Sapiandante, Jameela Rose O.

Francisco, Anna Joy V.

BSPH 3Y1-1
Worksheet on Exercise No. 7 Case Study on Diabetes Mellitus

PATIENT THERAPEUTIC CARE PLAN RECORD

Patient Name: Sarah Martin Gender: Female

Age: 43-year-old
Address: ---
Birthdate: ---

Medical Condition:

 Type 2 DM x 6 months
 HTN x 15 years Race: Caucasian
 Bipolar Disorder x 25 years
 Dyslipidemia x 10 years
 Morbid Obesity x 15 years

Tobacco/Alcohol/Substance Use: Drinks

alcohol occasionally (5 beers/wine per Weight: 109 kg
week)

Allergies: Morphine - Hives Height: 5’8”

MEDICATION RECORD

Drug Name Indication Strength Regimen Adverse Drug Reactions

 Nausea, heartburn, stomach full
 Oral ness, and weight gain may
 Glyburide 5 mg BID
hypoglycemic occur. 
  Dizziness, lightheadedness,
tiredness, or headache may
 Lisinopril Lowers BP  20 mg OD occur as your body adjusts to
the medication. Dry cough may
also occur. 

 Acute & Drowsiness, dizziness, lighthead

maintenance edness, stomach upset, dry
Zyprexa treatment of 5 mg Q HS mouth, constipation, increased
schizophrenia & appetite, or weight gain may
other psychoses  occur. 

Nausea, vomiting, dizziness,
Carbamaze  anticonvulsant or drowsiness, constipation, dry
pine anti-epileptic drug 200 mg  TID mouth, or unsteadiness may
occur. 

 Drowsiness, dizziness, loss of
coordination, headache, nausea, 
blurred vision, change in sexual
Lorazepam Anxiolytics 1 mg TID PRN interest/ability, constipation, hear
tburn, or change in appetite may
occur.

Suicidal thoughts and behaviour,

Fluoxetine  Antidepressant 20 mg Q AM
serotonin syndrome.

Upset
EC ASA  Anticoagulant 81 mg OD stomach and heartburn may
occur.

Nausea, vomiting, heartburn,

diarrhoea, headache, cough,
insomnia, chest pain, rash,
 Dyslipidemic fatigue, dizziness, influenza,
Pravastatin 40 mg OD
Agent blurred vision, myalgia, elevated
serum transaminase, alopoecia,
paraesthesia, impotence,
gynaecomastia.

         
 

ASSESSMENT, PLAN AND FOLLOW-UP EVALUATION

Medical Goal, Current Status

Drug-Therapy Problem Follow-up Plan
Condition and Interventions

Glyburide is not enough to

 The patient Goals: - Lifestyle advice
control Type 2 Diabetes
suffers from and education.
Mellitus of the patient. - To avoid acute
Type 2
decompensation - Explore the
Diabetes
- To prevent or patient’s
about 6
Some medication of delay possible understanding of
months ago.
comorbidities have a drug future the need for
Along with
interaction with Glyburide. complications. good glucose
that, she is
- To decrease control.
also suffering
mortality.
from - Assist the
- To keep the blood
Hypertension patient in
sugar in normal
(for 15 years), adopting
level.
Bipolar necessary
- To prevent tissue
Disorder (for lifestyle changes
damage caused
25 years), and encourage
by too much sugar
Dyslipidemia pro-active self-
in the blood
(for 10 years), management.
stream.
and Morbid
- To maintain - Encourage the
Obesity (for 15
agood quality of patient to attend
years).
life. for an annual
She is diabetic review.
Pharmacological
complaining of
Interventions: - Review the
experiencing
Nocturia, medication
- Metformin (first
Polyuria, and therapy plan and
line oral
Polydipsia on free of side
hypoglycemic
a daily basis. effects to
agent)
improve patient
- Thiazolidinedione
care outcome.
s
 - Reduce the
complexity of
therapy by fixed-
dose
combination pills
and less frequent
dosing regimens,
using
medications that
- Alpha glucosidase are associated
inhibitors with fewer
adverse events
Non-pharmacological (hypoglycemia or
Interventions: weight gain),
educational
- Blood glucose
initiatives with
monitoring
improved
- Regular exercise
patient–
- Medical Nutrition
healthcare
Therapy
provider
- Diet Modification
communication,
- Meal Planning
reminder
systems and
social support to
help reduce
costs.

PATIENT COUNSELLING
 Pharmacist: Good morning ma’am!

Patient: Good morning!

Pharmacist: Thank you for attending our diabetes education class. May I know your
name, ma’am?

Patient: I’m Sarah Martin, but you can call just call me Ms. Martin.

Pharmacist: Alright, Ms. Martin! In what ways can I help you?

Patient: I was recently diagnosed with possible diabetes and would like to have my blood
sugar tested. I think that my blood sugar is running low because I have a terrible
headache.

Pharmacist: Okay ma’am! To address your complaint of experiencing headache, the

reason is not just because your blood sugar is running low, it may also indicate that your
blood sugar is high. May I know the medication that you’re taking, Ms. Martin?

Patient: I’ve started taking Glyburide 5 mg 6 months ago when I went to the hospital for a
checkup. I’m also trying to control my diet and do daily exercise.

Pharmacist: Are there any significant changes that you’ve noticed ma’am?

