-
-
- QUESTION
Week 3 Discussion Question 2
MT is a fifty-six-year-old obese (BMI 31.5) Caucasian female with a significant family history of cardiovascular disease. She has uncontrolled hypertension and is currently taking metoprolol 50 mg twice daily. She has dyslipidemia and is taking exetimibe 10 mg daily and garlic. Her current cholesterol is 240 mg/dL, HDL is 41 mg/dL, LDL is 163 mg/dL, and triglycerides are 183 mg/dL. Her blood pressure today is 174/94, and her pulse is 90.
Answer Instructions:
*Review the medications she is taking for hypertension and dyslipidemia.
*Evaluate the efficacy of these medications. *Review them in terms of her age, gender, and ethnicity.
*Suggest any changes you would recommend, with clear justification for those choices.
*For medications, include dosages and schedules.
*Include highlights of patient teaching and/or lifestyle alterations.
*Support your decisions with at least one reference to a published clinical guideline and one peer-reviewed publication.
-
109
| Subject | Nursing | Pages | 3 | Style | APA |
|---|
Answer
Advanced Pharmacology
MT has uncontrolled hypertension and dyslipidemia that are currently managed by medications. She takes 50 mg metoprolol twice daily for hypertension and 10 mg ezetimibe daily and garlic to manage dyslipidemia. Metoprolol is an effective antihypertensive agent that is usually administered orally, and the initial dosage can be 25-100 mg once daily till adjusted by an authorized healthcare professional. Ezetimibe lowers blood cholesterol level by reducing the intestinal absorption of cholesterol. 10 mg per day of ezetimibe is usually effective in reducing blood cholesterol level in an adult.
However, these medications need some adjustments due to MT’s current health status, race, age, and gender. Drug monitoring is important to check the safety of the patient and to ensure efficiency of the administered drugs. The efficacy of the daily 50 mg metoprolol is very low in reducing high blood pressure. Therefore, appropriate recommendations would be essential for MT to change her lifestyle to complement the role of the medication. The first consideration would be MT’s older age that might predispose her to the effects of polypharmacy and reduced drug metabolism. Administration of drugs to older patients should consider their slow rate of metabolism, and therefore, their dosage should be lower than the dosage for other adults (NHS Cumbria Medicines Management Team, 2013). It is also evident that the rate of metabolism of drugs among the Caucasians is low due to their genetic variation. MT is a Caucasian descent. Therefore, the metoprolol dosage should be reduced to 25 mg twice daily. However, this reduction should be accompanied by educating MT to change her lifestyle such as engagement in more daily physical activities such as running and consumption of low-fat diets because her blood pressure is still as high as 174/94 mmHg. The ezetimibe medication seems to improve her dyslipidemia condition, and her current cholesterol level is 240 mg/dL. On the hand, the normal average cholesterol level is 200 mg/dL, and this indicates that MT is improving towards the normal cholesterol level. However, the effects of garlic and the ezetimibe are additive in reducing blood cholesterol level. Also, Shi & Klotz (2012) opine that garlic competes with the other medications for metabolism by the CYP450 enzymes. MT is at a marked risk of slow metabolism of the drugs owing to her old age, Caucasian background, and the combination of the ezetimibe with the garlic. Therefore, garlic acid should be withdrawn from her dose regimen to enhance the metabolism of the medications as well as compliance with the medication regime that is low in older patients due to polypharmacy.
Obesity is a risk factor for the development of high blood pressure and lipid metabolism disorders. Consequently, MT should also be educated to adopt positive health-seeking behavior and healthier lifestyle owing to her obesity, the family risk of cardiovascular disease, and dyslipidemia. The importance of daily and regular physical exercises must be emphasized to MT. She should at least run around a football pitch for 35-45 minutes every day both in the morning and evening. The exercise will assist in burning the excess calories in her body. Adoption of well-balanced and low-fat diet should be stressed as well. MT should be encouraged to avoid fast foods such as fried potatoes. She should be encouraged to eat more fruits and vegetables and drink more fluids.
ns
References
|
NHS Cumbria Medicines Management Team (2013). Clinical Medication Review: A Practice Guide. Retrieved January 25, 2016, from http://www.cumbria.nhs.uk/ProfessionalZone/MedicinesManagement/Guidelines/MedicationReview-PracticeGuide2011.pdf Shi, S., & Klotz, U. (2012). Drug interactions with herbal medicines. Clinical pharmacokinetics, 51(2), 77-104.
|