Student Pulmicort flexhaler DMI (0.09 mg/actuat), Ventolin HFA

Student Name: Jagdeep Bhullar                                             Student
ID: 989244381                               

Case Name (including
Date): 1/30/18    

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Problem/ Disease

Pertinent Data
Collected (S/O)

Drug related problem (DRP) * identified

Assessment of the Drug related problem (DRP), immunization status
& preventative care needs, guidelines used

Plan (Treatment goals,
non-drug & optimal pharmacological Tx plan, patient education )

Rationalize your optimal pharmacologic plan.
List 3 alternatives.

Follow-up (Monitoring &
Evaluate effectiveness, ADR, etc.)

Diabetes

41 yo WM; BMI 43; Ht: 5’10”; Wt: 300 lbs; gained
13 lbs since last visit;
Polydipsia, fatigue, irritability, trouble
initiating sleep,
 
SH:
2 to 3 alcoholic drinks; 3 to 4 cups of coffee per
day.
 
Med
list: 
Glyburide 10 mg BID, Benazepril 10 mg qd,
Pravastatin 20 mg qd, , Pulmicort Flexhaler, Ventolin HFA, Aspirin 81 mg qd,
Ibuprofen 400 mg Q6H prn back pain, Glucosamine 2 tabs qd for knee pain.
 
Labs:
Glucose: 176 mg/dL
A1C: 8.5%
HDL: 34 LDL:120
TG: 240 (high)
eGFR 75.9
ALT 39 (High)
AST 41 (High)

Needs additional drug therapy

The patient is currently on Glyburide 10 mg BID
for his uncontrolled DM 2. Since the patient is experiencing weight gain,
which may also further complicate his co-morbidities, he should be considered
for alternative therapies. According to the ADA guidelines, the patient is
indicated for Metformin 500 mg BID which is first line therapy for his
disease state. However, due to the side effect profile which has previously
led to severe GI complications, alternatives such as GLP-1 should be
considered.
 
 
Immunizations:
–        
Influenza
–        
Hep B. (3 series)
–        
PPSV 23

Goal of therapy:
–        
Control
DM2-> A1c