Primary Care Medication Management for Mrs. Lyons- Evidence-Based Responses and Rationales for Hypertension and Dyslipidemia Question One: The First-Line Treatment Recommendations

Primary Care Medication Management for Mrs. Lyons- Evidence-Based Responses and Rationales for Hypertension and Dyslipidemia

Mrs. Lyons is a 57-year-old African American female who recently developed headaches and had an elevated blood pressure reading at her work health fair. Her blood pressure was taken at the health fair, and the reading was 168/99. She has returned to the drugstore 3 other times to take her blood pressure. The readings have been 145/90, 150/89, and 140/88. At the health fair, she was told that her BMI was elevated. Her cholesterol levels were also measured at the health fair. The results were: total cholesterol level of 250, LDL 138, HDL 48, and Triglycerides 170.

She has not been to see a primary care provider in over 5 years. At her last office visit, which was 5 years ago, her blood pressure was (135/95). Her LDL and triglycerides were also elevated at that time. The patient was supposed to monitor her blood pressure at home and trial diet and lifestyle changes. She was supposed to return for a follow-up with her blood pressure log and for a recheck of her labs. She, unfortunately, did not do this.

Today in the clinic, her vital signs are:
BP 146/92, HR 90, Temp 98.4, RR 12, O2 98%, Height 5’5, Weight 220 lbs, BMI 36.6

She is not currently taking any medications. She has NKDA. Family history: her brother and sister both have been diagnosed with hypertension and DM. Diagnoses for the patient are HTN, Obesity, and Hyperlipidemia.

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Primary Care Medication Management for Mrs. Lyons- Evidence-Based Responses and Rationales for Hypertension and Dyslipidemia Question One: The First-Line Treatment Recommendations

 

The JNC8 recommends that pharmacologic therapy be started when the blood pressure (BP) is 150/90 mmHg or higher in individuals aged 60 years and older and 140/90mmHg or higher in individuals younger than 60 years (Khera et al., 2018). Initial drugs should be thiazide diuretics, ACE inhibitors, calcium channel blockers, or ARBs in non-black patients, and calcium channel blockers or thiazide diuretics in black patients (Khera et al., 2018). For the AHA/ACC guidelines, the target BP is less than 130/80 and the first-line medications are CCBs, thiazide diuretics, ARBs or ACEIs (Reboussin et al., 2018). Our assignment writing help is at affordable prices to students of all academic levels and disciplines.

Question Two: Recommended Medications

The patient is an African American and has stage 2 hypertension. She will have a combination of two first-line agents. The agents are thiazide diuretic and calcium channel blocker (Khera et al., 2018). The medications will start on chlorthalidone and Amlodipine. The brand name for chlorthalidone is thalitone. The starting dose is 15mg once daily (Kerndt & Patel, 2020). Clorthalidone is a thiazide-like diuretic. The brand name for Amlodipine is Norvasc. The starting dose for Amlodipine is 25mg once daily (Bulsara & Cassagnol, 2021). Amlodipine is a calcium channel blocker.

Question Three: The Mechanism of Action of the Listed Drugs

Chlorthalidone blocks the sodium-chloride transporter in the distal convoluted tubule, resulting in the inhibition of sodium reabsorption (Kerndt & Patel, 2020). The enhanced sodium excretion results in the lowering of intravascular volume. Amlodipine is a calcium channel blocker. It blocks type L calcium channels which inhibits the influx of calcium, resulting in reduced contractility and increased vasodilation (Bulsara & Cassagnol, 2021).

Question Four: Side Effect Profile of the Listed Medication

The side effects of Amlodipine include peripheral edema, abdominal pain, skin rash, nausea, drowsiness, headache, and flushing (Bulsara & Cassagnol, 2021). The side effects of Chlorthalidone include hypokalemia, hyponatremia, anorexia, stomach irritation, orthostatic hypotension, weakness, impotence, and muscle spasms.

Question Five: Interactions between the Prescribed Medications

There are no significant interactions between the two medications.

Question Six: Suggestions for Other Non-Pharmacological Interventions

Non-pharmacological interventions will include weight loss, dietary sodium restriction, physical activity, and reduced intake of saturated fats (Khera et al., 2018).

References

Bulsara, K. G., & Cassagnol, M. (2021, April 7). Amlodipine – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK519508/

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