AG's Medical Conditions
AG is currently being treated for hypertension, gouty arthritis, and hypothyroidism. The patient did not complain of gouty arthritic symptoms such as pain, decreased movement, swelling of affected joints, or erythema (Wynne, Woo, & Olyaei, 2007, p. 745). As a result, allopurinol withdrawal is required to assist decrease drug interaction and undesirable effects produced by the xanthine oxidase inhibitor, allopurinol. Because of the intrinsic risk of cardiovascular problems caused by hypothyroidism and a high BMI, hypertension treatment should be continued.
Hypothyroidism Treatment
AG has hypothyroidism, according to the most current clinical testing. Previously, the patient was taking 88 micrograms of levothyroxine each day. The dosage can be titrated up at intervals of 25 micrograms per at an interval of 4 weeks (Wynne, Woo, & Olyaei, 2007, p. 531). Despite the increment, low doses should be observed in patients with preexisting cardiac diseases (Katzung, Masters, & Trevor, 2012). Thyroid hormone levels should be monitored based on the desired TSH levels of the patient. Also, low-density lipids and triglycerides are abnormally high while the high-density lipoprotein levels remain relatively low thus indicating the presence of mixed dyslipidemia. Statins can be prescribed to lower the levels of LDL and triglycerides while increasing HDL levels. A preferable statin would be simvastatin which has a role in diabetic patients where it reduces the cardiovascular risk significantly (Wynne, Woo, & Olyaei, 2007, p. 955). Adverse effects in this age group will be minimal when statins are used. A starting dose of 20 mg/day can be used with up-titrations that do not exceed 80 mg/day depending on the lipid profile ministering (Wynne, Woo, & Olyaei, 2007).
Type II Diabetes Mellitus
Finally, both the AC1 levels and fasting blood sugar levels indicate the presence of type II diabetes mellitus in the patient. All sulphonylureas produce hypoglycemia which is an undesirable adverse effect in the elderly. However, third generation sulphonylureas have been shown to have the least adverse effect (Katzung, Masters, & Trevor, 2012). Nateglinide and repaglinide also possess similar hypoglycemic adverse effects as sulphonylureas thus cannot be used in the patient. Thiazolidinediones, alpha-glucosidase inhibitors, and metformin are less likely to lead to hypoglycemic conditions. However, thiazolidinediones are contraindicated in patients with congestive heart failure, alpha-glucosidase inhibitors are poorly tolerated while metformin is contraindicated in elderly patients with heart failure or renal failure (Wynne, Woo, & Olyaei, 2007, p. 953). The safest drug for the patient would be glimepiride which is a third class sulphonylureas. To deal with the weight gain lifestyle changes such as proper dieting and exercise is recommended for the patient.
References
Katzung, B. G., Masters, S. B., & Trevor, A. J. (2012). Basic & clinical pharmacology. New York [u.a.:: McGray-Hill Medical.
Wynne, A. L., Woo, T. M., & Olyaei, A. J. (2007). Pharmacotherapeutics for nurse practitioner prescribers. Philadelphia: E. A Davis Company.
