Week 3: Pharmacotherapy for Cardiovascular Disorders | Case Study 1
Main Discussion Post
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:
Atenolol 12.5 mg daily
Doxazosin 8 mg daily
Hydralazine 10 mg qid
Sertraline 25 mg daily
Simvastatin 80 mg daily
Factor: Behavior
While there can sometimes be a genetic link to hypertension and hyperlipidemia, lifestyle
behaviors are more often a contributing factor. Obesity increases the risk of many diseases including, heart disease, diabetes, gastrointestinal problems, cancer, and breathing problems such
as sleep apnea and asthma (Bombaci, 2017). Obesity can affect all four aspects of pharmacokinetics, which includes absorption, distribution, metabolism, and elimination. Careful
monitoring of patients is essential in obese patients due to the fact that medications can work differently in this patient population (Nickson, 2015). This patient's recent weight gain would indicate that the patient is not following a healthy diet aimed at decreasing weight and therefore decreasing cholesterol and blood pressure. The patient is on three medications that address hypertension; hydralazine, doxazosin, and atenolol. Hydralazine is a vasodilator and causes smooth muscle relaxation of the arteries that results in a decrease in blood pressure. Doxazosin is an alpha-1 blocker antihypertensive drug. It acts by dilating both arteries and veins, which results in smooth muscle relaxation. It is commonly used in patients with benign prostatic hypertrophy and not normally prescribed for hypertension alone. Atenolol is a cardio-selective beta-1 blocker because it binds mainly to the beta-1 receptors in the heart and kidneys. It decreases cardiac output and sympathetic outflow by
blocking central and peripheral beta receptors. This mechanism of action results in decreased blood pressure (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).
The Joint National Committee (JNC 8) is a guideline that providers can use in the treatment of hypertension. These guidelines follow an algorithm based on a patients age, ethnicity, lifestyle, and comorbidities to manage hypertension and prescribe antihypertensive medications. The first line of treatment is to initiate a thiazide diuretic, angiotensin converting enzyme inhibitor, angiotensin receptor blocker, a calcium channel blocker, or a combination titrated to blood pressure goal (James, Oparil, & Carter, 2014). According to Schroeder and Ahmad (2017), the use of multiple drug classes at submaximal levels can decrease side effects and increase treatment success. The drugs that the patient is currently on are not the first line of treatment that is suggested by the JNC 8 guidelines and the dosages are abnormal. According to Drugs.com (2017a,b,c), the initial dose of atenolol is 50 mg daily with a maximum of 100 mg per day, the initial dose of doxazosin is 1 mg per day with a maximum daily dose of 8 mg, and the initial dose of hydralazine is 10 mg four times per day with a maintenance dose of 50 mg four times per day. Managing this patient’s hypertension would include behavior modification by setting up plan for diet and exercise, and possibly getting the patient in contact with a dietician and a personal trainer. Without demographics available, I would discontinue the current hypertensive
Main Discussion Post
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:
Atenolol 12.5 mg daily
Doxazosin 8 mg daily
Hydralazine 10 mg qid
Sertraline 25 mg daily
Simvastatin 80 mg daily
Factor: Behavior
While there can sometimes be a genetic link to hypertension and hyperlipidemia, lifestyle
behaviors are more often a contributing factor. Obesity increases the risk of many diseases including, heart disease, diabetes, gastrointestinal problems, cancer, and breathing problems such
as sleep apnea and asthma (Bombaci, 2017). Obesity can affect all four aspects of pharmacokinetics, which includes absorption, distribution, metabolism, and elimination. Careful
monitoring of patients is essential in obese patients due to the fact that medications can work differently in this patient population (Nickson, 2015). This patient's recent weight gain would indicate that the patient is not following a healthy diet aimed at decreasing weight and therefore decreasing cholesterol and blood pressure. The patient is on three medications that address hypertension; hydralazine, doxazosin, and atenolol. Hydralazine is a vasodilator and causes smooth muscle relaxation of the arteries that results in a decrease in blood pressure. Doxazosin is an alpha-1 blocker antihypertensive drug. It acts by dilating both arteries and veins, which results in smooth muscle relaxation. It is commonly used in patients with benign prostatic hypertrophy and not normally prescribed for hypertension alone. Atenolol is a cardio-selective beta-1 blocker because it binds mainly to the beta-1 receptors in the heart and kidneys. It decreases cardiac output and sympathetic outflow by
blocking central and peripheral beta receptors. This mechanism of action results in decreased blood pressure (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).
The Joint National Committee (JNC 8) is a guideline that providers can use in the treatment of hypertension. These guidelines follow an algorithm based on a patients age, ethnicity, lifestyle, and comorbidities to manage hypertension and prescribe antihypertensive medications. The first line of treatment is to initiate a thiazide diuretic, angiotensin converting enzyme inhibitor, angiotensin receptor blocker, a calcium channel blocker, or a combination titrated to blood pressure goal (James, Oparil, & Carter, 2014). According to Schroeder and Ahmad (2017), the use of multiple drug classes at submaximal levels can decrease side effects and increase treatment success. The drugs that the patient is currently on are not the first line of treatment that is suggested by the JNC 8 guidelines and the dosages are abnormal. According to Drugs.com (2017a,b,c), the initial dose of atenolol is 50 mg daily with a maximum of 100 mg per day, the initial dose of doxazosin is 1 mg per day with a maximum daily dose of 8 mg, and the initial dose of hydralazine is 10 mg four times per day with a maintenance dose of 50 mg four times per day. Managing this patient’s hypertension would include behavior modification by setting up plan for diet and exercise, and possibly getting the patient in contact with a dietician and a personal trainer. Without demographics available, I would discontinue the current hypertensive
