treatment of chronic hypertension and the medication
Order ID | 53563633773 |
Type | Essay |
Writer Level | Masters |
Style | APA |
Sources/References | 4 |
Perfect Number of Pages to Order | 5-10 Pages |
I require assistance in responding to three posts.
DO NOT REPEAT THE SAME INFORMATION, OR SAY I AGREE OR SOMETHING SIMILAR. NEW INFORMATION SHOULD BE ADDED TO THE DISCUSSION.
Each response must be at least 200 words long.
The APA style must be followed for one scholarly reference (NO MAYO CLINIC/ AHA).
At the end of each response, there should be a reference.
The reference should be from the last five years.
Q-1
The therapy of persistent hypertension was the disease process I chose for this post, and the drug I chose was Amlodipine (Norvasc).
According to the World Health Organization, hypertension is on the rise around the world, and it is now one of the most common disease processes (Lee et al., 2019). Patients aged 65 and up had the highest rate of occurrence, with a prevalence rate of 67 percent (Lee et al., 2019). When compared to other generations of calcium channel blockers, amlodipine (Norvasc) has a longer half life and a slower onset (Lee et al., 2019).
Norvasc works by preventing constriction of the cardiac muscle and vascular smooth muscle by inhibiting the passage of calcium ions into vascular smooth muscle cells and cardiac muscle cells (Lee et al., 2019). This prevents the arteries from contracting, allowing for smooth blood flow and lowering blood pressure through lowering peripheral vascular resistance (Lee et al., 2019). Administration by mouth
The vasodilation of the blood arteries is one of Norvasc’s most common side effects (Hong et al., 2019). Peripheral edema, dizziness, palpitations, weariness, nausea, abdominal pain, somnolence, and flushing are some of the symptoms (Hong et al., 2019). Blood problems, impotence, depression, peripheral neuropathy, insomnia, tachycardia, gingival enlargement, hepatitis, and jaundice are all rare side effects (Hong et al., 2019).
There are a number of medicines that interact with Norvasc (Hong et al., 2019). Any medicine that increases the bioavailability of Norvasc in the body by influencing the level or efficiency of CYP3A inhibitors (Hong et al., 2019). When a patient is on cardizem, clarithromycin, and antifungal medications, there are certain potential interactions that can arise (Hong et al., 2019). Norvasc’s bioavailability in the body is also increased as a result of certain medication interactions (Hong et al., 2019).
There was a time when a patient with a hypertensive emergency presented to the ER, and this patient was on beta-blockers and an ARB. We started this guy on cardine for a B/P of 195/103 when he arrived in the ICU. When we got his blood pressure out of the stroke area, the doctor put him on Norvasc 5mg p.o. daily. We gave him his first dose and noted that his blood pressure had dropped to a normal level. With the new combination of anti-hypertensives and the fact that we were targeting three of the four strategies to control hypertension, we were able to wean the patient off of cardine and keep him off.
References:
Hong, S. J., Jeong, H. S., Cho, J.-M., Chang, K., Pyun, W. B., Ahn, Y., … Kim, H.-S. (2019). Efficacy and Safety of Triple Therapy With Telmisartan, Amlodipine, and Rosuvastatin in Patients With Dyslipidemia and Hypertension: The Jeil Telmisartan, Amlodipine, and Rosuvastatin Randomized Clinical Trial. Clinical Therapeutics, 41(2), 233–248. https://doi-org.lopes.idm.oclc.org/10.1016/j.clinthera.2018.12.008
Lee, D. W., Jung, M., Wang, H. W., Khan, Z., &Pinton, P. (2019). Systematic Review with Network Meta-Analysis: Comparative Efficacy and Safety of Combination Therapy with Angiotensin II Receptor Blockers and Amlodipine in Asian Hypertensive Patients. International Journal of Hypertension, 1–8. https://doi-org.lopes.idm.oclc.org/10.1155/2019/9516279
Q-2
Hypertension is a condition in which the systolic blood pressure is greater than 140 mmHg or the diastolic blood pressure is greater than 90 mmHg for a period of time. It can be caused by an increase in cardiac output, total peripheral resistance, or a combination of the two. The renin-angiotensin-aldosterone system is one manner in which the body manages blood pressure. Renin production in the kidneys is activated by lower blood pressure in the renal circulation. Renin degrades angiotensinogen, resulting in inactive angiotensin I. Angiotensin I is converted to angiotensin II, a powerful vasoconstrictor, in the presence of an angiotensin-converting enzyme (ACE) from the pulmonary and renal endothelium. High blood pressure, heart failure, diabetic nephropathy, and type 2 diabetes mellitus are all conditions that ACE inhibitors (ACEI) are used to treat. Captopril (Capoten) is an ACE inhibitor that has a high affinity for ACE and competes with the natural substrate, angiotensin I, to prevent it from being converted to angiotensin II.
