Question:

45-year old respite care resident has cellulitis left leg and prediabetes that cannot be managed by lifestyle changes. Overweight BMI- 30.6.

A high-risk patient for cardiovascular disease. Patient currently takes amlodipine 10mg for hypertension once daily. Recent blood tests show she has diabetes (HbA1c= 63). Metformin 500mg is being started twice daily.

Prescribers should provide a pharmacotherapy strategy to support the prescription of metformin. They also need to discuss pharmacotherapeutic considerations, such as dosing, drug to drugs interactions and possible treatment outcomes.

Discuss treatment goals and outcomes. This includes monitoring and evaluation. Finally, discuss patient factors and management.

Discuss patient education with respect to drug adherence.

Discuss the potential risks and benefits associated with drugs and other conditions that could require dosage adjustments.

Answer to Question: BIOM2009 Human Physiology And Pharmacology A1

The subject of diabetes has gained traction in modern clinical discourses.

Research has shown that the number of people diagnosed with diabetes has increased recently. Medical scientists attribute this to changes in lifestyle.

There are many treatment options available to treat this disease.

Metformin is the main medication used to treat this condition.

Metformin can be used to treat type 2 diabetes.

Metformin works by lowering blood sugar and improving insulin handling (Zaccardi et. al., 2016).

It is common to prescribe metformin for patients with diabetes if diet and exercise have failed to reduce blood sugar.

This paper will provide a detailed discussion on a pharmacotherapy program supporting the prescribing of metformin. Also, it will discuss the pharmacotherapeutic considerations regarding dosing and drug to drug interactions. Discuss the expected therapy goals, desired treatment outcomes, monitoring and evaluation, and make recommendations for continued treatment based on patient factors (Sonesson Johansson Johnsson and Gause-Nilsson 2016).

Discuss patient education related to drug compliance.

Discuss the potential risks and benefits of drug use and discuss conditions that may necessitate a dosage adjustment.

The paper will address 45 years of patient in respite.

Pharmacotherapy Plans Supporting the Prescription Of Metformin

The truth is that metformin comes with information about patients.

The respite patient is 45 years old and must be able to read the whole information thoroughly before taking the prescribed metformin.

Patients should then ask their doctors any questions they may have.

Primarily, the 45-year-old is expected to follow the prescribed meal plan.

This is important especially for controlling a patient’s condition. It is also essential if the medication is supposed to work (Tahrani Barnett and Bailey, 2016).

While testing for sugars in patients’ blood or urine, it is necessary to exercise regularly.

Metformin should not be taken in isolation. It is meant to be taken along with meals, in order for it to reduce stomach and bowel side effects.

The 45-year old patient should swallow the tablet.

This should be a normal process and there shouldn’t be any panic.

It is best to swallow the tablet whole with water.

Additionally, you must measure the oral liquid with a marked measuring spoon (or syringe) or medicine cup.

Because the average household teaspoon can sometimes not hold the correct amount of liquid, this is a good idea.

Remember that patients are only supposed to take the metformin prescribed by their doctors.

This is because some brands may not be suitable for treating diabetes.

A 45-year old patient may begin to see some improvements in as little as one to two months.

But, the full effect regarding blood sugar regulation can take almost three months (Lu Min. Chuang. Kokubo. Yoshida., Cha, 2016).

Patients can now ask their doctor any questions about the condition.

Not able to prescribe Metformin

First, there are many reasons why a doctor should prescribe metformin for diabetics.

Metformin has been shown to increase longevity.

Metformin has long been associated to nearly 24 per cent lower mortality rates than patients who did not take it.

Metformin is said to be able to moderate hypertension while allowing for weight loss.

This is a case where metformin should be used to treat hypertension.

Metformin is well-known for its ability to prevent and treat heart disease.

In these circumstances, metformin is recommended.

Metformin would help the 45-year-old patient with diabetes to manage their condition and also make it easier for them to use the insulin they naturally produce.

Pharmacotherapeutic Consideration with Respect to Dosing And Drug-to-Drug Interaction

Medical professionals should consider a number of factors before deciding on the appropriate dosage or treatment method for a patient.

The dosing of metformin will vary for different types of patients.

Follow the instructions on the label, as well the orders given by doctors.

If the dose given to a patient differs, the doctor should direct the patient to modify the dosage.

Also, how strong the medication is can have a significant impact on how much medicine an individual takes.

Consider the specific medical problem the medication is being prescribed.

This defines how many doses are taken every day, how long each one is allowed to take between doses, and the number of daily doses that an individual takes.

Although it is not recommended that you use certain drugs together there are instances where multiple medicines may be combined.

Sometimes, doctors may alter the dosage or make other recommendations.

Metformin is a medicine that can be taken alongside other medications. It is important to let your health care provider know if you are taking any other medicines.

Some medicines should not be taken along with metformin.

Iopanoic Acid is, Diatrizoate and Iobenzamic Acid are all examples of such medicines.

