Research Paper On Diabetes And Depression

Question 1

As a drug, metformin is often prescribed for patients of type 2 diabetes. This drug is sometimes prescribed in combination with other medications and sometimes even with insulin. Jeff, who is the patient in this case study, has been diagnosed with type 2 diabetes, and it is, therefore, no surprise that the doctor prescribed this drug to him. The dosage prescribed was 500m g twice a day.
The dosage does not seem to have been effective. This is because the diagnosis is still the same as the previous week. His blood sugar level is still significantly high. This means that the drug has not yet worked.
However, this does not mean that the drug should be dismissed as non-effective immediately or at this stage. It may take some time before the drug is able to exhibit any positive results in form of reduced blood sugar level. This is why the doctor has prescribed that Jeff continues with the same dosage of the drug for the next week. The expectation is that the drug will at one point bring about a reduction in blood sugar level. This drug works by suppressing the production of glucose by the liver (Dardano et al., 2014). With time, the drug may be able to do so. However, if after a significant time there is no change, then reinforcements may be made in the form of increased dosage or substitution with other drugs.

Question 2

Jeff stopped talking Lyrica because it was having negative effect on him. He reported that his lips, throat and neck were feeling funny right and puffy, and he therefore stopped taking the drug. Lyrica has several possible adverse effects. These include muscle pains and general body weakness. In addition, an individual who is under this medication may suffer from easy bruising as well as bleeding. The person may also suffer from hands and feet swelling as well as rapid gains in weight. Other minor adverse effects include dizziness and drowsiness, loss of coordination and balance as well as problems with concentration and memory.

Question 3

Zoloft is an antidepressant that first entered the market in 1990 (Sharpe, 2012). The drug has continued growing in popularity and is one of the most prescribed antidepressants in the United States with over 30 million prescription being given on a yearly basis. Its clinical name is sertraline chloride (Sharpe, 2012). Jeff is one of these millions of citizens who are given a prescription Zoloft. The most common dosage that is often prescribed to patients is 50mg, and this is the exact prescription that was given to Jeff. If this dosage is followed strictly, the natural expectation is that the patient will exhibit significant improvement after one week going forward.
However in the case of Jeff, who was under the 50 mg dosage, the drug does not seem to have been effective in treating his depression. This is because even after he had been under the 50 mg Zoloft medication in a week, there had been no much observable change. This was in spite of the fact the medication was accompanied by counselling. Jeff was still suffering from episodes of feeling down and worried. He also has frequent periods where he feels worthless. These are symptoms that he still had the previous week before the Zoloft medication was prescribed.
The treatment plan adopted for Jeff was continued weekly counselling sessions together with the ingestion of 50mg Zoloft daily. Perhaps the reasons for the continuation of this treatment plan was to give more time to see if any change would be exhibited. Improvement may not be necessarily visible after one week, and this is why the doctor thought it would be advisable to continue with this treatment plan and possibly observe any changes the coming week. If no improvement was observed, the main recommendation would be to increase the dosage of Zoloft to about 100mg daily.

Question 4

As an antibacterial drug, ciprofloxacin is used for both gram-negative and gram-positive bacteria. Jeff’s wound culture came back as gram-negative. Being a drug that can treat both gram negative and gram positive, ciprofloxacin is, therefore, an appropriate drug. It is bacteriostatic in nature. This means that it works by inhibiting the growth of bacteria (Fischbach & Walsh 2009). The alternative to a bacteriostatic agent is a bactericidal agent which works by destroying bacteria. Ciprofloxacin inhibits cell division by inhibiting the DNA gyrase, a topoisomerase of type II as well topoisomerase IV enzymes which are necessary for the separation of bacterial DNA (Fischbach & Walsh 2009).
When administered into the body, it distributes into the body tissues. It also partly penetrates into the central nervous system. About fifty to seventy percent of the drug administered is excreted in urine in un-metabolized form. Its serum half-life is about four to six hours.
People suffering from diabetes often suffer from chronic leg and foot ulcers. One of the reasons for this is reduced sensation on the skin around the feet (Wu et al., 2009). High blood sugar level can cause damage to the nerves, a condition known as peripheral neuropathy (Wu et al., 2009). Loss of sensation means messages to the brain about pain cannot be sent, and one can easily damage and aggravate their feet without knowledge (Wu et al., 2009). One cannot protect even small wounds, and they may develop into chronic ulcers.
Diabetic people also have an increased risk of peripheral arterial disease which means the narrowing of the body arteries due to depositing of fats in the arteries. This leads to a reduction of blood flow to the organs such as the feet. Skin without proper blood supply heals slowly, and chances of damage are increased. Jeff is probably having fever because of the wound infection. A fever often serves as an immune system function that can help to kill invading organisms.

References

Dardano, A., Penno, G., Del Prato, S., & Miccoli, R. (2014). Optimal therapy of type 2 diabetes: a controversial challenge. Aging (Albany NY), 6(3), 187–206.
Fischbach, M. A., & Walsh, C. T. (2009). Antibiotics for emerging pathogens. Science, 325(5944), 1089-1093.
Sharpe, K. (2012). Coming of age on Zoloft: How antidepressants cheered us up, let us down, and changed who we are. New York: HarperPerennial.
Wu, S. C., Driver, V. R., Wrobel, J. S., & Armstrong, D. G. (2007). Foot ulcers in the diabetic patient, prevention and treatment. Vascular health and risk management, 3(1), 65.