week 5 disc 1 reply to Yosef L

Q1. Which classes of diabetes medications are either weight neutral or cause weight loss? Please give one (1) example of a drug’s generic and trade name in that class.

A1: A class of diabetes medication that also helps with weight loss are Glucagon-like peptide 1 agonists. An example of this class is the generic drug exenatide, with the brand name Byetta (Van Gorp et al., 2020).

Q2. Based on the current guidelines of the ADA, it would be appropriate to treat her with monotherapy since the patient is hesitant to take any injections. What agent would you recommend? Please provide the trade name, generic name, the dose you would start the patient with frequency, and route.

A2: Based on this patient’s medical history of obesity and hyperlipidemia, her reluctance to injections and the ADA guidelines, I would suggest Jardiance, generic name empagliflozin, a type of SGLT2 inhibitor. This medication not only helps against type II diabetes, but also has some medium level efficacy against obesity as well as decreasing the possibility of Major Adverse Cardiac Events (MACE) (“Standards of Care in Diabetes—2023 Abridged for Primary Care Providers,” 2022). This medication, however, can be expensive, depending on her insurance. Depending on how obese she versus how much her insurance covers would be the deciding factor. The recommended dose for Jardiance is 10mg, once daily in the morning (Ingelheim, 2023)

Q3. What are the contraindications of your selected diabetic therapy?

A3: Contraindications for Jardiance include: pregnancy, renal insufficiency, bariatric surgery and any surgery in general (Empagliflozin: Drug Information – UpToDate, n.d.).

Q4. What lab workup should you obtain? What sort of results will you see in patients who have hypothyroidism and hyperthyroidism? 

A4: to assess for either hypo or hyperthyroidism, I would obtain a TSH lab with an additional free thyroid hormone T-4 one. If the TSH is high and T4 is low then the patient would be diagnosed with hypothyroidism. If it is reversed, with TSH being low and T4 high, then we would diagnose hyperthyroidism (American Thyroid Association, 2020).

Q5. What is the treatment of choice for hypothyroidism? What is the mechanism of action? Please provide the initial dose, trade, and generic name of the drug, route, and frequency.

A5: Choice of treatment for hypothyroidism is Synthroid, a type of levothyroxine medication. It works because it is a synthetic form of thyroxine, the endogenous hormone in the body. Dosing for Synthroid depends on patients medical history, TSH and free T4 levels as well as patient’s weight. So the initial starting dose would be 1.6 mcg/kg/day (patient’s weight is unknown) and increase the dose by 12.5-25mcg every 3-6 weeks based on lab results. She should take it once a day, early in the morning, without food (Dosing & Administration – SYNTHROID®, n.d.)

Q6. What are the adverse effects, and what important teaching will you provide this patient on thyroid replacement therapy?

A6: Adverse reactions of Synthroid are symptoms of hyperthyroidism. This includes: increased BP, dyspnea, diarrhea, weight loss, sweating, vomiting, anxiety and headache, to name a few. Teaching for this medication include: not crushing the medication, taking it on an empty stomach, early in the morning and not within four hours of any calcium- or iron-containing products or bile acid sequestrants. It should be stored at room temp and that she should tell her provider if she plans or becomes pregnant (Levothyroxine: Drug Information – UpToDate, n.d.)