peer response

Peer response
Length: A minimum of 150 words per post, not including references
Citations: At least one high-level scholarly reference in APA per post from within the last 5 years
Peer Post:
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.
Screen all patients initially for substances that can interfere with the blood pressure medications. If possible, consider altering or eliminating the substance that raises blood pressure (Unger et al., 2020). The black population develops hypertension and associated organ damage due to physiological differences, such as early vascular aging such as stiffness, altered renal sodium handling, and increased cardiovascular reactivity. It is recommended to use a single pill combination including thiazide with calcium channel blocker or calcium channel blocker with angiotensin receptor blockers (ARBS) as a first line drug of choice. Diuretics are indicated to increase water loss through the urine, decreasing the blood volume, plasma, and cardiac output, resulting in lower blood pressure. It is not preferable to use ARBS, and ace inhibitors as it can cause angioedema for black patients. Loop diuretics will be ideal for the patient since thiazide maybe contraindicated because of his allergy to sulfonamides. Common Calcium channel blockers (CCB) are Nifedipine (Procardia) 30mg – 60mg once daily, Amlodipine (Norvasc) 5mg – 10mg, which works on the smooth muscle of the blood vessel that causes dilatation and assists in blood flow, it is also indicated for angina as ischemia can cause pain when there is no enough oxygenation to the tissues (Rosenthal & Burchum, 2017). Verapamil (Calan) 100mg – 400mg daily and Diltiazem (Cardizem) 120mg – 540mg per day. Verapamil is another type of CCB, which is the non-dihydropyridines that help with the contractility of the heart but have a less vasodilation effect. Diuretics such as Bumetanide (Bumex) 0.5mg/day – 2mg/ day, Furosemide (Lasix) 80 mg/day, usually divided into 40 mg orally twice a day, and Torsemide (Demadex) starting dose of 5mg/day up to10mg/day (Whelton et al., 2018). Titrate medication depending on the response of the patient to the treatment.
Discuss any potential side effects and drug interactions for this patient.
Various medications can antagonize the effects of the anti-hypertensive drug, and it can cause fluctuations in blood pressure. The outcome depends on the total health of a patient, especially with comorbidities such as kidney disorders (Unger et al., 2020). Amlodipine and aspirin can increase blood pressure, or if taking combination pills may decrease the blood pressure. Calcium channel blockers can cause peripheral edema, dizziness, tachycardia, flushing, and gingival hyperplasia. Verapamil and Diltiazem are another type of CCB and are contraindicated with patients with heart failure and bradycardia as they decrease myocardial contractility and moderate vasodilation. Constipation, bradycardia, and hyperprolactinemia are the common side effect of CCB of the non-dihydropyridines. Diuretics can cause dizziness, weakness, headache, shortness of breath. Rare cases diuretics can cause swollen glands, ulcers in the mouth, wheezing, painful urination.
What non-pharmacological interventions would you suggest?
Lifestyle modification is the priority for hypertensive clients (F. Piepoli, 2017). It is advisable to maintain a healthy diet such as avoiding high salt, lower alcohol consumption. Consume vegetable, whole grains and fruits. Limit sodium intake into 2,400 mg per day. Smoking cessation is advised if the patient is nicotine dependent. Practice relaxation techniques to avoid stress as it can trigger high blood pressure. Incorporate a daily exercise routine such as jogging or walking and, most importantly, adhere to the entire course of the treatment and monitor blood pressure
What patient education would you provide?
Patients taking anti-hypertensive medications should be educated about the possible side effects and what to watch for, and when to call to avoid unfavorable circumstances (Unger et al., 2020). If taking the hypertensive medications for the first time avoid driving or operating machineries until the initial response has been established. Avoid alcohol as it can aggravate the side effect. Avoid sudden changes. Measure fluid intake, too much water can be unsafe. Always check with the provider for proper volumes. Consult with your provider before taking or discontinuing any medication. Calcium channel blockers, in rare cases, can cause angina if you take it for the first time. If you missed a dose for more than 12 hours, skip the missed dose. Do not take extra medications for the missed dose. Watch out for allergic reactions. Call for help if you start having trouble breathing, hives, swelling on the throat, face, lips, and neck. Lastly, remember to follow up with your provider for evaluation of treatment.
References
F. Piepoli, M. (2017). 2016 european guidelines on cardiovascular disease prevention in clinical practice. International Journal of Behavioral Medicine, 24(3), 321–419. https://doi.org/10.1007/s12529-016-9583-6
Rosenthal, L., & Burchum, J. (2017). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants – e-book (2nd ed.). Saunders.
Unger, T., Borghi, C., Charchar, F., Khan, N. A., Poulter, N. R., Prabhakaran, D., Ramirez, A., Schlaich, M., Stergiou, G. S., Tomaszewski, M., Wainford, R. D., Williams, B., & Schutte, A. E. (2020). 2020 international society of hypertension global hypertension practice guidelines. Hypertension, 75(6), 1334–1357. https://doi.org/10.1161/hypertensionaha.120.15026
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner, P., Ovbiagele, B., Smith, S. C., Spencer, C. C., Stafford, R. S., Taler, S. J., Thomas, R. J., Williams, K. A.,…Wright, J. T. (2018). 2017 acc/aha/aapa/abc/acpm/ags/apha/ash/aspc/nma/pcna guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: Executive summary: A report of the american college of cardiology/american heart association task force on clinical practice guidelines. Hypertension, 71(6), 1269–1324. https://doi.org/10.1161/hyp.0000000000000066

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