Question

JM, a 50 year old male returns to the clinic for a follow up visit. On his last visit BP was 136/90, HR 86, RR 18- weighs 220 lbs- at that time he was advised to limit salt intake and consume low fat diet- New visit - VS are as follows: BP 150/92, HR 88, RR 20 and weight 235 lbs

1). What is the most appropriate medication to be used for JM- which parameters need to be addressed? What is the disease state being presented here? (4 points)

2). Please address all pertinent patient education topics before patient leaves clinic (2 Point)

2 weeks later JM calls the clinic complaining of a dry cough- what do you suspect? Are any interventions required at this time? If so, what are they? (4 Points)

JM is doing well on his new regimen until he starts a new job in sales- his new boss is very demanding and pushes all his team members to excel in sales. JM tries very hard to exceed all numbers in sales, ignoring his own health, engaging in poor eating habits- his weight steadily increases, he has low energy, dyspnea and pedal edema – goes back to clinic, his HCP performs a physical exam and notes him to be in CHF

3). How did JM develop CHF? (3 Points)

4). Please comment on appropriate pharmacologic interventions at this time- provide rationale for your choices (2 Points)

5). Which lab values need to be monitored? (2 Points)

6). Can multiple agents be used to treat one diagnosis, when might this happen? Answer should pertain to this case study. (2 Points)

7). What is a cardiac glycoside? When are these agents used? What are some concerns when using these agents? (4 Points)

8). What causes atrial fibrillation? What are the most common complications of atrial fibrillation? How are they treated? How is atrial fibrillation treated? (6 Points)

JM has a strong family history for cardiac disease, his father passed away at age 60 from an MI and his 2 older brothers have had MI’s and stent placement. Does JM need any additional medication based on his own history and his family history? (2 Points)

Please devise a medication regimen for JM and provide a rationale for each medication recommended- additionally, please note all the non pharmacologic interventions as well.

(4 points)

Answer 1

Ans) 1) JM is suffering from Hypertension,

Drugs such as angiotensin converting enzyme inhibitors(ACEIs), calcium channel blockers (CCBs), angiotensin-receptor blockers (ARBs), beta-blockers, and diuretics are all considered acceptable alternative therapies in patients with hypertension.

2) Eating lots of foods high in saturated fat and trans fat may contribute to heart disease. Eating foods high in fiber and low in saturated fats, trans fat, and cholesterol can help prevent high cholesterol. Limiting salt (sodium) in your diet can also lower your blood pressure.

3) The narrowing and blocking of blood vessels caused by high blood pressure (HBP or hypertension) increases your risk of developing heart failure. While it is still able to pump blood, it becomes less efficient. The larger the heart becomes, the harder it works to meet your body's demands for oxygen and nutrients.

4) Pharmacological Intervention:

Examples include carvedilol (Coreg), metoprolol (Lopressor) and bisoprolol (Zebeta). These medicines reduce the risk of some abnormal heart rhythms and lessen your chance of dying unexpectedly.

- BetaBeta blockers may reduce signs and symptoms of heart failure, improve heart function, and help you live longer

- Diuretics.