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Key Topics
- Report on Hypertension Case of R.S
- Specific goals for treating R.S.’s hypertension
- Drug Therapy Prescription and Reasoning
- Parameters for monitoring success of the therapy
- Specific patient education based on the prescribed therapy
- Adverse reactions for the selected agent that would cause you to change therapy
- Second Line Therapy
- Alternative medications would be appropriate for R.S
- Lifestyle changes
- Drug Food Interaction
- References
Answer the following questions:
1.What drug therapy would you prescribe? Why?
2.What are the parameters for monitoring success of the therapy?
3.Discuss specific patient education based on the prescribed therapy.
4.List one or two adverse reactions for the selected agent that would cause you to change therapy.
5.What would be the choice for second-line therapy?
6.What over-the-counter and/or alternative medications would be appropriate for R.S.?
7.What lifestyle changes would you recommend to R.S.?
8.Describe one or two drugs or drug food interaction for the selected agent.
Report on Hypertension Case of R.S
Specific goals for treating R.S.’s hypertension
The goals encompass the lifestyle modification in case of R.S. The prevention of high blood pressure will ascertain management of hypertension. With the risk factors that arise due to the cardiovascular diseases, the change in lifestyle would function as primary goal. The antihypertensive therapy can be adopted that reduces the risk of any complications arising on account of hypertension (Peterson, E. D., Gaziano, J. M., & Greenland, P., 2014; Go, A. S., Bauman, M. A., King, S. M. C., Fonarow, G. C., Lawrence, W., Williams, K. A., & Sanchez, E., 2014; De Nicola, L., Provenzano, M., Chiodini, P., Borrelli, S., Garofalo, C., Pacilio, M., ... & Minutolo, R., 2015). The goal to bring about the changes in the diet plan of R.S. also forms essential. With the High-density lipoprotein cholesterol: 30 mg/dL, and the consideration of consumption of tobacco too in case of R.S., the goal is associated with changing the habit of smoking and reducing it to null. The vodka consumption too in R.S. case is more and this needs to be significantly brought down.
Drug Therapy Prescription and Reasoning
The drug therapy in case of R.S. would involve prescription of pills that aid in the reduction of blood pressure. The lowering of the risk associated with the blood pressure complications can be helpful. The changes in the lifestyle of R.S also form part of the prescription. The environmental effects have to be catered to well (Peterson, E. D., Gaziano, J. M., & Greenland, P., 2014; Go, A. S., Bauman, M. A., King, S. M. C., Fonarow, G. C., Lawrence, W., Williams, K. A., & Sanchez, E., 2014; De Nicola, L., Provenzano, M., Chiodini, P., Borrelli, S., Garofalo, C., Pacilio, M., ... & Minutolo, R., 2015). The moderate alcohol consumption and taking ACE inhibitors drugs would be prescribed for R.S. Monitoring of the blood pressure and taking into account the impact due to antihypertensive drugs would need to be well monitored.
Parameters for monitoring success of the therapy
The parameters that would be utilized in the monitoring of success based on the therapy for R.S. would stand to be the watch on the weight of R.S. The 90 kg weight is on higher side. With the therapy including the dosage and the regular exercise with the change in lifestyle will need to be strictly monitored (James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., ... & Smith, S. C., 2014; Bell, K., Twiggs, J., & Olin, B. R., 2015; Tinetti, M. E., Naik, A. D., & Dodson, J. A., 2016). R.S. also needs to be regularly monitored for the changes in the blood pressure and the hypertensive symptoms should reduce considerably. There is a mild arterial narrowing too that was determined for R.S. while he was examined. The same has to be monitored by deploying the funduscopic examination. The improvement in Doppler imaging diastolic function also needs to be normalized (James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., ... & Smith, S. C., 2014; Bell, K., Twiggs, J., & Olin, B. R., 2015; Tinetti, M. E., Naik, A. D., & Dodson, J. A., 2016). With the monitoring done on a regular basis, the progress has to be determined so the condition can improvise in case of R.S.
Specific patient education based on the prescribed therapy
The patient education that would need to be imparted to R.S based on the prescribed theory would include the sharing of consequences on account of non-adherence (Daskalopoulou, S. S., Rabi, D. M., Zarnke, K. B., Dasgupta, K., Nerenberg, K., Cloutier, L., ... & McKay, D. W., 2015; Lange, E. M., Shah, A. M., Braithwaite, B. A., You, W. B., Wong, C. A., Grobman, W. A., & Toledo, P., 2015). Also the benefits of medication with the improvised lifestyle and moderate exercise done can bring about changes. The same needs to be well imparted to R.S. The education involving the lifestyle change with the impact and the benefits that would accrue needs to be clearly demonstrated by provisioning examples of cases.
