with regard to time of day and relation to meals to avoid large fluctuations in blood levels, which may alter its effects. In addition, absorption of levothyroxine may be decreased by foods such as soybean flour, cotton seed meal, walnuts, dietary fiber, calcium, and calcium fortified juices.
What non-pharmacological interventions would you suggest?
DM: Weight loss with a BMI <30 goal, increase fiber through vegetables and limited fruits, whole grains. The patient needs to increase exercise daily, this can include walking 30 mins a day for start. GERD: keeping the head of the bed elevated, losing weight, quitting smoking, avoiding caffeine, alcohol, mints, and not eating 2 hours before bedtime. Hypothyroidism: lower stress levels through exercise, medication, breathing. Staph Infection: Prevention through good hygiene and skin care. (Rosenthal & Burchum, 2021). What patient education would you provide? DM: The patient needs education on all medications, uses, side effects and interactions. She must have education on glucometer use and frequency. She must rotate injection sites for insulin therapy. She must have education on diet and exercise. She must also be educated in signs and symptoms of hyper/hypoglycemia, foot care, and follow up care. Metformin should be taken with meals. GERD: She also needs education on GERD prevention, dietary contributions and prevention. Raising head of bed, avoiding triggering foods like spicy foods or acidic foods. Staph ed: Keep your hands clean by washing them thoroughly with soap and water or use an alcohol-based hand sanitizer. Keep cuts and scrapes clean and covered with bandages until they heal. Avoid contact with other people's wounds or bandages. Do not share personal items such as towels, clothing, or cosmetics. Teach how to preform dressing changes and signs of worsening infection. Hypothyroid ed: Do not use caffeine and other stimulants. These can make symptoms worse like a fast heartbeat, nervousness, and problems focusing. Do not smoke. Smoking can make your condition worse and may lead to more serious eye problems. Lower your stress. Learn to use biofeedback, guided imagery, meditation, or other methods to relax. Notify APRN of symptoms of hypothyroidism, such as fatigue, cold intolerance, constipation, unexplained weight gain, depression, joint or muscle pain, thinning hair or hair loss, dry skin, hoarseness, and abnormal menstrual periods. (Rosenthal & Burchum, 2021). Brock, Z. (2020). New Onset Type II Diabetes: Pharmacological Interventions. Rosenthal, L. D., Burchum, J. R. (2021). Lehne's pharmacotherapeutics for advanced practice nurses and physician assistants. Elsevier.

Last Completed Projects