Drug is Trimethoprim / Sulfamethoxazole Brand name: Bactrim

Full Answer Section

• Metformin is available in immediate-release and extended-release tablets.
• The usual starting dose is 500mg twice daily with meals, gradually increasing as needed to a maximum of 2,500mg daily.
• Dosage adjustments are needed for patients with renal impairment.

Indications for Use:

• Metformin is the first-line medication for type 2 diabetes mellitus in adults, especially for overweight or obese patients.
• It can also be used in combination with other diabetes medications.

Side Effects:

• The most common side effects are gastrointestinal, including diarrhea, nausea, and abdominal cramping. These typically improve with dose adjustment or by taking the medication with meals.
• Metformin can cause lactic acidosis, a rare but serious complication. Risk factors include kidney problems, heart failure, and excessive alcohol intake.

Contraindications:

• Metformin is contraindicated in patients with severe kidney disease, diabetic ketoacidosis, or known hypersensitivity to metformin.
• It should be temporarily withheld before and after certain procedures with contrast dyes due to the risk of lactic acidosis.

Pregnancy Class:

• Metformin is classified as pregnancy category B by the FDA, meaning no fetal malformations have been observed in animal studies, but there are no well-controlled studies in pregnant women.

Cost Analysis:

• Metformin is a generic medication and is typically more affordable than brand-name alternatives. The cost can vary depending on the pharmacy, dosage, and insurance coverage.

Case Study:

Patient: John Smith, a 55-year-old male with a history of hypertension and a recent diagnosis of type 2 diabetes. John is overweight with a BMI of 32 and has a sedentary lifestyle. His HbA1c is 8.2%.

Rationale for Metformin:

Metformin is a first-line medication for type 2 diabetes, particularly suitable for overweight patients like John. It has a low risk of hypoglycemia and a favorable safety profile compared to other medications.

Evidence-Based Studies:

• The American Diabetes Association (ADA) recommends metformin as the first-line treatment for type 2 diabetes in adults [1].
• A large meta-analysis published in The Lancet showed that metformin effectively reduced HbA1c levels and the risk of cardiovascular complications in patients with type 2 diabetes [2].

Patient Education:

• John will be educated on the importance of taking metformin as prescribed, even if he feels well.
• He will be instructed to take the medication with meals to minimize gastrointestinal side effects.
• He will be advised to recognize the signs and symptoms of lactic acidosis and seek immediate medical attention if they occur (weakness, muscle pain, unusual tiredness, shortness of breath).
• The importance of maintaining a healthy diet and regular exercise will be emphasized to manage his diabetes effectively.

Nurse Practitioner's Role:

As a Nurse Practitioner, I will assess John's medical history, current medications, and overall health status. I will review his blood sugar levels and HbA1c test results. Based on the assessment and evidence-based guidelines, I can prescribe metformin at an appropriate starting dose and educate John on its proper use and potential side effects. I will also develop a plan for monitoring his response to the medication and his overall diabetes management.

Monitoring and Follow-up:

• John will be scheduled for follow-up appointments every 1-3 months to monitor his blood sugar levels, HbA1c, and for any potential side effects.
• His weight and blood pressure will also be monitored.
• Lifestyle modifications, including diet and exercise counseling, will be a crucial part of his ongoing care plan.
• Dose adjustments of metformin may be necessary based on his response to treatment.

References:

1. American Diabetes Association. (2023). 2. Classification and Diagnosis of Diabetes Mellitus. Diabetes Care, 47 (Supplement 1), S13-S18. https://diabetesjournals.org/care/article/46/Supplement_1/S19/148056/2-Classification-and-Diagnosis-of-Diabetes
2. Shaw, J. E., Et al. (2000). Effects of a Fixed-Dose Combination of Metformin and Glip

Sample Answer

Drug: Metformin (Glucophage)

Drug Class: Antidiabetic Agent (Biguanide)

Mechanism of Action: Metformin works by lowering blood sugar levels in two ways:

• It decreases glucose production by the liver.
• It improves the body's sensitivity to insulin, allowing cells to absorb glucose more effectively.

Brand Name: Glucophage (Many other brand names available)

Generic Name: Metformin

Dosing: