John is a 46-year-old male who presents for his yearly physical examination. He has no complaints. Previous medical history is notable for obesity and hyperlipidemia. He reports a very sedentary lifestyle. He sits at a desk for 8 to 10 hours per day and when he comes home he “just wants to relax ...
John is a 46-year-old male who presents for his yearly physical examination. He has no
complaints. Previous medical history is notable for obesity and hyperlipidemia. He reports a very
sedentary lifestyle. He sits at a desk for 8 to 10 hours per day and when he comes home he “just
wants to relax in front of the television.” He doesn’t feel motivated enough to exercise on a
regular basis, although he knows he should.
John is allergic to penicillin (hives). Medications include atorvastatin 10mg daily and a
multivitamin. He occasionally takes acetaminophen for a headache.
Family history is significant for diabetes (mother, maternal grandmother, paternal grandfather)
and hypertension (father and brother). He is a nonsmoker and reports drinking “a few beers on
the weekend during football season”. His diet largely consists of fast food meals. He drinks
sweet tea with every meal and an additional 3-4 cups of coffee per day. Previous labs and exam
last year are unremarkable.
Vitals today: BP 130/70 mm Hg, pulse 82 and regular, temperature 98.7, respirations 18, height
6’1”, weight 235 pounds (up 3 lbs. since his visit 1 year ago). He completed fasting labs prior to
this appointment as he was instructed which reveal the following:
Fasting plasma glucose=209 mg/dl, HgbA1C=9.1%, TSH=4.0mU/L and Free T4=1.1
ng/dl. Fasting lipid panel includes the following: total cholesterol=190 mg/dL, HDL=35 mg/dL,
LDL=120 mg/dL and triglycerides=260 mg/dL.
Physical exam is remarkable for obesity but is otherwise normal.
What are your treatment goals for John?
What is your pharmacologic plan and rationale? (cite with appropriate clinical practice
guidelines or scholarly, peer-reviewed journals)
What is the mechanism of action for each drug?
Please give five medication teaching points for each drug prescribed.
How would you change the plan if his initial HbgA1C was 14.0 mg/dL and his fasting
blood glucose was 350mg/dL along with a urine dipstick that revealed 3+ glucose and +
ketones? Provide a detailed alternative plan with the rationale.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Milestonee. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $9.73. You're not tied to anything after your purchase.