Even though they are not usually recommended to be taken along with metformin there are certain medicines that can still be used.

These medicines include Aspirin. Balofloxacin. Norfloxacin. Bupropion.

This is because they may increase side effects.Amlodipine Use In Pre-Diabetes To Control Hypertension

Primarily, amlodipine can be used alone or in combination with other drugs.

Amlodipine, in most cases, improves endothelial function.

This medication can help improve cardiovascular outcomes.

Metformin in Diabetes

Metformin, in essence, is an antihyperglycemic that is designed to increase glucose tolerance in type 2 diabetics aged 45 and older.

Metformin’s action has two parts. It lowers the basal as well as the postprandial glucose.

Primarily, it is an antihyperglycemic agent that is used as a pharmacological instrument of action.

Metformin is designed to lower hepatic sugar production and decrease overall absorption of glucose in the intestine. This also increases insulin sensitivity via increased peripheral uptake of glucose.

Metformin does NOT cause hypoglycemia, and is safe for patients with type 2 diabetes as well as people who are healthy.

Metformin’s Expected Treatment Goals, Outcomes, and Monitoring and Evaluation of Treatment Outcomes

Goals

Each medication strategy should have a goal in mind to reach a particular outcome.

The general goals of metformin-based therapy for diabetes are discussed in this context.

This therapy is designed to treat diabetic patients. The goal of the therapy is to decrease the severity of acute decompensation, improve quality of life and delay or prevent the appearance of later illness and complications.

To treat diabetes, the patient must be able to achieve therapeutic goals.

Glycosylated haemoglobin (HbA1c), which is a measure of glucose control, is commonly referred to as the best. This indicates how well the patient has managed their diabetes.

A therapeutic target is essential for patients older than 60 who have a low chance of developing severe hypoglycemia.

Consider the target value for the patient’s blood pressure and lipid profile. It is important that you remember that some diseases, such as ischemic heart disease, are the main cause of death in diabetics.

Patients with diabetes often have the same cardiovascular risks as patients who don’t have the disease.

It is important that the target values required by diabetics be as precise as those needed for patients with existing coronary illnesses.

Desired Outcomes

There are many outcomes that can be expected for a 45-year old diabetic who is taking metformin.

It is evident that diabetes patients have a higher incidence of heart failure.

One expected outcome of this therapy, in this light, is to lower the chance that a patient will develop heart failure (Hadjadj. Rosenstock. Meinicke. Woerle. Broedl.2016).

Another aspect of metformin treatment is to improve the patient’s quality life.

This means that the medication is meant to lower other risk factors, such heart disease and diabetes.

The outcome of life expectancy is a major concern, especially for older patients.

The current therapy is predicted to increase a patient’s overall lifespan.

Metformin therapy will also reduce cognitive impairment.

Metformin Treatment Outcome Monitoring and Evaluation

To ensure a full recovery phase, it is important to keep track of a patient’s progress, particularly in the first few days after taking metformin.

It is crucial to monitor the patient’s progress and conduct urine and blood tests to determine if there are any side effects.

Metformin might interact with the dye often used to take X-rays, or CT scans.

Accordingly, doctors should tell patients to stop taking the medication before any kind of medical examination or other diagnostic test. This may result in a decrease in urine output.

Metformin should be started within 48 hours of the examination to allow for good monitoring.

Additionally, it is essential to ensure that any dentist or doctor who treats a patient with diabetes understands that the patient is taking metformin.

It is also advised that patients stop using metformin days before they undergo surgery or a medical test.

A patient’s body can become lactic acidosis when they take too much Metformin.

It is vital to monitor patients and make sure they seek medical attention immediately.

Metformin has been shown to be effective in treating type-2 diabetes.

To ensure the best possible outcome, patients taking metformin must be closely monitored (Bilezikian, et al. 2016).

Doctors must know when a patient is receiving metformin therapy.

This is the only way to have a close, successful monitoring process.

Recommendation

It is true, diabetes type 2 is treated with lifestyle changes, especially for older adults.

Many patients, even after having a positive response to metformin therapy, fail to maintain their target levels of glucose (A1C), particularly over consecutive three to five year periods.

It is recommended that patients receive a second medication when they fail to achieve their individualized glycemic treatment targets or goals after receiving metformin along with lifestyle intervention (Dujic und al., 2016).

This decision is often based upon the A1C results that are usually taken after about three to six months following the last therapy.

There are many recommended medications that can be used with metformin if patients are unable to meet their objectives on the initial therapy.

These options include insulin and glucagon-like Peptide-1 (GLP-1) agonists, as well as repaglinide and insulin (Kohler (2016)).

Patients need to be aware of the fact that all recommended medications have both advantages and disadvantages depending on how they affect a patient.

A1C greater that 8.5 percent on the overall metformin is recommended. Patients who have obstinate symptoms or hyperglycemia should also be considered.

GLP-1 receptor agonist, despite the fact that basal insulin was for many years the preferred medicine to be used during metformin therapy when A1C rises, is still an option.

