Case Study – Patient Diagnosed with Hypertension and Hyperlipidemia
Medication Recommendations
The patient’s conditions, signs, and symptoms will guide the drugs to be given to the patient. The patient is hypertensive, meaning he has to be given antihypertensive medications. Combining different classes of drugs will help manage hypertension (Correa et al., 2018). The patient should be given a thiazide-like diuretic, an ACE inhibitor, and a calcium channel blocker as a first-line treatment (Correa et al., 2018). The patient should be given Chlorthalidone 25 mg once a day as the starting dose. The drug belongs to a class of medications known as thiazide-like diuretics. The drug prevents the body from absorbing a lot of salts, which can cause the retention of fluid. Chlorthalidone will also reduce the swelling of the patient’s feet since it reduces fluid retention in the body. This medication is preferred over hydrochlorothiazide since it is longer-acting and more potent, with improved outcomes (Hripcsak et al., 2020). The trade names for chlorthalidone are Hygroton, Thalitone, and Chlorthalid. When Chlorthalidone interacts with other hypertensives, it can lead to hypotension. NSAIDs may also decrease the effectiveness of the drug. Side effects of Chlorthalidone include hypotension, vasculitis, dizziness, jaundice, constipation, and vertigo.
The patient should also be prescribed nifedipine 10mg Bid daily. Nifedipine is a calcium channel blocker that inhibits smooth muscle contraction and excitation. The trade name of nifedipine include Adalat CC, adalat XL, Procardia, and Afeditab. Side effects of the drug include headache, shortness of breath, tinnitus, and blurred vision. The nifedipine effect is reduced when it interacts with anti-TBs such as rifampin. Interaction with itraconazole and erythromycin increases nifedipine levels and effects.
P.O Enalapril 5mg once a day. Enalapril is an ACE inhibitor, the trade name of which is Vasotec. The drug can interact with other hypertensives to result in hypotension. Side effects include hypotension, headache, cough, vertigo, and weakness. For hyperlipidemia, the patient should be given Niacin 10mg once a day with dietary supplements (Ponce et al., 2019). Niacin is a lipid-lowering agent with the trade names Niac, Niacor, and Nicobid. Accordingly, its side effects include panic, dizziness, and blurred vision. Niacin interacts with antihypertensive, leading to hypotension. Interaction with other lipid-lowering agents leads to myopathy.
Nonpharmacological interventions
One of the nonpharmacological interventions is for the patient to focus on his diet. The patient should feed on a healthy diet composed of more fruits and vegetables. The patient should also avoid foods with high fats and high sodium (Verma et al., 2021). Relaxation techniques will also help in the management of the patient. Techniques such as meditation and yoga reduce stress hormones, and therefore they can be used in the management of hypertension (Verma et al., 2021). Physiotherapy sessions also help in managing hypertension and relieve the patient’s pain. The patient should perform some exercises 2 to 3 days a week (Verma et al., 2021). Lifestyle modification is also essential, and the patient should avoid smoking and drinking alcohol. Other nonpharmacological factors to be considered include guiding and counseling the patient. Social interaction with people decreases factors that lead to hypertension, such as stress, depression, and anxiety.
Patient Education
The patient should be taught the importance of adhering to medications. Adhering to medication is key in managing hypertension to prevent complications. The patient should also be taught lifestyle modification (Verma et al., 2021). The patient should be explained why he should not smoke or drink alcohol. Performing some light exercises is healthy for the patient. Nutritional education is essential, and the patient should be taught the foods to avoid, such as those containing high sodium and fats (Verma et al., 2021). The patient should be educated on the signs that indicate complications, which he should report to the facility.
References
Correa, A., Rochlani, Y., Khan, M. H., & Aronow, W. S. (2018). Pharmacological management of hypertension in the elderly and frail populations. Expert review of clinical pharmacology, 11(8), 805-817.
Hripcsak, G., Suchard, M. A., Shea, S., Chen, R., You, S. C., Pratt, N., Madigan, D., Krumholz, H. M., Ryan, P. B., & Schuemie, M. J. (2020). Comparison of cardiovascular and safety outcomes of Chlorthalidone vs Hydrochlorothiazide to treat hypertension. JAMA Internal Medicine, 180(4), 542. https://doi.org/10.1001/jamainternmed.2019.7454
Parekh, N., Page, A., Ali, K., Davies, K., & Rajkumar, C. (2017). A practical approach to the pharmacological management of hypertension in older people. Therapeutic advances in drug safety, 8(4), 117-132.
Ponce, O. J., Larrea-Mantilla, L., Hemmingsen, B., Serrano, V., Rodriguez-Gutierrez, R., Spencer-Bonilla, G., … & Murad, M. H. (2019). Lipid-lowering agents in older individuals: a systematic review and meta-analysis of randomized clinical trials. The Journal of Clinical Endocrinology & Metabolism, 104(5), 1585-1594.
Verma, N., Rastogi, S., Chia, Y. C., Siddique, S., Turana, Y., Cheng, H. M., … & Kario, K. (2021). Nonpharmacological management of hypertension. The Journal of Clinical Hypertension.
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Question 
Medication Recommendations
Discussion Prompt
Mr. Smith is a 64 year old African American male. He was diagnosed with hypertension and hyperlipidemia 5 years ago and has not taken meds regularly for the last year. He states he has been experiencing chest pain when working around the house and sometimes while on his evening walk. He also complains that his feet are swelling in the evening. His vitals today: P-105, B/P-165/100, R-20. Wt-260 Ht-5’9” Labs: TC- 240, LDL- 145, HDL- 30, Trig-250. Sulfa allergy. You are assigned as his new PCP.
Medication Recommendations
- What medication recommendations will you make? Include the drug class, generic and trade name, and starting dose range. Provide a rationale for your choices.
- Discuss any potential side effects and drug interactions for this patient.
- What non-pharmacological interventions would you suggest?
- What patient education would you provide?
Expectations
Initial Post:
Length: A minimum of 500 words, not including references
Citations: At least two high-level scholarly references in APA from within the last 5 years