Scenario:
A 70 year-old man presents to the clinic for the first time with complaints that he is experiencing
increased difficulty breathing over the past few days. He has just moved to this city to be nearer his
son and family and does not have his medical records. He indicates that he has a history of COPD,
CAD, and HTN. He empties a bag containing his current medications on the table: propranolol (Inderal) 60 mg BID nitroglycerin transdermal patches (with instructions to change q24h) nitroglycerine tablets labeled prn for chest pain: 1 sublingual every 5 minutes times 3 (call
911 if not effective) ASA, 81 mg every AM ipratropium bromide (Atrovent) MDI 2 puffs q6h
Major abnormal objective data this AM includes: BP 170/100 with pulse, 72 and regular;
respirations, 28; expiratory wheezes bilaterally; negative crackles, JVD or peripheral edema. From
the physical exam and a detailed history, the advanced practice nurse diagnosed HTN and COPD
exacerbation.
Instructions:
Discuss the drug classes (NOT specific drugs) currently used to treat HTN, addressing the
manipulation of preload, afterload, and fluid retention. Be specific. Be sure to address MOA of
each drug class, intended outcomes, and common side effects.
Discuss drug classes (NOT specific drugs) currently used to treat COPD. Be sure to address MOA of
each drug class, intended outcomes, and common side effects.
Many interventions are appropriate for this man at this time. Based on his current
medications, determine if they need to be continued or changed to another drug and
why
Sample Solution