Patient Profile:
Age: 50
Gender: Male
Height/Weight: 5’9”, 230 lbs
Medical History: Hypertension (diagnosed 3 years ago), Type 2 Diabetes (well-controlled with metformin), elevated cholesterol
Current Medications: Metformin 500 mg BID, Atorvastatin 20 mg daily
Blood Pressure: 160/98 mmHg
Instructions for Students:
Assess the patient’s current medications and identify potential interactions.
Recommend a pharmacologic treatment plan for hypertension. Consider first-line and alternative medications.
Justify your medication choice based on patient history and current guidelines.
Discuss any adjustments needed in the patient’s other medications (e.g., statins, diabetes medications) if new drugs are introduced.
Monitor: List parameters for monitoring the efficacy and safety of the chosen therapy (e.g., BP, kidney function, side effects).
Counsel: Create patient education points focusing on medication adherence, lifestyle changes, and potential side effects.
Full Answer Section
Potential Medication Interactions:
- Atorvastatin + Metformin: No significant pharmacokinetic interactions.
- Hypertension Meds (if added): Must consider interactions with metformin (e.g., ACE inhibitors may increase metformin levels).
2. Pharmacologic Treatment Plan for Hypertension
First-Line Recommendation: ACE Inhibitor (Lisinopril 10 mg daily)
- Rationale:
- First-line per ACC/AHA 2017 Hypertension Guidelines for patients with diabetes and hypertension (BP ≥140/90 mmHg).
- ACE inhibitors (e.g., lisinopril) provide renal protection in diabetics.
- No significant interaction with metformin or atorvastatin.
Alternative Option: ARB (Losartan 50 mg daily)
- If ACE inhibitor causes cough (common side effect), switch to ARB (equal efficacy).
Why Not CCBs or Thiazides?
- CCBs (e.g., amlodipine): May worsen edema (already a concern with obesity).
- Thiazides (e.g., HCTZ): Can worsen hyperglycemia (patient has diabetes).
3. Adjustments to Other Medications
- Atorvastatin: Continue 20 mg daily (no interaction with ACE inhibitors).
- Metformin: No dose adjustment needed unless lisinopril causes hyperkalemia (monitor potassium).
4. Monitoring Parameters
5. Patient Counseling Points
Key Education Topics:
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Medication Adherence:
- "Take lisinopril daily, even if you feel fine. High BP often has no symptoms."
- "Use a pill organizer to avoid missing doses."
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Lifestyle Modifications:
- Diet: Reduce sodium (<2,300 mg/day), increase potassium-rich foods (e.g., bananas, spinach).
- Exercise: 30 min/day walking (improves BP and insulin sensitivity).
- Weight Loss: Aim for 5–10% reduction (improves BP and diabetes control).
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Potential Side Effects:
- ACE Inhibitor Risks:
- Dry cough (report if persistent).
- Rare: Angioedema (seek immediate help for swelling of face/lips).
- Monitor potassium (avoid high-potassium salt substitutes).
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When to Seek Help:
- Dizziness, fainting, or severe swelling.
- Persistent cough or difficulty breathing.