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respond to provided post in one or more of the following ways:
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Case Study #3: Pharmacotherapy for Cardiovascular Disorders
Patient CB has a history of strokes. The patient has been diagnosed with type 2 diabetes, hypertension, and hyperlipidemia. Drugs currently prescribed include the following:
Glipizide 10 mg PO daily
HCTZ 25 mg daily
Atenolol 25 mg PO daily
Hydralazine 25 mg qid
Simvastatin 80 mg daily
Verapamil 180 mg CD daily
Introduction: Hypertension also known as high blood pressure can lead to severe complications that increase the risk of heart disease, stroke, and death. Blood pressure is the force exerted by the blood against the walls of the blood vessels. Due to increased tension or pressure exerted by blood against arterial walls, hypertension can be a lifetime condition if not taken care of effectively. Blood pressure is determined both by the amount of blood the heart pumps and the amount of resistance to blood flow in the arteries. The more blood the heart pumps and the narrower the arteries, the higher the blood pressure. High blood pressure (hypertension) can exist for years without any symptoms and even without symptoms, damage to blood vessels and the heart continues and can be detected and uncontrolled high blood pressure increases the risk of serious health problems, including heart attack and stroke. Although it is an imbalance in the autoregulation of the renin-angiotensin system, some factors such as genetics, gender, ethnicity, age, or behavior factors contribute to hypertension.
Factors that Influence the patient’s pharmacokinetic and pharmacodynamic process
Ethnicity: Ethnicity is one of the factors that influence the patient’s pharmacokinetics and pharmacodynamics process. High blood pressure is common among people of African heritage, often developing at an earlier age than it does in other ethnic groups. Serious complications, such as stroke, heart attack and kidney failure, also are more common in people of African heritage and hypertension in the elderly population is characterized by a systolic above 140 mm Hg and diastolic of 90 mm Hg. This is common with this ethnic group because of salt sensitivity called blunted natriuretic responses. For example, after eating or consuming high glucose drinks the body excretes sodium in the first 12 hours after that salt or sodium load. With people of this ethnic background, the excretion of sodium and potassium is relatively delayed due to blunted natriuretic responses. This occurs more in an obese patient where a high-fat diet is associated with significant sodium retention and extracellular fluid volume expansion. According to researchers, the impaired natriuretic response to a salt load in hypertensive blacks could result from a reduced ability to generate natriuretic substances such as dopamine (DA), prostaglandin E? (PGE2), and atrial natriuretic factor (ANF) (Sowers, Zemel, & et. la., 1998).
Impact on pharmacokinetic and pharmacodynamics: Renin secretion is suppressed when the kidney detects that the amount of sodium ions reaching the sodium sensor (macula densa) in the nephron is raised. People of this ethnic group have low renin which means that AB drugs (AB drugs (angiotensin-converting enzyme inhibitors, angiotensin blockers, and calcium blockade) are less effective, and β blockers are less effective in this population. Healthcare providers should use CD drugs (calcium blockers and diuretics). Although race plays a role in high blood pressure with the complication of stroke heart attack and kidney failure, consumption of high sodium diet (bacon, sausage, and sugars) predispose this group to strokes, type 2 diabetes, hypertension, and hyperlipidemia.
How to improve this patient drug therapy: Provider must monitor patient’s CBC, liver functions panels, lipid panel, ANA titer and renal panels periodically. The patient in this case study is on medications: HCTZ 25 mg daily (diuretic), Atenolol 25 mg PO daily (beta blocker), Hydralazine 25 mg four times daily, and Verapamil 180 mg CD daily. Assuming this patient is of an African descent, Atenolol should be discontinued because it will interact with calcium channel blockers (verapamil) and the antidiabetic medication (Glipizide) should also be adjusted while Simvastatin 80 mg daily should be decreased to a maximum of 10 mg daily because calcium channel blockers potentiate the effects of Statins (Simvastatin). Diet modification, exercise, and education will also be provided. Too much sodium in diet can cause the body to retain fluid, which increases blood pressure.ad too little potassium in the diet can also cause hypertension because potassium helps balance the amount of sodium in the cells. If enough potassium is not got from diet, this may lead to accumulate of too much sodium in the blood.
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.) Ambler, PA: Lippincott Williams & Wilkins.
Brown, M. J. (2006). Hypertension and ethnic group. BMJ. 2006 Apr 8; 332(7545): 833–836. doi:10.1136/bmj.332.7545.833.
Luft, F. C., Grim, C. E., Fineberg, N., & Weinberger, M. C. (1979). Effects of volume expansion and contraction in normotensive whites, blacks, and subjects of different ages. Circulation. 1979;59: 643-50. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1432176/.
Sowers, J.R., Zemel, M.B., & et. la. (1998). Salt Sensitivity in Blacks Salt Intake and Natriuretic Substances. AHA-Journals. Hypertension 12: 485-490, 1988). http://hyper.ahajournals.org/content/hypertensionaha/12/5/485.full.pdf.
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