Case studies are a useful way for you to apply your knowledge of pharmacokinetics and pharmacodynamic aspects of pharmacology to specific patient cases and health histories.
Eevaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.
To Prepare:
- Review the case studies and answer ALL questions.
- When recommending medications, write out a complete prescription for each medication. What order would you send to a pharmacy? Include drug, dose, route, frequency, special instructions, # dispensed (days supply), refills, etc. Also state if you would continue, discontinue or taper the patient’s current medications.
- Use clinical practice guidelines in developing your answers. Please review all Required Learning Resources. Use the Medscape app or website and JNC 8 to complete assignment.
- Include at least three references to support each scenario and cite them in APA format. Please include in-text citations. You do not need an introduction or conclusion paragraph.
SCENARIO 4
Sandra is a 55-year-old African American female that was prescribed Toprol XL 50 mg daily for high blood pressure. Her PMH consists of depression treated with venlafaxine 225 mg daily. She states that she only occasionally takes her little white pill because she does not like the side effects of fatigue and dizziness. Her blood pressure today is 158/92. What information would you provide to the patient at her visit? What is her goal blood pressure? How would you improve Sandra’s medication therapy (include a complete medication order)?
Case Study Evaluation: Sandra's Hypertension Management
Patient Information:
- Name: Sandra
- Age: 55
- Gender: Female
- Ethnicity: African American
- Medical History: Hypertension, Depression
- Current Medications: Toprol XL (metoprolol succinate) 50 mg daily, Venlafaxine 225 mg daily
- Blood Pressure: 158/92 mmHg
Patient Education
1. Understanding Hypertension: Educate Sandra on the importance of maintaining a healthy blood pressure. Explain that hypertension can lead to serious complications such as heart disease, stroke, and kidney damage.
2. Medication Adherence: Discuss the significance of adhering to her prescribed medication regimen. Emphasize that occasional use can lead to uncontrolled blood pressure and increase her risk for cardiovascular events.
3. Side Effects Management: Address her concerns about fatigue and dizziness. Recommend strategies such as adjusting the timing of her medication intake (e.g., taking Toprol XL at night) or discussing with her healthcare provider about dosage adjustments or alternatives.
4. Lifestyle Modifications: Encourage lifestyle changes that can help manage her blood pressure, such as a low-sodium diet, regular exercise, weight management, and reducing alcohol consumption.
5. Goal Blood Pressure: Reinforce that her goal blood pressure should ideally be less than 130/80 mmHg, as recommended by the American College of Cardiology/American Heart Association (ACC/AHA) guidelines for adults under the age of 65 (Whelton et al., 2018).
Medication Therapy Improvement
Given Sandra's elevated blood pressure and her concerns about medication side effects, a reconsideration of her antihypertensive therapy is warranted. The current regimen of Toprol XL may not be sufficient.
Medication Order Recommendation:
1. Medication: Amlodipine 5 mg orally once daily
- Route: Oral
- Frequency: Once daily
- Special Instructions: Take at the same time every day; may cause swelling in the legs; monitor blood pressure regularly.
- Days Supply: 30 days
- Refills: 2 refills
2. Continued Medication:
- Continue Toprol XL at 50 mg daily to maintain dual therapy.
- Monitor for any adverse effects or interactions with venlafaxine.
3. Medication Adjustment Order:
- Discontinue: None
- Adjustment: Consider increasing Toprol XL to 100 mg daily after two weeks if blood pressure remains above goal (if tolerated), based on follow-up evaluation.
Complete Prescription Example:
Prescription
Amlodipine 5 mg
Take one tablet by mouth once daily.
Dispense: 30 tablets (30-day supply)
Refills: 2
Special Instructions: Monitor blood pressure regularly and report any swelling in legs or persistent dizziness.
Continue Toprol XL 50 mg daily.
References
1. Whelton, P. K., Carey, R. M., Aronow, W. S., et al. (2018). 2017 Guideline for High Blood Pressure in Adults: A Report from the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension, 71(6), e13-e115. https://doi.org/10.1161/HYP.0000000000000065
2. Oparil, S., Schmieder, R. E. (2015). Mechanisms of Hypertension: The Role of the Renin-Angiotensin System. Journal of Clinical Hypertension, 17(9), 727-733. https://doi.org/10.1111/jch.12606
3. American Psychiatric Association (2020). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
By addressing Sandra's hypertension with a comprehensive medication plan and emphasizing the importance of adherence and lifestyle changes, we can work towards achieving her target blood pressure and improving her overall health outcomes.