Interactive Hypertension Case Study
Interactive Hypertension Case Study
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.
NU641 Advanced Clinical Pharmacology
Week 7 Assignment
Interactive Upper Respiratory Case Study
Jackieis a 45-year-old white female with past medical history of controlled hypertension, controlled asthma, and eczema. She has a four-day history of nasal congestion, headache, sore
throat, sneezing, and productive cough. She denies fever, nausea, vomiting, and myalgias. She has three children who recently went back to school following a summer vacation. No one else in her household is currently presenting with similar symptoms. She has no known drug allergies but is allergic to mums and ragweed. She calls her primary care provider’s office requesting a medication to treat her illness. She takes several medications, including the following:
• Mometasone 220 mcg—1 puff daily for asthma.
• Albuterol 90 mcg—1 to 2 puffs q4–6 hours as neededfor shortness of breath.
• Lisinopril 10 mg—one tablet by mouth daily forhypertension.
• Oxymetazoline hydrochloride 0.05% nasal spray—2sprays per nostril bid × 3 days.
Provide rationales for your answers:
1. Which of the following is the MOST appropriate drugto recommend?
a. Oxymetazoline hydrochloride 0.05% nasal spray—2 sprays per nostril bid until symptoms resolve.
b. Naproxen 220 mg—one tablet by mouth every12 hours as needed until symptoms resolve.
c. Dextromethorphan ER oral liquid—60 mg every12 hours until symptoms resolve.
d. Amoxicillin–clavulanic acid 500 mg every 8 hoursfor seven days.
2. Which of the following nonpharmacological therapiesis NOT recommended?
a. Steam inhalation
b. Increased water intake
c. Menthol lozenges
d. Saline gargle
3. Jackieis insistent on taking a complementary therapy tohelp treat her symptoms. What is the MOST appropriaterecommendation?
a. Echinacea purpurea tincture—0.75 mL
b. Fresh garlic—3 cloves
c. Acidophilus probiotic—1 tablet daily
d. Vitamin C—1 g
NU641 Advanced Clinical Pharmacology
Week 10 Assignment
Interactive Anxiety Case Study
Ivy, age 23, is a white woman who graduated from college last year. She began working as an accountant one month after graduating. Approximately two months ago, she moved into a two-bedroom apartment with another woman who works at the same accounting firm. She states that her roommate recommended that she sees a doctor to find out if she has anemiaor “some sort of fatigue syndrome.” She states that she has felt “restless” and “on edge” for most of the past nine months. She becomes easily fatigued and irritable and has difficultyconcentrating and falling asleep. She states that sometimes her mind “just goes blank,” and she is worried that her work performance is no longer excellent.
She reports that all herlife she had good grades in school and was very successful in everything she attempted. Although she has been “a worrier from the day I was born,” now she worries more than she ever has and feels nervous “all the time.” Ivyreports that she has a good relationship with her boyfriend, but they do not get to see each other very often because he is attending graduateschool 100 miles away. She reports having a satisfying sexual relationship with him. She denies having any problems with relationships with her parents, roommate, or peers. She denies having any financial worries unless she is fired from her job for poor work performance. She reports that she has always been healthy and has taken good care of herself. The only medication she takes is birth control pills, which she has taken for the past four years without any adverse effects.
Diagnosis: Generalized Anxiety Disorder
1. List specific treatment goals for Ivy.
2. What drug therapy would you prescribe? Why?
3. What are the parameters for monitoring the success ofthe therapy?
4. Describe specific patient monitoring based on the prescribedtherapy.
5. List one or two adverse reactions for the selected agentthat would cause you to change therapy.
6. What would be the choice for second-line therapy?
7. What dietary and lifestyle changes should be recommendedfor this patient?
8. Describe one or two drug–drug or drug–food interactionsfor the selected agent.
NU641 Advanced Clinical Pharmacology
Week 14 Assignment
Interactive Thyroid Case Study
Mariais a 29-year-old woman with a seven-month history of heavy, irregular menses, a 5-lb weight gain, constipation, and decreased energy. Her past history is unremarkable. She takes no prescription medications but uses iron and calcium supplements. She has a family history of thyroid disease. On examination, her weight is 152 lbs, her heart rate is 64 bpm, and her blood pressure is 138/86. Her thyroid gland is mildly enlarged, without nodularity. She has trace edema in her lower extremities, and her reflexes are slow.
Laboratory studies are as follows:
TSH is 15.3 mIU/mL (elevated), free T4is 0.3 mIU/mL (decreased), and total cholesterol is 276 mg/mL.
Diagnosis: Primary Hypothyroidism
1. List specific goals of treatment for Maria.
2. What drug therapy would you prescribe? Why?
3. What are the parameters for monitoring the success ofthe therapy?
4. Discuss specific patient education based on the prescribedtherapy.
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 Maria?
8. What lifestyle changes would you recommend to Maria?
9. Describe one or two drug–drug or drug–food interactionsfor the selected agent.
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