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Links to other Consults on our site Need Drug info (free) use our contact us feature leave your e-mail or phone and name RxPERTUSA Medication Therapy Management Services 440 North Second St., P.O. Box 1288, Eunice, LA 70535 Phone (337) 457-4604 Fax (337) 546-0900 Cell (337) 344-2297 Charles S. Feucht,PD,FASCP Senior Care Clinical Pharmacist
Patient Profile for: Mr Mxxx Sxxxxx Personal Information Patient ID: #602006 Attending Physician: xxxxxxxx,MD Patient Name: xxxx xxxxxxx Address: xxxxxx. City: Crowley State: LA Zipcode: 70526 Country: USA Phone: xxx xxx xxxx Fax: xxx xxx xxxx ____________________________________________________________________________ Medical Information ____________________________________________________________________________ Diagnosis: None provided: suspected from current drug therapy Type II diabetes mellitus Hypertension Hypothyroidism Arthritis Gout General complaints not listed as diagnosis by your doctor: Weak spells NOS when blood sugar drops – frequency not provided time of events not provided Feet swell daily and painful right side swells more than left 1 fall this past year Sporadic complaints of heartburn Allergies: ? Dosing considerations: Renal impairment ( assessment made by this reviewer from estimated creatinine clearance calculation based on serum creatinine of 1.5 obtained 4/18/2006.) CrCl = 34.1ml/min Gender: Male DOB: November 27, 1919 Age: 86 Height: 70" ( 175cm) Serum Creatinine: 1.5mg/dl Date:4/18/2006 Estimated Creatinine Clearance: 34.1ml/min
Laboratory Values: Lipid Panel Triglycerides 126 5-22-06 Total cholesterol 148 5-22-06 HDL cholesterol 39 low 5-22-06 LDL-Cholesterol 84 5-22-06 Chl/hdl ratio 6.1 5-22-06 Protime INR 2.5 5-22-06 Microalbumin urine 101 4-18-06 Complete Metabolic Profile: BUN 28 4-18-06 Creatinine 1.5 4-18-06 BUN/Cr 19 4-18-06 Sodium 139 4-18-06 Potassium 4.1 4-18-06 Chloride 103 4-18-06 CO2 2 4-18-06 Calcium 9.4 4-18-06 Protein, Total 6.5 4-18-06 Albumin 4.1 4-18-06 Globulin 2.4 4-18-06 Alb/glob 1.7 4-18-06 Bilirubin, total 0.6 4-18-06 AKPhos 80 4-18-06 AST 20 4-18-06 ALT 16 4-18-06 CBC Within normal limits 4-22-06 PSA 5.0 4-22-06 T-3 & T4 within normal limits no TSH available Medications: Furosemide 40mg 1 tablet by mouth daily Celebrex 200mg 1 capsule by mouth daily Klor-con 10mEq 1 tablet by mouth daily Levoxyl 100mcg 1 tablet by mouth before meal daily Insulin glargine(Lantus) 65units sc daily Lotensin 10-12.5 1 tablet by mouth daily Coumadin 5mg 1 tablet by mouth on Sunday, Tuesday, & Wednesday 1 ½ tablets by mouth on Monday & Friday Allopurinol 300mg 1 tablet daily for gout Actos 45mg 1 tablet by mouth daily
June 27, 2006 Pharmacology Review and recommendations: Initial review & assessment The patient is an 86 year old white male. The history provided is sparse. The main complaint is that of painful and edematous feet particular the right side. This assessment is made based on a very limited history, the current complaints, current drug regimen and limited lab values. Ideally, hemoglobin A1C levels along with at least two weeks of blood pressure readings and fingerstick plasma glucose levels would provide more insight for specific recommendations. Thiazolididiones such as the Actos you are taking are known to cause fluid retention. Generally in elderly patients, doses should be less than 45mg daily if used in combination with insulin to prevent aggravation of congestive heart failure or retention of fluid. This fluid retention can be especially problematic when combined with insulin. It isn’t clear if you are taking the Lasix for congestive heart failure or if your furosemide is being used for edema problems. Avandia is another drug in this class of diabetic medications but it is not a viable alternative. Avandia is also a thiazolidindione drug like Actos and carries the same potential to induce fluid retention. Other alternatives for combination oral hypoglycemic agents(agents that lower your blood sugar and are taken by mouth) such as metformin (Glucophage) in conjunction with insulin have been used and resulted in very good control. However, due to your kidney function the drug metformin should not be used. The only remaining alternative oral hypoglycemic and insulin therapy combination would be to use a drug from the class known as secretagogues. Glyburide, Nateglinide, glipizide or glimiperide in combination with the basal insulin, Lantus, you are now taking would be an alternative. If you can log your fasting blood glucose levels which you test using your home meter and provide those I can make more specific dosage recommendations. Hemoglobin A1C levels should be monitored every 3 months to determine the level of diabetes control you are achieving and would also be helpful in desiging a plan for control of your blood sugars.
The Lasix(furosemide) you are taking has a short half life. Torsemide(Demadex) is more favorably suited for you because of the following reasons:
Suggestions to review with your physician:
Thank you for this consult Chalres S. Feucht,PD,FASCP. PharmD(cand)
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