Dyslipidemia Management case study

Dyslipidemia Management Submitted by Shannon Delite Leake The University of Texas at Arlington College of Nursing In partial fulfillment of the requirements of Advanced Pharmacology N5334 Mary Davis, DNP, MSN, RN, APN-BC, CRNP, ADM-BC November 2, 2017 Hypertension Management CASE SUMMARY: Ms. Felicia A. Thorngrass is a 56-year-old female. Presents today for medication refill prescriptions and to establish care. Ms. Thorngrass is post-menopausal with 1 Dyslipidemia Management a medical history of hypertension, dyslipidemia, and obesity. She reports a family history of cardiovascular disease. Her father had a MI and both her sisters has hypertension and one has had “mini-strokes”. She complains of shortness of breath and muscle cramps with exertion. Patient plan today will include refilling all of patient medications, while it seems her blood pressure is uncontrolled, patient is agitated and may have not taking metoprolol due to the fact she hasn’t had primary care visit in 11 months; discontinue to naproxen sodium and ibuprofen, may use Tylenol for pain and begin Tricor (fenofibrate) for treatment of dyslipidemia; referrals to physical therapy for evaluation, Care Coordinator/Population health nurse for health coaching, and OB/GYN; and return to office in four weeks for follow up. 5334 CASE SUMMARY TABLE 1. Symptoms: List two pertinent signs and symptoms Requires refill prescriptions Complains of shortness of breath and muscle cramps upon exertion In office blood pressure reading of 162/92 2. Recommended Drugs: **Drug of choice – list at least 3 recommended drugs List recommended drugs as indicated for this diagnosis  Tricor (fenofibrate) (Vallerand, Deglin, & Sanoski, 2017).  Altoprev (lovastatin) (Vallerand, Deglin, & Sanoski, 2017).  Welchol, (colesevelam) (Vallerand, Deglin, & Sanoski, 2017).  Tylenol (Acetaminophen) 500mg one to two tabs every six hours as needed for pain (Vallerand, Deglin, & Sanoski, 2017). 3. Drug Categories and Subcategories: Identify the category of each recommended drug. 2 Dyslipidemia Management  Tricor (fenofibrate) therapeutically it is a lipid-lowering agent, pharmacologically a fibric acid derivative, and a pregnancy category C medication (Vallerand, Deglin, & Sanoski, 2017).  Altoprev (lovastatin) therapeutically it is a lipid-lowering agent, pharmacologically a HMG-CoA reducatase inhibitor, and is a pregnancy category X medication (Vallerand, Deglin, & Sanoski, 2017).  Welchol (colesevelam) therapeutically a lipid-lowering agent, therapeutically a bile acid sequestrant, and a pregnancy category B medication (Vallerand, Deglin, & Sanoski, 2017).  Tylenol (Acetaminophen) therapeutically a non-opioid pain reliever and an antipyretic and a pregnancy B category medication (Vallerand, Deglin, & Sanoski, 2017). 4. Drug(s) of Choice: FOR THE MAIN DIAGNOSIS ONLY, provide the chosen drug(s) of choice for treatment. 5. Rationale: Provide rationale, clinical guidelines, or evidence for the selected drug of choice  Tricor (fenofibrate) has been shown to decrease Low-density lipids, triglycerides, and increase high-density lipids in combination with ezetimibe and has been shown to be safe when the two are used in combination for long-term treatment (Oikawa, et al, 2017). Patient has the perception that she is allergic to statins, therefore prescribing a statin would adversely affect the trust between the patient and primary care clinician which can affect the chances of whether patient does, or does not take prescribed medications, follow dietary recommendations, instructions to exercise, participate in 3 Dyslipidemia Management referral recommendations, and of the chances of her returning for future visits (Dang, et al, 2017).  Tylenol (Acetaminophen) Non-Steroid Anti-Inflammatory Drugs carry a greater risk to increase blood pressure at levels for pain relief (NSAIDs, n.d.). 6. Contraindications and or Risks, as appropriate: Identify contraindications and risks as appropriate  Tricor (fenofibrate) hypersensitivity, pre-existing gallbladder disease, hepatic impairment, severe renal impairment, concurrent use of a HMG-CoA reductase inhibitor, do not breastfeed, use cautiously in pregnancy, warfarin therapy, safety has not been established in pediatric populations, and due to age related changes to the renal system the elderly are more likely to have adverse reactions (Vallerand, Deglin, & Sanoski, 2017).  (Vallerand, Deglin, & Sanoski, 2017).  Tylenol (Acetaminophen) previous hypersensitivity; consumption of alcohol, aspartame, saccharine, yellow dye number five, sugar, tartrazine, active liver disease, hepatic impairment (Vallerand, Deglin, & Sanoski, 2017). 7. What Patients Must Understand: Identify at least 3 appropriate teaching points for the patient and/or family (HINT: 3 teaching points is rarely adequate for good patient care)  Side effects/Adverse reactions include: Tricor (Fenofibrate) headache, fatigue, weakness, pulmonary embolism, deep vein thrombosis, arrhythmias, rash, pancreatitis, urticaria, cholelithiasis, decreased high-density lipids, hypersensitivity reactions, rhabdomyolysis (Vallerand, Deglin, & Sanoski, 2017).  Take this medication as instructed, do not skip or double up on doses. This medication will help control your elevated triglycerides and is not a cure (Vallerand, Deglin, & Sanoski, 2017). 4 Dyslipidemia Management  Since this medication will help you control your levels it is important that your watch what you eat. Lower the amount of fat, cholesterol, and carbohydrates you consume daily, do not drink or smoke, and increase your daily activity (Vallerand, Deglin, & Sanoski, 2017).  Consider adding to your daily diet 2 grams of plants stanols and sterols (Sorrentino, n.d.) such ass vegetables, seeds, legumes, and nuts (Griffin, n.d.), increasing your daily soluble fiber to 10-25 grams a day, and replacing some of your daily animal protein intake with soy protein (Sorrentino, n.d.).  Please keep your follow-up appointment in four weeks and all other visits with this office, as it is very important to monitor the effectiveness of the medication and to monitor you for any adverse reactions and side effects (Vallerand, Deglin, & Sanoski, 2017).  Promptly report any unexplained (not associated with exercise) muscle pain, tenderness, or weakness, especially if you experience fever, or malaise (Vallerand, Deglin, & Saoski, 2017). Tylenol (Acetaminophen) agitation, headache, anxiety, fatigue, atelectasis, insomnia, difficulty breathing, hepatoxicity, hypotension, hypertension, constipation, nausea, increased liver enzymes, vomiting, hypokalemia, renal failure in chronic use of high doses, neutropenia, pancytopenia, trismus, Steven’s Johnson’s Disease, muscle spasms, rash, Acute Generalized Exthematous Pustulosis, Toxic Epidermal Necrolysis, urticaria (Vallerand, Deglin, & Sanoski, 2017).  It is important that you keep a close watch on your salt intake and decrease this intake, exercise by walking daily, reduce your stress, and avoid drinking alcohol to assist in decreasing your blood pressure (Vallerand, Deglin, & Sanoski, 2017).  Do not take naproxen sodium or ibuprofen for your muscle cramps, take acetaminophen as they can increase your blood pressure (NSAIDs, n.d.).  Do not drink alcohol while taking or limit your alcohol consumption to less than three 5 Dyslipidemia Management glasses if taking one or two doses of Tylenol (Acetaminophen) as this increases hepatoxic effects (Vallerand, Deglin, & Sanoski, 2017)