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Case Study

A 53-year-old woman is seeing her diabetes specialist for evaluation of her glycemic control and medication review. She has a 1.5-year history of type 2 diabetes and comorbidities of hypercholesterolemia, hypertension, and coronary artery disease. Her medications include empagliflozin, metformin, enalapril, hydrochlorothiazide, atorvastatin, aspirin, and nitroglycerin. While her lipids and blood pressure are well-controlled, her HbA1c remains elevated despite medication adjustments. The specialist assesses her diabetes as uncontrolled and maintains her comprehensive pharmacologic regimen to improve glycemic control and reduce cardiovascular risk.

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lakshitataneja1998
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27 views19 pages

Case Study

A 53-year-old woman is seeing her diabetes specialist for evaluation of her glycemic control and medication review. She has a 1.5-year history of type 2 diabetes and comorbidities of hypercholesterolemia, hypertension, and coronary artery disease. Her medications include empagliflozin, metformin, enalapril, hydrochlorothiazide, atorvastatin, aspirin, and nitroglycerin. While her lipids and blood pressure are well-controlled, her HbA1c remains elevated despite medication adjustments. The specialist assesses her diabetes as uncontrolled and maintains her comprehensive pharmacologic regimen to improve glycemic control and reduce cardiovascular risk.

Uploaded by

lakshitataneja1998
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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CASE STUDY

SUBMITTED BY:
LAKSHITA TANEJA
PHARM D 5TH year
SUBJECTIVE
EVIDENCES
DEMOGRAPHICS

AGE :- 53 YEARS
GENDER:- FEMALE
WEIGHT:- 80.3 Kgs
BMI : 29.5
HEIGHT :- 165.1 cm
BP :- 126/76
PURPOSE OF VIST

She came for her monthly check up .


HISTORY
 has a 1.5-year history of type 2 diabetes (T2DM).
 Hypercholesterolaemia and Hypertension {controlled with medications}.
 Seven months ago she experienced anginal symptoms, and a cardiology work-
up revealed a 50% blockage of the distal left anterior descending artery
(LAD).
 Her weight has increased roughly 7 kg over the past 1.5 years.
 Her last HB A1c was 68.3 mmol/mol ( normal range – 20 to 43mmol/mol).
 Estimated glomerular filtration rate (eGFR) was 79.2 mL/min/1.73 m 2
 lipids have been in range since starting atorvastatin 80 mg daily
MEDICATION HISTORY
DRUG DOSE ROUTE FREQUENCY

Aspirin 80mg Oral OD

atorvastatin 80mg Oral OD

Empagliflozin 10 mg Oral OD

enalapril 10 mg Oral OD

Hydrochlorothiazide 12.5 mg Oral OD

Metformin 500mg Oral BD

Nitrogylcerin 0.4mg sublingual PRN


PREVIOUS TEST REPORTS
TEST NAME RESULT NORMAL RANGE
Ankle brachial index (ABI) R: 0.98 R: 1- 1.30
L: 0.97 L: 1- 1.30

Creatinine 0.8mg/dl 0.5 -0.9

GFR 79.2 mL/min/1.73m^2 0- 90

Hb A1c 68.3 mmol/mol 20-43

Cardiac troponin panel Troponin I : 0.1ng/ml 0- 0.5


Troponin T: 0 ng/ml 0- 0.1
OBJECTIVE
EVIDENCES
RECENT TEST REPORTS
TEST RESULTS NORMAL RANGE

HBA1C 72.7 mmol/L 20 - 43

ALBUMIN 4.6 g/dl 4–5

GLUCOSE 11.9 mmol/L 3.3 – 6.0

CREATININE 0.6 mmol/l 0.5 – 0.9

BUN 13 mmol/L 7 – 20

BILIRUBIN 1.0 mmol/L 0.3 – 1.3

SGOT 31 U/L 12 – 38

SGPT 29 U/L 7 - 41
Name Value Units Range

Cholesterol (total) 4.6 mmol/L 0.0 - < 5.2

LDL Cholesterol 2.5 mmol/L 0.0 - < 2.6

HDL Cholesterol 1.6 mmol/L 0.0 - > 0.91

Triglycerides 2.6 mmol/L 0.0 - < 1.7


ASSESSMENT
DIAGNOSES

 T2DM { uncontrolled }
 Coronary artery disease {CAD}
 Hypercholestolaemia
 Hypertention
PLAN
NEW MEDICATION
DRUG DOSE ROUTE FREQUENCY

Aspirin 40mg Oral BD

Atorvastatin 40mg Oral BD

Empagliflozin 10 mg Oral OD

Enalapril 10 mg Oral OD

Hydrochlorothiazide 12.5 mg Oral OD

Metformin 1000mg Oral BD

Nitrogylcerin 0.4mg sublingual PRN


MEDICATION USES MODE OF ACTION

ASPIRIN Anticoagulant Impair platelet aggregation via


inhibition of platelet
thromboxane A2 synthesis

ATORVASTATIN Cholesterol lowering agent HMG-Co A reductase inhibitor

EMPAGLIFLOZIN Antidiabetic drug SGLT-2 INHIBITOR

ENALAPRIL Antihypertensive drug ACE inhibitor

HYDROCHOROTHIAZIDE Antihypertensive drug Diuretics

METFORMIN Antidiabetic drugs AMP K activation

NITROGYLCERIN Angina pain Vasodilator


CASE SUMMARY
 A 53-year-old woman who is seeing her diabetes specialist today for evaluation of
glycaemic control and medication review. She has a 1.5-year history of type 2
diabetes (T2D). Her hypercholesterolaemia and hypertension have been controlled
with medications. Seven months ago she experienced anginal symptoms, and a
cardiology work-up revealed a 50% narrowing of the distal left anterior
descending coronary artery..
 T2D and coronary artery disease (CAD) put the patient at very high
cardiovascular risk, defined as a 10-year risk for cardiovascular death ≥ 10%., .
 She is on a comprehensive pharmacologic regimen that includes empagliflozin 10
mg once daily, metformin 1000 mg twice daily, enalapril 10 mg once daily,
hydrochlorothiazide 12.5 mg once daily, atorvastatin 40 mg once daily, aspirin 81
mg once daily and nitroglycerin (glyceryl trinitrate) 0.4 mg as needed.
 She reports good compliance with her prescribed medications. She has been
enrolled in a diabetes self-management, education and support programme .
 She has not been able to maintain her diet or be physically active four to five times
per week.
 Glycaemic control has been a challenge despite adjustments to her medication
regimen. Her low-density lipoprotein cholesterol has been consistently below 2.6
mmol/L and is now down to 1.4 mmol/L in response to starting high-intensity statin
therapy. She has not experienced any repeat episodes of angina since being
diagnosed with CAD. She has gained roughly 7 kg over the past 1.5 years.
 She has been screened for vascular complications and has shown minimal signs of
retinopathy but no clinically significant signs of nephropathy or neuropathy. She
denies recent illness, poorly healing skin lesions or symptoms of hypoglycaemia.
REFERENCE
https://simulations.medscape.com/edads-76/simulation?src=mbl_msp_android&ref=share

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