Advanced Clinical Pharmacology Case Study Week 2 – Hypertension Assignment

Advanced Clinical Pharmacology Case Study Week 2 – Hypertension Assignment

Advanced Clinical Pharmacology Case Study Week 2 – Hypertension Assignment

1. List specific goals for treating Darius’ hypertension.

The specific goal for treating hypertension will be to lower blood pressure and maintain it below <130/80 mm Hg. Besides, treatment will control the blood pressure to avoid progressing to stage 2 hypertension (Pavlou et al., 2018).

2. What drug therapy would you prescribe? Why?

Drug therapy will be HCTZ 12.5 mg PO once daily. HCTZ is an antihypertensive agent under the class of Thiazide diuretics.  ACE Inhibitors and angiotensin receptor blockers (ARBs) are the mainstay in the management of hypertension in non-blacks patients with diabetes (James et al., 2014). However, ACE Inhibitors and ARBs are less effective in the Black population. The Joint National Committee’s eighth report (JNC 8) recommends thiazide diuretics or Calcium Channel Blockers (CCBs) as preferred initial treatment classes for Blacks with diabetes (James et al., 2014).

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3. What are the parameters for monitoring the success of the therapy?

The success of treatment with HCTZ will be assessed through blood pressure monitoring to ensure it remains below 130/80 (Alencherry & Laffin, 2021).

4. Discuss specific patient education based on the prescribed therapy.

The patient will be educated that HCTZ is used to manage high blood pressure to prevent heart attacks, strokes, and kidney problems. The drug acts by causing one to make more urine, which helps the body get rid of extra salt and water. He will be instructed to take the drug orally, preferably once daily in the morning, with or without food (Alencherry & Laffin, 2021). Besides, he will be informed that he may need to wake up to urinate if he takes the drug too close to bedtime. Thus, it is best to take the medication at least 4 hours before bedtime. He will be advised to keep taking the medication even if he feels well to get the most benefit. In addition, he will be informed that he may experience dizziness, stomach upset, or headache as the body adjusts to the medication (Alencherry & Laffin, 2021).

5. List one or two adverse reactions to the selected agent that would cause you to change therapy.

HCTZ therapy would be changed if the patient presented with Hepatotoxicity (Alencherry & Laffin, 2021).

6. What would be the choice for second-line therapy?

The second-line therapy would be Verapamil 80 mg PO twice daily. Verapamil is an antihypertensive under Calcium Channel Blockers (CCBs). It belongs to non-dihydropyridines in the class of CCBs. CCBs (non-dihydropyridine) are recommended as second-line agents in treating patients with diabetes and hypertension (Alencherry & Laffin, 2021). They do not increase proteinuria, unlike Dihydropyridines such as nifedipine and amlodipine. They help in preventing stroke.

7. What over-the-counter and/or alternative medications would be appropriate for Darius?

Enalapril, an ACE inhibitor, would be an appropriate alternative medication. ACE inhibitors are beneficial in preventing new-onset diabetes and albuminuria. Besides, they protect kidneys by decreasing efferent glomerular arteriolar tone and inhibiting mesangial growth factors (James et al., 2014).

8. What lifestyle changes would you recommend to Darius?

The recommended lifestyle changes for Darius are non-pharmacological lifestyle modifications. This approach will include counseling weight management, reducing caloric intake, engaging in regular physical activity, cessation of tobacco smoking, and reducing caffeine intake (Pavlou et al., 2018). Weight management through regular exercises and a healthy diet will be essential in lowering blood pressure and maintaining optimal glycemic control.

9. Describe one or two drug-drug or drug-food interactions for the selected agent.

HCTZ has a drug interaction with carbamazepine. Either drug increases the effects of the other through pharmacodynamic synergism. Besides, it has a drug interaction with cyclosporine. Either drug increases the toxicity of the other through pharmacodynamic synergism. Therefore, carbamazepine and cyclosporine should be avoided or an alternative used in patients on HCTZ.

References

Alencherry, B., & Laffin, L. J. (2021). Treatment of Hypertension in Patients with Diabetes Mellitus: a Contemporary Approach. Current cardiology reports, 23(3), 14. https://doi.org/10.1007/s11886-021-01443-0

James, P. A., Oparil, S., & Carter, B. L. (20I4). 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)[published correction appears in JAMA. 20I4; 3II (I7): I809]. JAMA. 20I4, 507-520 https://doi.org/10.1001/jama.2013.284427.

Pavlou, D. I., Paschou, S. A., Anagnostis, P., Spartalis, M., Spartalis, E., Vryonidou, A., Tentolouris, N., & Siasos, G. (2018). Hypertension in patients with type 2 diabetes mellitus: Targets and management. Maturitas, 112, 71–77. https://doi.org/10.1016/j.maturitas.2018.03.013

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NU641: Advanced Clinical Pharmacology
Case Study Week 2 – Hypertension

Instructions
Review the patient case study and answer the questions provided. You are expected to include two evidence-based practice articles to support your work. Additionally, you will need to include the national guidelines for any treatment plans/options. All papers must conform to the most recent APA standards.

Case Study
Darius, a 65-year-old black man, was referred to the clinic for evaluation of high blood pressure noted on an initial screening. He reports having headaches and nocturia. He states that he has gained 8 pounds over the last year.

Past medical history:
• Appendectomy 30 years ago
• Peptic ulcer disease 10 years ago
• Type 2 diabetes mellitus for 10 years
• Gout

Family history:
• Father had hypertension; died of myocardial infarction at age 55.
• Mother had diabetes mellitus and hypertension; died of cerebrovascular accident at age 60.

Physical examination:
• Height 69 in, weight 90 kg
• BP: 140/89 mm Hg (left arm), 138/82 mm Hg (right arm)
• Pulse: 84 beats/minute, regular
• Funduscopic examination: mild arterial narrowing, sharp discs, no exudates or hemorrhages

Laboratory findings:
• Blood urea nitrogen: 24 mg/dL
• Serum creatinine: 1.1 mg/dL
• Glucose: 95 mg/dL
• Potassium: 4.0 mEq/L
• Total cholesterol: 201 mg/dL
• High-density lipoprotein cholesterol: 30 mg/dL
• Triglycerides: 167 mg/dL
• Urinalysis: within normal limit (no proteinuria)
• Electrocardiogram and chest radiograph: mild left ventricular hypertrophy

Social history:
• Tobacco: 35 pack years
• Alcohol: 1 pint of vodka/week
• Coffee: 2 cups/day

Diagnosis: Stage 1 Hypertension

1. List specific goals for treating Darius’ hypertension.

2. What drug therapy would you prescribe? Why?
3. What are the parameters for monitoring success of the therapy?
4. Discuss specific patient education based on the prescribed therapy.
5. List one or two adverse reactions for the selected agent that would cause you to change therapy.
6. What would be the choice for second-line therapy?
7. What over-the-counter and/or alternative medications would be appropriate for Darius?
8. What lifestyle changes would you recommend to Darius?
9. Describe one or two drug–drug or drug–food interaction for the selected agent.