Kininase II, like ACE, is an enzyme that breaks down bradykinin, a powerful vasodilator, into inert peptides. It is currently unknown if elevated bradykinin levels have a role in the therapeutic effects of ACE inhibitors. Bradykinin-induced vasodilation is expected to play a little role in ACE inhibitors’ blood pressure-lowering impact. ACE inhibitors’ “local” activity, rather than their systemic activity, may be more responsible for poor clinical effects. Local angiotensin II-induced sympathetic activity and/or local angiotensin II-induced vasoconstrictive activity may be reduced by ACE-inhibiting medicines acting locally (i.e., within a specific tissue) to reduce vascular tone. Reduced plasma angiotensin II levels lower aldosterone release, which leads to less salt and water retention. Captopril should not be given to patients with renal artery stenosis, pregnant women, or people who have high potassium levels (Prescriber’s Digital Reference [PDR], 2020). According to Robinson (2016, p. 295-305), patients with poor renal function, particularly older persons, and liver illness, should take caution. Serum potassium levels should be checked before starting an ACEI and again a week later to observe trends. Angioedema caused to an elevated level of bradykinin when ACE is suppressed is a severe ADR for patients on ACEI; thus, the medicine should be stopped immediately. Hypotension, dizziness, tiredness, and orthostatic hypotension are examples of mild and transitory ADR. A hacking cough is common in the first week of treatment, however switching to a later generation ACEI reduces this symptom. Lithium should not be taken with captopril or any other ACEI because the combination will raise lithium levels and cause toxicity symptoms. Captopril should not be taken with diuretics because it can cause severe hypotension and kidney damage. In patients with diabetes mellitus, aliskiren-containing medications are contraindicated when used in conjunction with an ACE inhibitor. Combining two renin-angiotensin-aldosterone systems (RAAS) inhibitors is generally not recommended, especially in individuals with a creatinine clearance of less than 60 mL/minute. Hyperkalemia, renal impairment, and other side effects are more likely with combination therapy.
I’d want to tell you about a time when I admitted a patient who had had new-onset abnormal cardiac rhythm after taking Captopril. When she arrived at the emergency room, her potassium level was far over the normal range. Unfortunately, her doctor failed to inform her about the importance of modifying her diet while on this medicine. Her diet was primarily composed of fruits and vegetables, since she was attempting to avoid fatty meat in order to better control her blood pressure. Unbeknownst to her, a high-potassium diet should be avoided since it might cause an abnormal spike in serum potassium, which can lead to an irregular heartbeat and potentially fatal rhythm.
References
Brashers, V.L. (2019). Alterations of vascular function. In N.S. Rote (Eds). Pathophysiology: The biologic basis for disease in adults and children (8th ed., pp. 1059- 1142). St. Louis, MO: Elsevier, Inc.
Huether, S.E. (2019). Structure and function of the renal and urologic systems. In V.L. Brashers & N.S. Rote (Eds). Pathophysiology: The biologic basis for disease in adults and children (8th ed., pp. 1228- 1292). St. Louis, MO: Elsevier, Inc.
PDR (2020). Captopril: Drug summary. Retrieved from https://www.pdr.net/drug-summary/Captopril-captopril-2348.4130#15
Robinson, M.V. (2016). Drugs affecting the cardiovascular and renal systems. In T.M. Woo (Eds). Pharmacotherapeutics for advanced nurse prescribers (4th Edition, pp. 295-359). Philadelphia, PA: F.A. Davis Company
Seema B., Sabina, Y., Vipin, S., Tulshi, C., Shailendra, S.C., & Yousuf, A. (2019). Treatment and Management of Hypertension by Targeting ACE Inhibitors: in silico Approach. International Journal Bioautomation, (1), 13. https://doi-org.lopes.idm.oclc.org/10.7546/ijba.2019.23.1.13-28
Q3-
For patients who are undergoing treatment for hypertension there are many factors that affect treatment adherence. The most common influencer is attitudes and beliefs of the individuals who are undergoing treatment (Ashoorkhani et al., 2018). The attitudes and beliefs of individuals changes based on the culture they come from (Ashoorkhani et al., 2018). For example, some cultures do not believe in medicine and would rather be treated homeopathically, but the patient themselves want treatment (Ashoorkhani et al., 2018). This patient would require a thorough explanation of medications, nutrition, lifestyle changes, and much more (Ashoorkhani et al., 2018). As healthcare providers it is our responsibility to ensure that the patients understand what they are taking and why as this would improve patient adherence (Ashoorkhani et al., 2018). This could even become a class that could extend to the rest of the practice that patients can be provided to in order for them to learn more about the medications they are taking (Ashoorkhani et al., 2018).
Another example is an ethnic and cultural difference but of food culture in Iranians (Ashoorkhani et al., 2018). Iranians enjoy a lot of salt in their foods and end up consuming 10 to 15 grams a day and is about two to three times higher than the global standard (Ashoorkhani et al., 2018). Ingesting a large about of salt is a common contributing factor to hypertension (Ashoorkhani et al., 2018). So an further example, an Iranian patient who is being treated for hypertension would have to have instruction on how to keep track of their salt intake and ways to reduce salt intake overall (Ashoorkhani et al., 2018).
In my approach I would have to find a way to reach this patient in a positive way that they would understand the information and want to make that change. Instructing a patient on a major lifestyle change positively and also suggesting a substitute actually increases the success rate of the patient converting to the new regimen (Garzon & Heredia, 2019). I would imagine information and explanation would be the best way to reach someone in order to make a change. So for the lifestyle change we would want to modify we would have to also suggest a adequate substitution. However, regardless of the amount of instruction we could give them in any setting, it is ultimately up to the patient if they want to make changes in their lifestyle. I would imagine that it would be difficult the longer the patient has been doing that routine.
References:
Ashoorkhani, M., Majdzadeh, R., Gholami, J., Eftekhar, J., &Bozorgi, J. (2018). Understanding Non-Adherence to Treatment in Hypertension: A Qualitative Study. International Journal of Community Based Nursing and Midwifery, (4), 314. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=edsdoj&AN=edsdoj.87f989c469464f199cb0ba6d1f7cc8d0&site=eds-live&scope=site
Garzón, N. E., & Heredia, L. P. D. (2019). Validity and Reliability of the Treatment Adherence Questionnaire for Patients with Hypertension. Investigacion&EducacionEnEnfermeria, 37(3), 99–111. https://doi-org.lopes.idm.oclc.org/10.17533/udea.iee.v37n3e09