Patient AO Has A History Of Obesity And Has Recently Gained 9 Pounds.
A practitioner who is prescribing medications must conduct a thorough assessment of all conditions for which the patient is being treated, as well as all medications that the patient is currently taking. This patient’s assessment information includes his history of obesity, current diagnosis of hypertension, and hyperlipidemia. A recent weight gain of 9 pounds is significant, but the length of time is unknown.
To determine the best course of treatment, pharmacokinetics and pharmacodynamics should be evaluated. Antihypertensive drugs were the first cardiovascular therapies for which clinical differences in response based on ethnicity were widely recognized (Johnson, 2008). African-Americans are more likely than any other ethnic group to suffer from hypertension as a result of inactivity and obesity (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). The most notable differences have been observed in response to beta blockers, ACE inhibitors, and angiotensin receptor blockers (ARBs) (Johnson, 2008). The ethnicity of A.O. is unknown.
A.O. is given atenolol. Beta-blockers help to lower blood pressure. Certain conditions, such as bradycardia, asthma, COPD, and cardiac failure, make beta-blockers contraindicated (Arcangelo et al. 2017). Do we know if this patient is adhering to his or her medication regimen? Beta-blockers should be tapered off gradually rather than abruptly stopped.
Options for treatment
If blood pressure remains stable, I will not change any medications at this time. Weight gain would be the focus of the subsequent evaluation. A.O. has hyperlipidemia as well. Current dietary habits journal. Is he suffering from edema? How old is A.O.? Education and possibly some dietary instruction could result in a decrease in the number of medications prescribed. Hypertension can be managed and controlled with a combination of medication and strict lifestyle changes (Jankowska-Polaska, Uchmanowicz, Dudek, & Mazur, 2016).
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V. F., & Reinhold, J. A. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Philadelphia, PA: Wolters Kluwer.
Jankowska-Polańska, B., Uchmanowicz, I., Dudek, K., & Mazur, G. (2016). Relationship between patient’s knowledge and medication adherence among patients with hypertension. Patient Preference and Adherence, Volume 10, 2437-2447. doi:10.2147/ppa.s117269
Johnson, J. A. (2008). Ethnic Differences in Cardiovascular Drug Response: Potential Contribution of Pharmacogenetics. Circulation, 118(13), 1383-1393. doi:10.1161/circulationaha.107.704023
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Question 
Case Study 1:
Patient AO has a history of obesity and has recently gained 9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia. Drugs currently prescribed include the following:
Patient AO Has A History Of Obesity And Has Recently Gained 9 Pounds.
- Atenolol 12.5 mg daily
- Doxazosin 8 mg daily
- Hydralazine 10 mg qid
- Sertraline 25 mg daily
- Simvastatin 80 mg daily
Case Study 2:
Patient HM has a history of atrial fibrillation and a transient ischemic attack (TIA). The patient has been diagnosed with type 2 diabetes, hypertension, hyperlipidemia and ischemic heart disease. Drugs currently prescribed include the following:
- Warfarin 5 mg daily MWF and 2.5 mg daily T, TH, Sat, Sun
- Aspirin 81 mg daily
- Metformin 1000 mg po bid
- Glyburide 10 mg bid
- Atenolol 100 mg po daily
- Motrin 200 mg 1–3 tablets every 6 hours as needed for pain
Case Study 3:
Patient CB has a history of strokes. The patient has been diagnosed with type 2 diabetes, hypertension, and hyperlipidemia. Drugs currently prescribed include the following:
- Glipizide 10 mg po daily
- HCTZ 25 mg daily
- Atenolol 25 mg po daily
- Hydralazine 25 mg qid
- Simvastatin 80 mg daily
- Verapamil 180 mg CD daily
To prepare:
- Review this week’s media presentation on hypertension and hyperlipidemia, as well as Chapters 19 and 20 of the Arcangelo and Peterson text.
- Select one of the three case studies, as well as one the following factors: genetics, gender, ethnicity, age, or behavior factors.
- Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
- Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
- Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.
With these thoughts in mind:
By Day 3
Post an explanation of how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you selected. Then, describe how changes in the processes might impact the patient’s recommended drug therapy. Finally, explain how you might improve the patient’s drug therapy plan.