Case study 1

Case study 1 It has a strict limit of 1000 words (range 800 to 1200), not including any inserted items (table. Diagram . references ) Case study 1 Mrs AB is a 56 yr old female patient who brings a prescription in for hydrochlorothiazide with an instruction to take when needed up to 2 tablets a day. Current medications: Gliclazide 60mg daily Metformin 500mg three times a day Carvedilol 2.5mg daily Sitagliptin 100mg daily Perindopril 5mg daily Olanzepine 10mg daily Hydrochlorothiazide prn mdu Mrs AB has been on these medicines for 6 months. She has been feeling tired lately and has had difficulty breathing when walking her dog along the beach over the last couple of weeks. She is concerned because despite watching what she eats, being overweight (95kg) she has put on 3 kg in the last 2 weeks. This she puts down to her lack of exercise due to being breathless. She uses the thiazide for swelling in her ankles but has stated that she has needed to use more in the past few weeks. Her Doctor started her on sitagliptin 100mg once daily 4 weeks ago. Questions: 1. Describe fully how sitagliptin works in the management of diabetes. Include in your answer any counselling for Mrs AB to improve the effect of this medicine. 2. Discuss what could be causing Mrs AB’s oedema and her worsening heart failure. 3. Describe what recommendations you would make to the prescriber and detail fully your rationale for these suggestions. Include in your response any aspects regarding her other medications that may be contributing to her presenting illness. 4. Discuss the use of acarbose as an additional medication for this patient. Include in your response how it works and whether it would be an appropriate choice and offer any benefits?