Jun 8, 2023
On this episode, we go over a pharmacotherapy plan for a patient with sickle cell disease, HFrEF, DM2, dyslipidemia, hypertension, POAG, dry eye disease, constipation, GERD, and OSA.
Episode 227 Patient Case Information
57-year-old male with sickle cell disease, HFrEF, DM2, dyslipidemia, hypertension, POAG, dry eye disease, constipation, GERD, and OSA comes to your clinic to establish care. His primary concern is the number of sickle cell crisis he has been experiencing (3 ER visits in the last 5 months). He is having significant constipation daily due to his maintenance opioid regimen. He also reports difficulty controlling his blood glucose. He has experienced 6 hypoglycemic events (BG range between 65 and as low as 42) and is confused as to what he is doing wrong with managing his diabetes. He is also concerned because he is having vivid nightmares almost every night. He also asks about the best artificial tears to get OTC because his Refresh Optive (carboxymethylcellulose) doesn’t seem to be working anymore.
Medication List:
Losartan 100 mg daily, atenolol 50 mg daily, torsemide 20mg – 4 tabs daily, metolazone 2.5 mg 2 times per week, amlodipine 5 mg daily, simvastatin 40 mg daily, fenofibrate 160 mg daily, lantus 40 units twice daily, humalog 5 units with meals if his pre-meal BG is > 150 mg/dL, metformin ER 500 mg twice daily, hydroxyurea 500 mg – two capsules daily (admits to limited adherence), latanoprost 0.005% nightly, esomeprazole 40 mg twice daily, famotidine 40 mg daily, MiraLax 17 grams daily, and bisacodyl 5 mg daily
He has a CPAP at home but admits to using it very infrequently.
BMP
BP – 165/89
HR – 82
Na – 137
K – 3.6
Cl – 102
CO2 – 26
Glucose – 253
eGFR – 95 mL/min
Ca – 8.9
Mg – 1.9
Lipid Profile
Chol – 162
LDL-C – 99
HDL-C – 49
Triglycerides - 242
Echo with EF – 32%
B-Type Natriuretic Peptide – 56.2
Vitamin B12 – 367
Hemoglobin – 7.2
Hematocrit – 20.8
MCV – 98.6
Ferritin – 1491.6 (received blood transfusion 2 weeks ago)
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