Diabetic Pharmacology And Guidelines Workshop W3 Flashcards
Mrs CA, (62 years old, white Caucasian) comes into your pharmacy to request a supply of
fluconazole (Canesten Thrush®) for vaginal thrush. She has had thrush on a number of occasions
in the past few months (self-treated with clotrimazole (Canesten®) cream she bought in the
supermarket) but it keeps coming back and her daughter recommended she tries the fluconazole
as it worked really well for her.
On questioning she mentions that she has been very tired recently and is drinking lots of fluid
which mean she has to keep going to the toilet including during the night. She is overweight (BMI
28) and has a 3 year history of hypertension.
You offer to carry out a check of Mrs CA’s blood glucose using the finger-prick test, which she
agrees and gives a result of 10mmol/l. You explain that the level of sugar in her blood is higher
than normal and advise that she makes an appointment to see her GP as soon as possible which
she does.
1. List the signs and symptoms and risk factors that Mrs JB has that made you suspect she
could have Type 2 DM and therefore suggest a blood glucose check? Explain the
pathophysiological basis for these signs and symptoms
Signs and symptoms:
• polyuria - frequent urination
• Polydipsia - excess thirst
• elevated glucose level
• fatigue
Risk factors:
• overweight
• Hypertensive
Glucose test:
• could have a fasting glucose
Mrs CA calls in a week later with her repeat prescription for her hypertension:
Amlodipine 10mg od
She tells you that her GP had arranged for her to have a blood test which showed her fasting
blood glucose was 11 mmol/l and HbA1c was 64mmol/mol (8%) and she has been diagnosed with Type 2 diabetes (DM). She was seen by the practice nurse who gave her some lifestyle advice
and made an appointment to see her in 3 months’ time to check her blood glucose again.
2. What lifestyle advice would be given to Mrs CA?
• fasting should be 7.0mmol/L or more is diagnostic
• HbA1c should 6.5% (48mmol/L) and hers is much higher
Yes we do lifestyle advice before drugs
• min of 30 mins moderate exercise 5 times a week
• Reduce sugars and fats for weight loss, 5-a-day and increase fibre
• Reduce carbs
• Smoker? Alcohol?
- Does Mrs CA’s treatment for her hypertension meet the current NICE clinical guideline for
the management of blood pressure in type 2 diabetes in adults and would you recommend
any changes?
Ramipril 2.5 OD - ACEI
5mg would be appropriate for her as she isnt on the lowest amplodipine
Finish doing the actual WS
