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Week 3 Discussion Response

Week 3 Discussion Response

Hello,

Thank you for sharing your post. There are several risk factors for HTN, as you have mentioned, including age and race. Other risk factors include a family history of HTN; hence, it would be good for the PCP to check into the patient’s family history. In addition, there is being overweight, physical inactivity, using tobacco and alcohol, stress, and other medical conditions such as sleep apnea, diabetes, and kidney disease. Uncontrolled HTN can result in heart attacks or stroke; aneurysm; heart failure; weak and narrow blood vessels to the kidneys; thick, torn, or narrow eye blood vessels; metabolic syndrome; dementia; and trouble with understanding or memory (Burnier & Egan, 2019).

The risk of developing hypertension can be significantly reduced through medication therapy that is effective as well as modifications in lifestyle. Medication adherence is the cornerstone in achieving control of HTN. HTN can be attributed to the global cardiovascular disease prevalence, which, by the year 2025, is projected to increase by 30%. Non-adherence to medication is common, with 43-65.5% of persons who do not adhere to their medications being hypertensive patients.

Medication non-adherence is a potential factor in concomitant diseases’ occurrence. Non-adherence is a continuing concern and is linked to adverse outcomes (Abegaz et al., 2017). Patients with complex diseases often have difficulty adhering to their medications. Uncontrolled BP can be traced back to non-adherence to medication by a majority of the patients. As a result, close to 75% of patients with HTN do not achieve optimal control of BP (Abegaz et al., 2017).

References

Abegaz, T. M., Shehab, A., Gebreyohannes, E. A., Bhagavathula, A. S., & Elnour, A. A. (2017). Non-adherence to antihypertensive drugs: A systematic review and meta-analysis. Medicine96(4), e5641. https://doi.org/10.1097/MD.0000000000005641

Burnier, M., & Egan, B. M. (2019). Adherence in hypertension: a review of prevalence, risk factors, impact, and management. Circulation research124(7), 1124-1140.

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Question 


Week 3 Discussion Response

  • Length: A minimum of 200 words per post, not including references
  • Citations: At least one high-level scholarly reference in APA per post from within the last 5 year

Mr. Smith is a 64-year-old African American male. He was diagnosed with hypertension and hyperlipidemia 5 years ago and has not taken meds regularly for the last year. He states he has been experiencing chest pain when working around the house and sometimes while on his evening walk. He also complains that his feet are swelling in the evening. His vitals today: P-105, B/P-165/100, R-20. Wt-260 Ht-5’9” Labs: TC- 240, LDL- 145, HDL- 30, Trig-250. Sulfa allergy. You are assigned as his new PCP.

What medication recommendations will you make? Include the drug class, generic and trade name and starting dose range. Provide rationale for your choices.

The patient in the referenced case study suffers from Stage II hypertension as evidenced by his blood pressure being 165/100. The patient suffers from hyperlipidemia as evidenced by total cholesterol (240), LDL (145) and (HDL (30) and triglycerides (250) being above the recommended reference ranges (Rosenthal & Burchum, 2021). The patient also suffers from angina as evidenced by the patient reporting pain while walking.

The patient has several risk factors that heightens his risk for developing coronary artery disease and myocardial infraction. Those risk factors include being African American, being a male over the age of 45, being hypertensive, having low levels of HDL, high levels of LDL and high total cholesterol (Rosenthal & Burchum, 2021). Additionally, the patient reports not taking his medication regularly after having been diagnosed with hypertension and hyperlipidemia five years ago.

Medication recommendations I would make include titrated doses of statins such as Lovastatin (10-80 mg) or Simvastatin (5-40 mg). The statin would be prescribed to treat the patient’s coronary artery disease. Statins may cause a reduction of cholesterol synthesis by inhibiting the enzyme HMG CoA reductase (Ghany et al., 2020). Diuretics such as 25 mg daily of hydrochlorothiazide of Furosemide may be prescribed along with a beta blocker such as propranolol to treat the patient’s hypertension. Nitrates such as 0.3 mg of Nitrostat may be prescribed for anginal pain. Nitrates vasodilate coronary arteries allowing increase perfusion of blood to the heart which aids in the relief of chest pain. To help prevent platelet aggregation and the recurrence of myocardial infraction antiplatelet drugs such as clopidogrel or 81-325 mg daily low dose aspirin may be prescribed (Ghany et al., 2020).

Discuss any potential side effects and drug interactions for this patient.

The patient has a sulfa allergy and should not be treated with drugs for hyperlipidemia such as fibric acid derivatives like Clofibrate and Gemfibrozil due to the risk of precipitate formation along with symptoms such as skin rashes (Rosenthal & Burchum, 2021).

What non-pharmacological interventions would you suggest?

Non-pharmacological interventions that I would suggest include a heart health low fat, low calorie diet to encourage weight loss as the patient is currently overweight. The consumption of foods rich in heart healthy omega-3 fatty acids would be recommended along with exercise as tolerated. The patient would also be advised to cease smoking, to decrease any alcohol consumption and to restrict consumption of sugary and salty foods.

What patient education would you provide?

Patient education that would be provided include side effects and risks associated with any prescribed medications. For example, the patient would be advised to rise slowly from a sitting position if taking a diuretic to avoid orthostatic hypotension. The patient would be advised to consume foods rich or deficient in certain electrolytes depending upon if the medication prescribed would cause sparing or depletion of a particular electrolyte (Rogers & Baker, 2020).

The patient would be educated on diet management to discourage weight gain. The patient would be advised to try to avoid situations that may cause stress which might exacerbate hypertension. Additionally, the patient would be advised to take precautions to avoid bodily trauma such as cuts while taking antiplatelet medications because bleeding might be prolonged (Rogers & Baker, 2020).

References

Ghany, R., Palacio, A., Chen, G., Dawkins, E., Forbes, E., Tajiri, T., & Tamariz, L. (2020). Patients with elevated blood pressure or stage 1 hypertension have structural heart disease. Blood Pressure Monitoring. 25(4), 178-183. DOI: 10.1097/MBP.0000000000000447

Rogers, J., & Baker, M. (2020). Understanding the most commonly billed diagnoses in primary care: Hyperlipidemia. Nurse Practitioner. 45(8), 42-48. DOI: 10.1097/01.NPR.0000681792.32984.96

Rosenthal, L.D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics f or Advanced Practice Nurses (2 nd ed.). St. Louis, MO: Elsevier.

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