Hi, need to submit a 750 words essay on the topic Medical case study report.
Frequent monitoring of the blood sugar at least after every 4 hours is also important to ensure the episodes of hypoglycaemia do not occur (1). The second scenario could be if Dooley’s creatinine clearance >.50-60 ml/min or higher, it is recommended that metformin be administered at a reduced dose while increasing as tolerated to a highest of 1G daily. The third scenario is if Mr. Dooley had comfortably used Gliclazide 60mg for a long time, it may be continued. However, this should be taken with food followed by close monitoring of blood glucose to avert any episode of hypoglycaemia (2). Therapeutics issues: Clarithromycin has the capability of interacting with simvastatin thus may lead to the increase in the simvastatin’s blood levels because clarithromycin is CYP 3A4 inhibitor and Simvastatin mainly metabolised by CYP3A4 administration with drugs that inhibit these enzymes may increase its concentration which increase risk of myopathy and rhabdomyolysis (Paravastatin are not metabolised by CYP enzyme therefore it had reduce risk) (3). Also verapamil interact with simvastatin which could increase in simvastatin level which increase risk of liver damage. Heart rate may also be lowered by combining verapamil and clarithromycin since this combination reduces blood pressure and may cause dizziness and headaches. The patient is also advised to cease use verapamil because it has potential for side effects such as constipation. Suggested use of CCB (lercanidipin) 10mg daily which can be increased in a two weeks time depending on the therapeutic response exhibited by the patient. Long term use of coloxy and Senna is not recommended since they stimulate laxatives in long term treatment of constipation. It should therefore be withdrawn gradually within two to four weeks and the bowel condition checked regularly. The use of high doses of Fosinopril dose is not healthy for the elderly patient since it could also contribute to dizziness and lightheadness. The
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