NURS 6512 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

 
Many patients who present for medical treatment of acute illness have multiple comorbidities that require consideration.  The focus of this post is a 68-year-old male patient who presents with acute community-acquired pneumonia (CAP).  Medical history includes Type II diabetes, hypertension (HTN), hyperlipidemia, and chronic obstructive pulmonary disease (COPD).

Current Drug Therapy
The patient’s current drug therapy includes Metformin 500 mg twice a day, glipizide 10 mg once daily, lisinopril 10 mg once a day, hydrochlorothiazide 20mg once a day, simvastatin 40mg once a day, albuterol inhaler two puffs every four to six hours as needed for wheezing or shortness of breath, tiotropium inhaler two puffs (18 mcg) once daily.  He is receiving ceftriaxone 1 Gm IV daily and azithromycin 500mg IV daily for the treatment of community-acquired pneumonia and is improving after three days of this therapy.

Metformin is an antihyperglycemic medication used in conjunction with diet and exercise to control blood glucose levels in diabetic patients.  This drug should be held for 48 hours when radioactive dye is used for diagnostic testing to prevent damage to the kidneys. Mechanisms of action include increased insulin sensitivity, decreased glucose secretion and decreased glucose absorption.  Metformin does not cause hypoglycemia.  Glipizide is a blood glucose lowering drug classified as a sulfonylurea drug used to control blood glucose levels in diabetic patients who do not achieve adequate control with diet, exercise, and metformin.  Glipizide works by stimulating insulin production and secretion in pancreatic beta cells and its action is dependent on functioning pancreatic beta cells.  Patients taking glipizide are at risk of hypoglycemia and should be educated on signs and symptoms of hypoglycemia.

The patient is taking lisinopril and hydrochlorothiazide for blood pressure control.  Lisinopril is an angiotensin converting enzyme

Discussion Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders
Discussion Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders
(ACE) inhibitor that works to lower blood pressure and protect diabetic patients from renal disease and is also cardio protective.  Hydrochlorothiazide is a diuretic and antihypertensive medication whose mechanism of action is not fully understood.  It works in the distal tubule to enhance the secretion of sodium and chloride.  It is not metabolized but is excreted by the kidneys and requires dosage adjustments in cases of renal impairment.  Patients taking hydrochlorothiazide should be monitored for fluid and electrolyte imbalances.

Simvastatin is a statin drug that acts to lower the risk of coronary heart disease by lowering cholesterol and triglyceride levels in high-risk patients.  Patient should avoid grapefruit while taking this medication.  Dosing adjustments should be considered in patients with decreased renal function.  Simvastatin interacts with several medications and prescribing providers must check drug-drug interactions when prescribing to avoid risk of rhabdomyolysis (Food and Drug Administration [FDA] & Merck Sharp & Dohme Corp [Merck & Co, Inc.], 2012).