1. Please explain the value and reason for doing your own work and not copying or taking answers

from another source and claiming them as your own.

In doing my own work I am expanding my knowledge in crucial areas that will be needed to be a

successful provider.

2. Use the John Jones case study to answer the following question. Using diagnostic criteria for

diabetes, what is John’s diabetic status? What treatment plan should be introduced at this time?

According to the diagnostic criteria provided by Rosenthal and Burchum (2021), the four criteria to

diagnose DM include:

•Fasting plasma glucose ≥126 mg/dL OR

•Random plasma glucose ≥ 200 mg/dL plus symptoms of diabetes OR

•Oral glucose tolerance test (OGTT): 2-h plasma glucose ≥200 mg/dLc OR

•Hemoglobin A1c 6.5% or higher;

Due to Mr. Jones' lab results, Hemoglobin A1c of 8.1%, it would be acceptable to diagnose Mr. Jones

with DM and initiation of pharmacological treatment, such as Metformin, should be started.

Reference:

Rosenthal, L., Burchum, J. (2021). Lehne's pharmacotherapeutics for advanced practice nurses and

physician assistants (2nd ed.). Elsevier Health Sciences.

3. Use the John Jones case study to answer the following question. Which of John’s behaviors should

be addressed to encourage lifestyle changes and decrease A1C levels?

Mr. Jones has a recorded BP of 130/90, weight of 235 pounds, with current diagnoses of

hyperlipidemia and obesity. Mr. Jones also reports having a very sedentary lifestyle of sitting for 8-10+

hours a day, without a regular exercise regimen. Mr. Jones also reported that his diet consists of mostly

fast-food with sweet tea every meal, in addition to 3-4 cups of coffee daily.

Mr. Jones should participate in dietary changes as well as introducing a moderate amount of

physical activity into his lifestyle to decrease the risks and improve the outcomes of his Type 2 DM

diagnosis (Rosenthal and Burchum, 2021).

Reference:

Rosenthal, L., Burchum, J. (2021). Lehne's pharmacotherapeutics for advanced practice nurses and

physician assistants (2nd ed.). Elsevier Health Sciences.

4. Use the John Jones case study to answer the following question. Which behavior in John’s social

history poses a potential concern with first line pharmacological treatment for diabetes and why?

According to ADA Standards of Medical Care in Diabetes (2020), Metformin is the first line of

defense in patients with a Hemoglobin A1C >6.5%. Mr. Jones reports "having a few beers on the

weekend during football season." Metformin is contraindicated in alcoholics as it increases the risk of

lactic acidosis. While it does not appear that Mr. Jones is suffering from alcoholism, further questioning

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is needed, in addition to educating Mr. Jones of the signs and symptoms of lactic acidosis, and the risks

of consuming alcohol while taking this medication (Rosenthal and Burchum, 2021)

References:

American Diabetes Association. (2020). Figure 9.1 [Graph]. Standards of Medical Care in Diabetes—2020

Abridged for Primary Care Providers. https://clinical.diabetesjournals.org/content/38/1/10

Rosenthal, L., Burchum, J. (2021). Lehne's pharmacotherapeutics for advanced practice nurses and

physician assistants (2nd ed.). Elsevier Health Sciences.

5. Use the John Jones case study to answer the following question. Name the specific names of labs

you would order and the intervals at which you would order them to monitor the safety and

efficacy of metformin.

A Complete Metabolic Panel (CMP) needs to be performed before treatment of metformin in order

to establish a baseline evaluation for renal and hepatic function, and should routinely be checked after

pharmacological initiation to assess for any changes. Hemoglobin A1C, which is included within a CMP,

should also be monitored before the initiation of metformin. The labs mentioned should be monitored

routinely, every three months to monitor for changes and to allow for medication adjustments as

needed.

Reference:

Rosenthal, L., Burchum, J. (2021). Lehne's pharmacotherapeutics for advanced practice nurses and

physician assistants (2nd ed.). Elsevier Health Sciences.

6. Use the Alfonso Giuliani case study to answer the following question. Atherosclerotic

cardiovascular disease (ASCVD) risk factors include age, gender, race, blood pressure, cholesterol

values, history of diabetes, tobacco use, treatment of hypertension, statin therapy, and aspirin

therapy. Look at Alfonson’s ASCVD risk factors. Should Alfonso be taking something for

hyperlipidemia? If so, what would you recommend?

Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., ... &

Ziaeian, B. (2019). 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease:

executive summary: a report of the American College of Cardiology/American Heart Association

Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 74(10),

1376-1414. https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000677 (Links to an

external site.)

According to Mr. Giuliani's ASCVD risk factors, he should be initiated on a high-intensity statin such

as atorvastatin 40-80 mg daily or rosuvastatin 20-40 mg daily (Arnett et al., 2019).

References:

Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., Himmelfarb,

C. D., Khera, A., Lloyd-Jones, D., McEvoy, J. W., Michos, E. D., Miedema, M. D., Muñoz, D., Smith, S. C.,

Virani, S. S., Williams, K. A., Yeboah, J., & Ziaeian, B. (2019). 2019 ACC/AHA guideline on the primary

prevention of cardiovascular disease: Executive summary: A report of the american college of

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