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Place Your OrderAdverse reactions for the selected agent that would cause you to change therapy
The adverse reaction that is likely to take place based on the therapy would include headaches increasing and the frequency to be more for them (Daskalopoulou, S. S., Rabi, D. M., Zarnke, K. B., Dasgupta, K., Nerenberg, K., Cloutier, L., ... & McKay, D. W., 2015; Lange, E. M., Shah, A. M., Braithwaite, B. A., You, W. B., Wong, C. A., Grobman, W. A., & Toledo, P., 2015). Also in case if the dizziness to the patient is more, it would lead to changing the therapy prescribed.
Second Line Therapy
The therapy would involve bringing R.S. to the consumption of drug based on diuretics. The diuretics in hypertension cases have worked with the passage of more urine.
Alternative medications would be appropriate for R.S
The alternative medications considered appropriate would be the renin inhibitors(Mercier, K., Smith, H., & Biederman, J., 2014). The inhibition in the first along with the rate limiting step can be successfully done with the treatment basis these. The renin inhibitors do block the particular enzyme renin to trigger the process and these aids in the regulation of blood pressure. The result would be witnessed with the relaxation of the vessels and the widening causing the blood flow to be appropriate. The targeting to impact the narrowing of blood vessels is worked upon with the aid of renin inhibitors.
Lifestyle changes
The lifestyle changes with the moderate exercise routine and appropriate sleep pattern would be recommended for R.S. Also it is essential that the appropriate food habits are maintained for R.S. With the tendency of consumption of cigarettes up to the current levels, the same needs to be worked so that it is minimized and reducing it further to no consumption. The alcohol consumption has to be in moderate quantities. The change in the active routine with moderate walking post meals will also impact and form crucial part in the change of lifestyle for R.S.
Drug Food Interaction
It would include the consumption of grape fruit juice. As metabolizing the drugs can be done in abnormal fashion with the consumption, the medication can get impacted. This would lower the impact of medication. Also the reduction in the consumption of grape fruit juice is advisable in case of R.S. Also the consumption of green leafy vegetables that tend to be high in vitamin K can reduce the ability of the medication to reach the goal and the impact cannot be up to the expected mark. The increasing or decreasing of the green leafy vegetable consumption has not to take place. With the slight change in the pattern of consumption of these vegetables, the impact of the therapy prescribed can yield fruitful results. The increased potassium intake due to the consumption of any substitute has to be avoided. This would work well in order to produce the effect.
References
Bell, K., Twiggs, J., & Olin, B. R. (2015). Hypertension: The silent killer: updated JNC-8 guideline recommendations. Alabama Pharmacy Association, 1-8.
Daskalopoulou, S. S., Rabi, D. M., Zarnke, K. B., Dasgupta, K., Nerenberg, K., Cloutier, L., ... & McKay, D. W. (2015). The 2015 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Canadian Journal of Cardiology, 31(5), 549-568.
De Nicola, L., Provenzano, M., Chiodini, P., Borrelli, S., Garofalo, C., Pacilio, M., ... & Minutolo, R. (2015). Independent role of underlying kidney disease on renal prognosis of patients with chronic kidney disease under nephrology care. PloS one, 10(5), e0127071.
Go, A. S., Bauman, M. A., King, S. M. C., Fonarow, G. C., Lawrence, W., Williams, K. A., & Sanchez, E. (2014). An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. Hypertension, 63(4), 878-885.
James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., ... & Smith, S. C. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Jama, 311(5), 507-520.
Lange, E. M., Shah, A. M., Braithwaite, B. A., You, W. B., Wong, C. A., Grobman, W. A., & Toledo, P. (2015). Readability, content, and quality of online patient education materials on preeclampsia. Hypertension in pregnancy, 34(3), 383-390.
Mercier, K., Smith, H., & Biederman, J. (2014). Renin-angiotensin-aldosterone system inhibition: overview of the therapeutic use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, and direct renin inhibitors. Primary Care: Clinics in Office Practice, 41(4), 765-778.
Peterson, E. D., Gaziano, J. M., & Greenland, P. (2014). Recommendations for treating hypertension: what are the right goals and purposes?. Jama, 311(5), 474-476.
Tinetti, M. E., Naik, A. D., & Dodson, J. A. (2016). Moving from disease-centered to patient goals–directed care for patients with multiple chronic conditions: Patient value-based care. JAMA cardiology, 1(1), 9-10.
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