Clinical guidelines and best practices
ANSWER
To address each case scenario effectively, I will provide detailed responses based on clinical guidelines and best practices. Below are the management plans and prescriptions for each patient:
Case 1: Sara
Assessment:
- Age: 45 years
- BP: 160/90 mmHg
- Height: 64 inches
- Weight: 195 lbs
- Current medication: Ibuprofen 600 mg tid
Goal for Blood Pressure: The goal BP for Sara, based on the 2023 ESH Hypertension Guidelines, should be less than 140/90 mmHg.
Medication Prescribed: Considering Sara’s blood pressure and clinical profile, I would prescribe an antihypertensive medication. A suitable initial choice could be an ACE inhibitor due to its proven effectiveness and favorable outcomes in hypertensive patients.
Prescription:
- Lisinopril 10 mg PO daily
Education:
- Educate Sara on the importance of blood pressure control and adherence to medication.
- Advise on lifestyle modifications such as weight loss, dietary changes (e.g., DASH diet), and regular physical activity.
- Discuss potential side effects of Lisinopril, including cough and hyperkalemia.
- Stress the need for regular follow-up to monitor BP and adjust treatment if necessary.
Case 2: Monty
Assessment:
- Age: 52 years
- Current medication: Lisinopril 20 mg PO daily
- Allergy: Penicillin
- Smoking: 1 pack per day
Lipid Profile:
- Total Cholesterol (TC): 266 mg/dL
- LDL Cholesterol: 180 mg/dL
- HDL Cholesterol: 40 mg/dL
- Triglycerides: 185 mg/dL
Treatment Plan for Lipid Profile:
- The goal LDL-C for Monty, according to the 2023 guidelines, should be less than 100 mg/dL.
- Based on his LDL-C level and other risk factors, Monty would benefit from statin therapy.
Medication Prescribed:
- Atorvastatin 20 mg PO daily
Monitoring:
- Monitor lipid levels (TC, LDL-C, HDL-C) after 6 weeks of therapy to assess response.
- Evaluate liver function tests at baseline and periodically thereafter.
- Encourage smoking cessation and lifestyle modifications.
Risk Factors for CAD:
- Monty has multiple risk factors: age (52 years), male gender, smoking history, elevated LDL-C, and potentially low HDL-C.
Case 3: Beatrice
Assessment:
- Age: 17 years
- Diagnosis: Mild persistent asthma
- Current medications: Flovent HFA 44 mcg two puffs BID, Proventil HFA two puffs Q 4–6 H PRN, Yaz, Propranolol 80 mg PO BID
Treatment Plan:
- Beatrice is experiencing increased asthma symptoms and frequent use of rescue inhaler, indicating poor asthma control.
- Step up therapy to achieve asthma control and minimize exacerbations.
Medication Changes:
- Increase Flovent HFA to 110 mcg two puffs BID (Step 3 therapy according to GINA guidelines).
- Consider discontinuing Propranolol due to potential bronchoconstrictive effects.
Monitoring:
- Assess asthma symptoms and frequency of rescue inhaler use weekly initially, then every 1-3 months once stable.
- Perform spirometry if not recently done to assess lung function.
Case 4: Daute
Assessment:
- Age: 56 years
- History: Chronic bronchitis, 40-pack-year smoking history
- Medications: Previously prescribed Salmeterol/Fluticasone (Advair Diskus) not currently using
Treatment Plan:
- Daute has symptoms suggestive of COPD exacerbation due to chronic bronchitis and smoking history.
- Initiate appropriate treatment to manage symptoms and prevent exacerbations.
Medications Prescribed:
- Salmeterol/Fluticasone (Advair Diskus) 250/50 mcg one inhalation twice daily
- Short-acting bronchodilator (e.g., Albuterol MDI) as needed for rescue
Monitoring:
- Assess symptoms of dyspnea and exercise tolerance regularly.
- Consider pulmonary function testing (spirometry) to evaluate lung function and disease progression.
These management plans are aligned with current clinical guidelines and aim to optimize therapeutic outcomes while considering individual patient needs and preferences. Each prescription is formatted to include necessary details for pharmacy dispensation.
QUESTION
To Prepare:
· Review the case studies (attachment) and answer ALL questions.
· When recommending medications, write out a complete prescription for each medication. What order would you send to a pharmacy? Include drug, dose, route, frequency, special instructions, # dispensed (days supply), refills, etc. Also state if you would continue, discontinue or taper the patient’s current medications.
· Use clinical practice guidelines in developing your answers. Please review all Required Learning Resources. Use the Medscape app or website and JNC 8 to complete assignment.
· Include at least three references to support each scenario and cite them in APA format. Please include in-text citations. You do not need an introduction or conclusion paragraph.
Current guidelines to use for Cases
1.2023 ESH Hypertension Guideline Update
https://www.acc.org/Latest-in-Cardiology/Articles/2024/02/05/11/43/2023-ESH-Hypertension-Guideline-Update#:~:text=The%20ESH%20guidelines%20target%20BP,140%20and%20150%20mm%20Hg.Links to an external site.
2. GOLD COPD
3. Asthma -The 2023 Global Initiative for Asthma (GINA) guidelines for asthma treatment include two tracks for adults and adolescents 12 and older:
The Assignment
· Sara is a 45-year-old female presenting for her annual exam. Her blood pressure today is 160/90 HR 84 RR 16. Her height is 64 inches and her weight is 195. Her last visit to the clinic 3 months ago shows a BP of 156/92. She is currently taking ibuprofen 600 mg tid for back pain. She has no known allergies. What is the goal for her blood pressure? What medication would you prescribe to treat her blood pressure? What education would you prescribe?
· Monty is a 52-year-old male following up on his labs that were drawn last week. He smokes 1 pack per day. He is currently on Lisinopril 20 mg po daily. He is allergic to penicillin. Fasting lipid profile shows total cholesterol 266, LDL cholesterol 180, HDL cholesterol 40, and Triglycerides 185. What treatment plan would you implement for Monty’s lipid profile? What is the goal Total Cholesterol (TC), HDL-C, and LDL-C level for Monty? How would you monitor the effectiveness of your treatment plan? How many risk factors for coronary artery disease does this patient have? Identify them specifically.
· Beatrice is a 17-year-old female diagnosed with mild persistent asthma since age 7. During her visit today, she reports having to use her albuterol MDI 3 to 4 days per week over the past 2 months. Over the past week she has been using albuterol at least once per day. She reports being awakened by a cough three nights during the last month. She is becoming more short of breath with exercise. She also has a fluticasone MDI, which she uses “most days of the week.” Her current medications include: Flovent HFA 44 mcg, two puffs BID, Proventil HFA two puffs Q 4–6 H PRN shortness of breath, Yaz one PO daily, Propranolol 80 mg PO BID. What treatment plan would you implement for this patient? What medication changes would you make? How would you monitor the effectiveness of this plan?
· Daute is a 56-year-old man seeking evaluation for increasing shortness of breath. He noticed difficulty catching his breath about 3 years ago. Physical activity increases his symptoms. He avoids activity as much as possible to prevent any SOB. His previous physician had placed him on salmeterol/fluticasone (Advair Diskus) one inhalation twice daily 2 years ago. He thinks his physician initiated the medication for the shortness of breath, but he is not entirely sure. He did not refill the prescription and has not been taking it. Pertinent history – Chronic bronchitis X 8 years with one exacerbation in last 12 months of treatment with oral antibiotics. He has a 40-pack-year smoking history. What treatment plan would you implement for this patient? What medication(s) would you prescribe? How would you monitor the effectiveness of this plan?