Patient: As per my physician, I should monitor my blood sugar atleast once a day. I’ve
noticed that my blood sugar levels are still high.

Pharmacist: Are there any symptoms that you’ve been experiencing aside from
headache?

Patient: I frequently wake up at night to pee. And oh! I also noticed that I always feel
thirsty. Could it be the reason why I’m peeing frequently?

Pharmacist: Yes, ma’am. I could tell that you’re experiencing nocturia, polyuria, and
polydipsia. These are signs that you may have diabetes. How about your blood sugar
level, Ms. Martin?

Patient: It’s at a range of 215-260 mg/dL.

Pharmacist: It it indeed high. I suppose that we must combine or change Glyburide with
Metformin because it seems like Glyburide alone is not effective enough to control your
diabetes, Ms. Martin. I’ll refer you to a physician and rely my diagnosis on you. Is it okay
with you, Ms. Martin?

Patient: Yes, ofcourse!

Pharmacist: Is there any more drugs that you’ve been taking, Ms. Martin? May I know if
there’s any?

Patient: Sure, here’s my prescription.

Pharmacist: Oh, ma’am! I can see that based from the number of drugs you’ve been
taking, you may be experiencing side effects from that.

Patient: So, what can I do with that?

Pharmacist: You have to talk it out to your doctor, so that he’ll find alternative drugs that
won’t affect the other drugs’ effects.

Patient: Okay, I’ll surely do that.

Pharmacist: Also, continue with your diet modification because it will be beneficial for
optimal glycemic control. Make sure to regularly exercise too, but refrain doing heavy
ones. These interventions is helpful in diabesity management.

Patient: Noted ma’am! The information that you’ve shared will surely help me a lot.

Pharmacist: If you are having a hard time preparing your meals, you may opt for meal
planning, Ms. Martin.

Patient: I’ll consider to do that! Thank you!

Pharmacist: No worries, Ms. Martin! It is our duty to improve patient care outcomes and
provide you what you need in the best way that we can. So Ms. Martin, don’t forget to
seek medical assistance and concern these things that I’ve listed out for you. Also, make
sure to comply with your medication regimen and do supplemental interventions if
possible. Remember that if you neglect your situation today, it could become worse in the
future.

Patient: Great! Thank you again, Ma’am!

QUESTIONS:

1) What are this patient’s drug therapy problems?

 - Glyburide is not enough to lower the blood glucose levels of the patient. There are
also numbers of potential drug interactions due to comorbidities experienced by the
patient that may cause serious side effects.
2) What findings indicate poorly controlled diabetes in this patient?

- Ms. Sarah Martin’s blood glucose level is relatively high, given that she’s already
taking an oral antidiabetic drug matched with non-pharmacological interventions such
as proper diet and exercise. Moreover, the patient has gained weight as well. A number
of drug interactions has been found due to comorbidities.

3) What are the goals of treatment for Type 2 diabetes in this patient?

- The goals of treatment for Type 2 Diabetes in Ms. Martin’s case are to avoid acute
decompensation, prevent or delay the possible future complications, decrease mortality,
to keep the her blood sugar in normal levels, to prevent tissue damage caused by too
much sugar in the blood stream, and to maintain a good quality of life. 

4)  What non-pharmacologic interventions should be recommended for this patient’s

drug therapy problems?

- The non-pharmacologic interventions should be recommended for this patient’s drug

therapy problems is to continue diet modification, weight control, and regular exercise.
Nutritional interventions are important in achieving optimal glycaemic control in patients
with T2DM. Most patients with T2DM are overweight or obese Regulation of sleeping
pattern is also as important because sleep deprivation and poor quality of sleep result in
altered metabolic and hormonal function, leading to the development of T2DM. Medical
nutrition therapy is advised where carbohydrates, protein, and fat intake must be
monitored. Meal planning approaches will be beneficial.

Ms. Martin must avoid alcohol intake and make sure to live a healthy lifestyle and
diet. Most importantly, blood glucose monitoring must be kept as part of the patient’s
routine.

5) What pharmacotherapeutic regimen would you recommend for each of the patient’s
drug therapy problems?

- Combine or Alternate Glyburide with Metformin to lower the blood glucose levels.
Metformin would be the first medication recommended. Thiazolidinediones or Alpha
glucosidase inhibitors may also work.
6) What parameters should be monitored to evaluate the efficacy and possible adverse
effects associated with the optimal regimens you selected?

- The pharmacist may provide counseling about monitoring glucose levels and how to
manage out-of-range levels, including developing an action plan for what to do if
sugar levels go too low. Pharmacist can help patients select the most appropriate
hypoglycemic management strategy on an individual basis. Moreover, pharmacist
can counsel on an appropriate diet and exercise routine to compliment medication
management in treating diabetes. The number of treatment options for diabetes has
increased substantially over the past few years, and pharmacists are best
positioned to help patients understand the fundamentals and intricacies regarding
the medication as well as helping them understand which medications may be best
suited for them. Pharmacists can also help guide patients through the management
of adverse effects, knowing when and how to treat these so that therapy can be
continued and when it might be better to switch to an alternative treatment regimen.
It is also important to have an eye check to detect if there would be any problems
with the retina, take urine tests as a test for the presence of protein, foot checks in
order to prevent foot ulcer and other necessary blood tests.

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