Hypertension is a condition best characterized by consistently high blood pressure that threatens the patient’s health with adverse long-term consequences. Jack is a patient who requested a renewal for his Rosuvastatin prescription. The last clinical data on Jack is the following: HgA1C 9.0, 170/110 mm Hg, pulse 88, and respirations 22. This paper will analyze the case study of the 54 years old patient Jack, who requested to renew the prescription for Crestor.
Jack initially contacted the medical facility to renew his prescription for Rosuvastatin. This medication is used to prevent cardiovascular disease in patients at high risk. This medication affects blood pressure and has a lipid-lowering effect (Acosta, 2020). Since Crestor’s records have varied dosings and the patient also takes medication for hypertension, it is necessary to conduct several additional assessments before prescribing Jack with Rosuvastatin again.
Hypertension is a condition that affects a patient’s blood pressure and can cause serious adversities, such as a heart attack. Acosta (2020) describes it in the following manner: “the pressure rises and stays elevated over time, the person is said to have hypertension” (p. 208). Jack’s pressure is 170/110 mm, according to the case study. The typical blood pressure for a hypertension diagnosis is 120/80 (Acosta, 2020; CDC, 2020). Considering Jack’s systolic and diastolic blood pressure, he has stage 2 hypertension (Acosta, 2020). Hence, upon examining Jack’s labs, pharmacological and lifestyle treatment plans should be prescribed to him.
The patient currently takes medication for hypertension, which is Lisinopril. It is a common medication to treat high blood pressure. Jack takes 20 mg of this medication each day. Metformin is a medication for type 2 diabetes, which Jack takes at a dose of 1,000 mg two times each day. Notably, the medication for Jack’s pulmonary disease is unknown and should be examined before prescribing new medications.
To diagnose hypertension, some additional clinical information is necessary. His lipid labs were done a year ago and should be retested. Lipid labs allow seeing the triglycerides and cholesterol profile. Additionally, common tests for hypertension include blood and urine tests and ECG reading (Medline, 2020). To determine the exact cause of hypertension, the potential kidney disease or tumors should be tested as well.
Differential diagnosis is a list of potential conditions that caused Jack’s hypertension. Jack has several comorbid conditions, such as diabetes, CABG, and a mild case of chronic obstructive pulmonary disease. However, Acosta (2020) notes that in most cases, hypertension has no apparent cause, which is referred to as essential hypertension. With secondary hypertension, kidney disease, or tumors of adrenal glands are common causes. Kidney disease is especially a concern since this patient has diabetes.
The desired treatment outcome for Jack is lowering his blood pressure to a normal level to prevent potential heart problems in the future. According to Acosta (2020), “managing the medical condition causing secondary hypertension results in the patient regaining normal blood pressure” (p. 208). However, with essential hypertension, lowering the blood pressure will be achieved through medication and lifestyle changes, and the expected blood pressure should be below 120/80.
Non-pharmacological therapy for hypertension includes lifestyle changes (Acosta, 2020). Considering that this patient also has diabetes, a proper diet should become essential to manage his health. Weight loss is another common recommendation for hypertension management (Acosta, 2020). Jack’s current weight is 30 BMI, which is classified as obesity. Hence, weight loss and lifestyle changes are recommended for Jack as a non-pharmacological therapy for hypertention.
The pharmacotherapeutic plan would differ for different patients. For example, children are typically prescribed lower doses of the medication. Obstetrics patients cannot use Crestol due to potential side effects (Kaplan Nurisng, 2019). Geriatrics patients should also be prescribed lower dosages to limit potential side effects. Moreover, Dorobantu et al. (2019) note that people of Asian ethnicity are more susceptible to the side from Crestol, which is why their initial dosage should be lower. B-adrenergic blocking drugs are designed to slow down the heart rhythm. Diuretics allow to remove salt and fluids from the body, and one example is Thiazide (Kaplan Nursing, 2019). The mechanism of action is linked to the exertion of sodium (Acosta, 2020). In essence, the majority of hypertension medications are designed to increase the size of blood vessels (Acosta, 2020). This allows for the blood to have more space to circulate properly. A combination of diuretic and Angiotensin-converting-enzyme inhibitors (ACE inhibitors) is another option for hypertension treatment at stage 2 (Acosta, 2020). ACEI act as relaxation for blood vessels that allows them to work with more blood. An example of a combination of a diuretic and an ACEI would be Hydrochlorothiazide 25 mg and Propanolol with the dosage of 40 or 80 mg (Acosta, 2020).
The pharmacotherapeutic plan for this patient should begin with standard treatment for hypertension. Typically, the initial treatment for hypertension consists of a diuretic and a beta-blocker, which is the most effective combination (Acosta, 2020). However, as with any other condition, there is no single best medication, and the best approach is to monitor the patient’s response and modify treatment based on it. This patient is currently taking a combination of medication for diabetes, heart problems, and pulmonary condition.
The combination of medications of the agent interactions for this drugs administered to Jack has several implications. As for the new therapy, the two-drug combination for hypertension treatment is a commonly used method, and there are no precautions apart from potential allergies or side effects, which should be monitored (Acosta, 2020). These drugs are taken once per day orally and administered as pills, and this is lifelong therapy. To monitor the patient’s response to therapy, his blood pressure should be monitored regularly. If this combination of medications does not work, a different dosage or a type of medication used with a diuretic should be used.
To counsel Jack about his new treatment plan, it is important to provide him the clinical data, rationale, and an explanation for why he needs to take his medication consistently, without taking two-month breaks as he did before. Acosta (2020) argues that patient education is vital since hypertension treatment is a life necessity for Jack and will require proper adherence to medication and lifestyle changes. Some important recommendations with this treatment are monitoring side effects such as dizziness. Additionally, Jack should not discontinue using the therapy, especially abruptly. Jack should not take nonprescription drugs or herbal remedies without a consultation with a medical professional.
Overall, in this case, study a 54 years old patient Jack requested to renew his prescription for Rosuvastatin, which is a medication used to prevent heart problems, which lowers blood pressure and affects a person’s lipid profile. Based on the patient’s history, he should undergo some lab tests and be prescribed therapy for hypertension. The most common treatment plan for hypertension is a diuretic and an antihypertensive drug.
Acosta, R. W. (2020). Study guide for pharmacology for health professionals (2nd ed.). Cengage. CDC. (2020). Facts about hypertension. Web.
Dorobantu, M., Mansia, G., Grassi, G., & Voicu, V. (Eds.). (2019). Hypertension and heart failure. Springer.
Kaplan Nursing Guide. (2019). Family nurse practitioner certification prep plus. Kaplan.
Medline. (2020). High blood pressure tests. Web.