Hypothyroidism

Directions: For each of the scenarios below, answer the questions below using clinical
practice guideline where applicable. Explain the problem and explain how you would
address the problem. If prescribing a new drug, write out a complete medication order
just as you would if you were completing a prescription. Use at least 3 sources for each
scenario and cite sources using APA format.
1. Mary is a 35-year-old woman that has been diagnosed with hypothyroidism. Her
labs today show a TSH of 20, MCV 78, MCHD 26, Ferritin 9, TIBC 418. She has
a history of iron deficiency anemia for 2 months. Current medications include
Kelp tablets daily, ibuprofen 400 mg daily as needed, and ethinyl
estradiol/norgestrel one tablet daily.What medication would you start this patient
on for her hypothyroidism? How would you monitor this patient’s response to the
medication? What education would you provide regarding her medications and
their interactions?
2. Joe is a 48-year-old male diagnosed with Type II Diabetes Mellitus for a year
ago. He has controlled his blood glucose through dietary changes. He has
hypertension and is currently on Lisinopril 20 mg po daily. He has no known
allergies. His lab work includes these results: fasting BG is 225 mg/dL; HgA1C =
7.5%. Basic Metabolic Profile (BMP) is normal except for a Cr of 2.0 and eGRF
of 28. What treatment plan would you implement for Joe? What medications
would you prescribe and how would you monitor them? What education would
you provide regarding his treatment plan?
3. Jose is a 55-year-old truck driver being evaluated for his commercial driver’s
license. He has a known history of diabetes mellitus type II. Current medications
include Metformin 1000 mg Bid, Glipizide 20 mg po daily. Diltiazem 120 mg po
BID. He is allergic to sulfa. Lab results show a fasting blood glucose of 325
mg/dL, HgA1C = 10.6%. Basic metabolic Profile is normal. What treatment plan
would you implement for Jose? What medications would you prescribe and how
would you monitor them? What education would you provide regarding his
treatment plan?
4. Jenny is a 63-year-old woman with complaints of heartburn 4 to 5 times a week
over the past 3 months. Her symptoms are worse at night after going to bed. Her
heartburn is worse, and she coughs a lot at night. She has tried OTC Prevacid 24
hour once daily for the past 2 weeks. This has helped the symptoms some, but
she is still bothered by them. Current medications include Diltiazem CD 120 mg
PO once daily, Hydrochlorothiazide 25 mg PO once daily, Metformin 500 mg PO
twice daily, Aspirin 81 mg PO daily, Fluticasone/salmeterol DPI 100 mcg/50 mcg
one inhalation twice daily. Your working diagnosis for this patient is GERD. What
treatment plan would you implement for Jenny? What medications would you
prescribe and how would you monitor them? What education would you provide
regarding her treatment plan?