How to address an advanced pharmacology case study (Solved)

How to address an advanced pharmacology case study (Solved)

Case study prompt:

Gami is a 48-year-old who you discover when completing a health history is taking cinnamon to treat Type II Diabetes. She is specifically using cassia Cinnamon. You also discover that she is taking Ginseng to assist with memory. Her prescribed medications are Aricept and Coumadin.

Ms. GM is a 48-year-old who presents to your clinic to establish care. During the health history, you learn that she has a history of Type II Diabetes. When asked about prescription and non-traditional medications, she reports being prescribed Aricept, Coumadin, Cassia cinnamon for Type II Diabetes and Ginseng for memory.

Is there any additional subjective or objective information you need for this client? Explain.

What would be your position on the Ms. GMs use of alternative supplements for her diabetes and memory? Explain and include contraindications, if any.

Are there any additional test/assessments you would complete for this patient given this list of medications? Explain.

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.

What health maintenance or preventive education is important for this client based on your choice medication/treatment?

Solution to the  Case Study

Question One

I would ask her old primary care provider for a complete set of vital signs and a copy of her medical records (PCP). Her medical and surgical history would be reviewed from head to toe, and I would undertake a full physical examination of her. I would ask about her medical history, smoking, drinking, and drug usage in the family (Chatzistougianni et al., 2020). If her previous PCP is willing to provide additional information of how long she has been diagnosed, taking medications, and taking supplements, I would note that.  Aside from that, I would like to know why the patient needs to take Coumadin and the recommended dosage. Was her PT INR recently checked in the lab, and has she experienced unusually heavy bleeding or bruising since getting the shot?  Could you let me know if she is on any other DMII meds and how her blood sugar is managed (i.e., diet, exercise)? I would also like to know if Cassia Cinnamon is the sole diabetes medicine right now. I would find out how frequently she checks her blood glucose levels at home and has the necessary meters or test strips. If there are any new or existing concerns or problems, I would want to know about them. Finally, I would explain why she is on Ginseng and Aricept and the recommended dosages for each.

Question Two

Because of the interactions with Coumadin and glucose levels, I recommend that Ms GM stop using Ginseng and Cassia Cinnamon. To boost or decrease coagulation, Ginseng interacts with Coumadin, while insulin interaction results in hypoglycemia in people with diabetes (Guo et al., 2020). Cinnamon and warfarin have also been linked to interactions that have been classified as substantial, meaning there is a greater chance of interaction occurring, and the two medications should not be taken together. Coumarins, which are present in large quantities in Cassia cinnamon in amounts that might be hazardous, are abundant in the herb.

Question Three

Yes. Blood clotting times (PT, INR, and PTT) and blood glucose levels (including an A1C) should be routinely watched for this patient. If the patient asks, I will tell her that taking cinnamon and Ginseng with Aricept and Coumadin is not safe for her right now (Liu et al., 2021). Certain therapeutic ranges are required for medications like Coumadin, which supplements can impair. The usage of the supplement may result in levels of the drug being either too high or too low, causing it to become toxic or ineffective. Cassia, because cinnamon has been linked to worsening liver illness, I would run a metabolic profile to see how well her liver functioned before consuming any more. In addition, a complete blood cell count (CBC) would be performed to look for signs of infection, anaemia and to determine the platelet count.

Question Four

I may put her on a diabetes medicine like Jardiance, based on her blood test results and how well her glucose has been controlled. For individuals with type 2 diabetes, Jardiance is a prescription drug used in conjunction with diet and exercise to lower blood sugar levels and minimize cardiovascular mortality risk (Guo et al., 2020). SGLT2 inhibitors, such as empagliflozin, are a novel family of medicines to treat diabetes type 2. If you use Jardiance, the suggested dosage is one 10 mg oral tablet in the morning, with or without meals. Jardiance can be increased to 25 mg in people who tolerate it well. Several adverse effects, such as low blood pressure, ketoacidosis, kidney damage, and hypoglycemia, have been reported. By assisting the kidneys with urine, this medication helps remove more excess sugar from the body and prevents it from being reabsorbed into the body. This medication should not be used by anyone with diabetes type 1 or kidney disease. According to the FDA, all SGLT2 inhibitor medications now come with a warning for an infection of the vaginal area known as Fournier’s gangrene, rare but deadly. This warning will be included in the prescription information and patient medication guide for these treatments. In addition to a high fever, symptoms might include pain, redness, and swelling in or around the genitals, all the way back to the rectum. Patients with these symptoms who are taking SGLT2 inhibitors should see a doctor very away.

Question Five

For those who do not choose to quit taking the supplements, Ms Gm. should be informed that Cinnamon supplements appear safe for most people when used for a short period and in small doses. Cinnamon can cause an allergic reaction in certain people (Sayeed et al., 2021). The chemical coumarin found in cassia cinnamon can cause or worsen liver illness. Therefore she should have her liver function checked if she consumes any of it. I would tell the patient to keep all of her blood sugar tests and follow-up appointments and get her PT and INR done as prescribed. Be sure to follow the directions on her prescriptions and tell the doctor if she has any side effects. Ginseng comes in various forms, and the effects may vary depending on the components of the root utilized. Always report any unpleasant reactions, whether they are new or worsening.

References

Chatzistougianni, P et al. (2020). Level of knowledge and evaluation of perceptions regarding pediatric diabetes among Greek teachers. Diabetes research and clinical practice, 159, 107952. https://doi.org/10.1016/j.diabres.2019.107952

Guo, W et al. (2020). Diabetes is a risk factor for the progression and prognosis of COVID‐19. Diabetes/metabolism research and reviews, 36(7), e3319. https://doi.org/10.1002/dmrr.3319

Saeed, M., Kamboh, A. A., Syed, S. F., Babazadeh, D., Suheryani, I., Shah, Q. A., & Chao, S. (2018). Phytochemistry and beneficial impacts of cinnamon (Cinnamomum zeylanicum) as a dietary supplement in poultry diets. World’s Poultry Science Journal, 74(2), 331-346.

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