Additionally, some patients are believed to have developed a heart condition or even heart failure (Storgaard Bagger Knop Vilsboll, Vilsboll and Rungby 2016).

The use of a GLP-1 receptor-agonist with cardiovascular advantages may be considered. However, this assumes that the patients will ultimately achieve the desired outcome.

If a patient has an A1C of less than or equal 8 it is recommended that the second metformin be chosen based on its efficacy, overall condition, weight impact, and hypoglycemia (Steven and co-authors, 2016).

Patients who have inadequate glycemic controls, particularly when receiving double therapy, must have their selection criteria personalized. They should follow the same guidelines as for patients with monotherapy failure but be determined on the overall efficacy.

Patients who do not achieve the targeted A1C should try another dual therapy. If they fail, then it is recommended that they start insulin or the GLP-1 receptor-agonist (Lipska Krumholz & Soones (2016)).

Patients who are currently on metformin as well as sulfonylureas must be tapered.

This is where metformin can also be continued.

Some patients may also have a history for myocardial or stroke-related complications. Patients who are at risk of these conditions should take two oral medications in addition to a GLP-1 agonist.

Three goals is another recommendation for patients close enough to achieve their glycemic goals.

Patient Education and Drug Adherence

Medication adherence can be defined as the patient’s compliance with prescribed medications.

This topic, particularly among pharmacists, has become a hot topic in recent years.

It is worse that the majority of modern medicine does not measure patients’ adherence to medication.

Therefore, it is essential to create a solid patient education strategy for drug compliance.

Softeland et. al. (2016). While prescription misuse can occur in many cases, it is not always intentional.

Unintentional disadherence is most common in cases where patients do not want to follow their treatment plans, but face challenges they can’t control.

Patients can be involved in the issuing of prescriptions. This is a clear educational activity nurses can use to reduce drug non-adherence.

Goldstein & Muller Wieland (2016) state that nurses can include patients in decision-making, particularly when issuing prescriptions.

A collaborative approach in this instance is more likely to increase patient cooperation.

The patient’s participation in the decision making process allows medical practitioners to give them a sense ownership. This gives them the feeling that more is being done for them (Ahren et. al. 2017, 2017).

Furthermore, car providers can increase prescription compliance by introducing a very simple drug regimen.

Care providers can communicate with patients and explain what the patient should do to ensure that the prescribed medication is followed correctly (Tseng (2016)).

The medical staff can also educate the patients about the medications they have been given and the proper way to use them.

A patient’s education about side effects is important (Nauck et. al., 2016,).

Metformin therapy has a delicate side effect. Therefore, patients need to be fully informed on how to follow prescribed instructions.

A forgetfulness is one of the main reasons for non-adherence.

Nearly half of patients who have been prescribed medication fail to remember to take it at one point or another (Qaseem Barry Humphrey, Forciea, & Forciea 2017.

Nursing tends to use a common tool in this instance to help patients remember their treatment. This includes email, voice mails, as well as text messages. (Chapman, Darling, & Brown,2016).

Nurses can remind their patients to keep their emails updated and to adhere to their therapy’s end date by providing education.

Nursing staff can also assist their patients to understand their prescriptions. This will help avoid misinterpretation of medication information.

This can be particularly helpful for patients who have complex prescriptions and need to follow a daily schedule.

Drugs and their risks. A dose may be adjusted.

It is important to remember that no effective medicine is without risks. Therefore, every medicine can cause side effects in some patients (Gaede (2016).

This is why the potential benefits of a particular medication should outweigh any risks.

Metformin is an effective medication for type 2 diabetes. It has many benefits.

Metformin promotes gut bacteria growth, which is ideal (Chatterjee Khunti and Davies, 2017).

Recent research shows that metformin could be an effective agent to improve the microbiota.

This is done by enabling mucin degradation.

Additionally, metformin can be used to prevent prediabetes becoming type–2 diabetics (Tian et. al., 2016,).

Changes in lifestyle habits can often help to prevent people with pre-diabetes (especially type 2 diabetes) from developing it.

Metformin has another benefit: it protects the eyes from glaucoma.

Metformin can have many benefits. But, metformin also has risks.

Gastrointestinal adverse events, diarrhea are some of the possible risks that diabetic patients may face after taking metformin. (Wu, et.al., 2016).

The life-threatening dangers associated with metformin are extremely rare and should therefore be avoided.

Conclusion

It is obvious that diabetes has become an epidemic in modern society. This can largely be attributed to lifestyle.

A lack of exercise, diet and physical activity has all contributed to obesity and diabetes.

Diabetes mostly affects older people. In this instance, the 45-yearold lady with cellulitis in one of her left limbs, it can lead to hypertension, stroke, heart disease, and other serious health problems.

It is crucial to set up measures to improve quality of life for patients with diabetes.

Metformin therapy, which has been used for years to control diabetes, is one of the most popular treatments.

This medication is not without risk. However, its benefits outweigh any potential risks and it is highly effective in controlling diabetes.

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