Case Study: Hypertension Treatment

Case

Sara, a 45-year-old woman, is in for her yearly physical. She has a blood pressure of 160/90 HR 84 RR 16. She weighs 195 pounds and is 64 inches tall. Her blood pressure reading, taken three months ago, was 156/92. She is now taking 600 mg of ibuprofen three times a day for her back discomfort. There are no recognized allergies in her system.

The goal for Sara's Blood Pressure

Sara should aim to lower her blood pressure to 130/80 mm Hg or below, from 156/92 mm Hg. The diagnosis and classification of hypertension have evolved over time. Nonetheless, individuals should be treated with the conventional therapeutic aim of 130/80 mm Hg or below if their blood pressure readings are consistently 140/90 mm Hg or above(Iqbal & Jamal, 2023).

Medication

Sarah's first line of treatment for her hypertension will be angiotensin-converting enzyme (ACE) inhibitors, namely fosinopril. The recommended starting dose for fosinopril in hypertension therapy is 10 mg, with a maximum dose of 80 mg (Herman & Bashir, 2023). It may be divided into two equal dosages during the day to regulate blood pressure.

Education for Sara

Sara should receive comprehensive guidance on controlling her weight, limiting her salt intake, effectively treating her obstructive sleep apnea, and exercising. Patients must be made aware at every appointment that these alterations are necessary for the remainder of their lives to effectively treat their disease (Iqbal & Jamal, 2023). Encouraging adherence to pharmaceutical medication should also be taught.

In conclusion, hypertension needs long-term care and control because it is a chronic illness. Restrictions on alcohol, nicotine, and smoking, together with weight control and physical exercise, are important strategies for lowering cardiovascular risk.

Case 2

52-year-old Monty is getting his labs drawn again after they were taken last week. He puffs on one pack a day. He takes 20 mg of Lisinopril po every day at the moment. He has a penicillin allergy. Total cholesterol is 266; LDL cholesterol is 180; HDL is 40; and triglycerides are 185 in the fasting lipid profile.

Treatment Plan for Monty

I will write Monty a prescription for thirty tablets of atorvastatin (20 mg). This prescription should be given simultaneously daily, regardless of whether food is consumed. Given that endogenous cholesterol synthesis is cyclical and peaks at night when fasting occurs, it is often advised to take statins right before bed (McIver & Siddique, 2021). On the other hand, atorvastatin's longer half-life, compared to other statins with shorter half-lives, allows for more dosage flexibility.

Cholesterol Levels Goals for Monty

Monty's goals should be to raise his high-density lipoprotein cholesterol (HDL-C) over 40 mg/dL, decrease his total cholesterol (TC) from 266 to 200 mg/dL or less, and decrease his high-density lipoprotein cholesterol (LDL-C) from 180 to less than 100 mg/dL (Lee & Siddiqui, 2022).

Monitoring the Effectiveness of the Treatment

Before starting atorvastatin, I will have a baseline lipid panel and liver function tests performed. A repeat lipid panel must be carried out six weeks into the course of treatment (McIver & Siddique, 2021). From a clinical perspective, repeating liver function tests is advised if necessary. Lipids should be evaluated every six to twelve months once the condition stabilized.

Risk Factors for Coronary Artery Disease

With his age of fifty-two, his daily pack of cigarettes, his hypertension, and his dyslipidemia, Monty is at a heightened risk of developing coronary artery disease. The second most prevalent risk factor for coronary artery disease is thought to be hyperlipidemia (Brown et al., 2023). Heart disease has historically been significantly increased by hypertension. Two factors are linked to 50% of coronary heart diseases: smoking and age.

In summary, it is critical to inform people about leading heart-healthy lives. The main contributor to the development of atherosclerotic heart disease is LDL-C.

Reference

Brown, J. C., Gerhardt, T. E., & Kwon, E. (2023, January 23). Risk Factors For Coronary Artery Disease. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554410/

Lee, Y., & Siddiqui, W. J. (2022). Cholesterol Levels. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK542294/#:~:text=Normal%3A%20less%20than%20150%20mg

McIver, L. A., & Siddique, M. S. (2021, September 9). Atorvastatin. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430779/#:~:text=Patients%20starting%20atorvastatin%20should%20have

Case 3

For the past two months, Beatrice, a 17-year-old with mild persistent asthma, has been taking albuterol MDI three to four days a week. She has been coughing three nights a month and gets more dyspnea when she exercises. On most days of the week, she additionally takes fluticasone MDI. Flovent HFA 44 mcg, Proventil HFA two puffs, Yaz one PO daily, and Propranolol 80 mg PO BID are her current meds.

Treatment Plan for Beatrice

For Beatrice, I will recommend Nebulizer, an inhaled corticosteroid. These medications are delivered directly to their locations of action via inhalation. Because it avoids the first-pass metabolism that occurs when medications are administered orally, this route of administration reduces the dose needed to have the desired effect (Liang & Chao, 2023). Additionally, adverse effects are minimized by the decreased systemic bioavailability. Each dosage of the corticosteroid should take ten to fifteen minutes.

Medication Changes I Will Make

For improved asthma control, I will advise increasing the dose of inhaled corticosteroids (ICS). The Flovent HFA dosage should be doubled (88 mcg, two puffs BID). Proventil HFA (albuterol) should be used as a rescue inhaler. Additionally, I plan to incorporate Long-Acting beta agonists (LABA) like salmeterol.

Monitoring the Effectiveness of the Treatment

Regular blood glucose and serum potassium monitoring are necessary to address early adverse effects (Liang & Chao, 2023). There are established methods for determining the amount of medication in the blood, including mass spectrometry-based liquid and gas chromatography.

In summary, the pathophysiology of asthma is complex and involves bronchial hyperresponsiveness, intermittent airflow restriction, and airway inflammation. Shortness of breath, chest tightness, wheezing, and coughing are some of the symptoms of the condition.

References

Liang, T. Z., & Chao, J. H. (2023, May 8). Inhaled Corticosteroids. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470556/

Case 4

Three years ago, Daute, a 56-year-old guy, started having more and more breathing difficulties. His previous doctor prescribed salmeterol/fluticasone, but he is not sure if that was because of his shortness of breath. He has had eight years of chronic bronchitis, with one flare-up in the previous twelve months. He had smoked forty packs of cigarettes. He has not been taking his prescribed medication and has not replenished it.

Treatment Plan

Daute's history of smoking and recurrent bronchitis suggests that he has chronic obstructive pulmonary disease (COPD). The recommended course of treatment for Daut should include bronchodilator medication and counseling to help patients quit smoking (Agarwal et al., 2023). I will write Daute a prescription for beta2-agonists or bronchodilators. When beta2-agonists are used, the smooth muscle in the airways is relaxed.

Monitoring the Effectiveness of the Treatment

I would regularly evaluate Daute’s symptoms and functional status, monitor lung function through periodic spirometry tests, and track the frequency and severity of exacerbations. The activation of the sympathetic nervous system is the cause of bronchodilator side effects (Almadhoun & Sharma, 2023). Trembling, anxiety, abrupt, visible heartbeats, and muscle cramps are among the most regular and typical side effects.

In conclusion, growing tissue damage and restricted airflow are hallmarks of the common and treatable illness called COPD. The disease is related to mechanical changes in the lungs due to continued inflammation resulting from long-term exposure to dangerous particles or gases, most commonly cigarette smoke.

References

Almadhoun, K., & Sharma, S. (2023, April 28). Bronchodilators. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519028/

Agarwal, A. K., Raja, A., & Brown, B. D. (2023, August 7). Chronic obstructive pulmonary disease (COPD). National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559281/