Clinical Pharmacy and Therapeutics - Case Study Example

Clinical Pharmacy and Therapeutics An individual’s genetics and family history affects a person’s risk factors for cardiovascular disease in the sense that it helps determine one’s risk for acquiring cardiovascular diseases in the future. “First degree relatives of hypertensive persons are at a two-fold greater risk of hypertension than the general population” (Izzo, et.al., 2007, p. 236). When both parents are involved, the risk becomes four-fold. Also, in instances when either parent is diagnosed with hypertension before the age of 60, the risk of hypertension in the offspring is again increased. When both parents develop hypertension before the age of 60, the risk for developing hypertension in the offspring is also increased. The shared family environment also increases the risk for developing hypertension. Family members usually share the same food and environment. Ingesting fatty foods and engaging in little exercise is usually the same for all family members; therefore they develop the same risk factors for developing similar diseases. Genetic researchers have also been led to “speculate that multiple interactions among genes and environments contribute to the prevalence of hypertension in populations” (Izzo, et.al., 2007, p. 237). In the case of Jack, his acquiring hypertension was increased by his family’s history of cardiovascular diseases. A cardiovascular risk calculator is a diagnostic tool that “estimates the risk of contracting CVD within 8 years, using data of the famous Framingham study” (de Vries & Bouma, 2009). This calculator uses details about the person’s gender, age, smoking status, diabetes status, blood pressure and total cholesterol level in order to calculate the person’s risk for hypertension. In the case of Jack, based on the Cardiovascular Risk Calculator, he carries a moderate risk for cardiovascular disease. Based on the chart, he falls in the male, non-diabetic, and 50 years of age area. After checking his HDL level, he falls in the mild category; however, since he has a strong family history for CVD, his risk needs to be increased one color or one level (National Prescribing Service Limited, 2004). This makes him fall in the moderate risk for CVD. The treatment I would recommend for Jack would be selective beta blockers. Beta blockers are considered one of the first lines of treatment against hypertension. Selective beta blockers “primarily block B1 receptors, and therefore, mostly affect the heart and do not affect air passages” (Ogbru, 2009). For this purpose, I would recommend Metoprolol to help decrease his blood pressure. I would also recommend that he be given a thiazide diuretic. Thiazide diuretics function to increase the kidney’s passage of urine. “A thiazide-type diuretic should be considered as initial therapy in most patients with uncomplicated hypertension” (National Guideline Clearing House, 2009). By increasing the passage of urine, the volume of water in the blood will be decreased, thereby decreasing pressure on the arterial walls. Thiazide diuretics also tend to dilate the blood vessels. “A combination of these two effects reduces the blood pressure” (Patient, UK, 2004). I also recommend that Jack increase his physical activities in order to keep his weight down. His BMI is within normal range, but with his decreased metabolism, any activity would largely benefit him. I would also recommend that he watch his diet, to stay away from foods with high cholesterol. He already has slightly elevated level of LDL, and low HDL. HDL is the good cholesterol which should be increased, and LDL is the bad cholesterol which should be decreased. In his initial phase of treatment, I would advise him to have his blood pressure regularly (preferably daily) monitored. This will ensure that the blood pressure does not increase to dangerous and possibly deadly levels. Monitoring of blood pressure helps ensure that his blood pressure is being adequately managed and that his medications are sufficiently keeping his blood pressure down. I would also recommend that his HDL and LDL levels be monitored. His HDL is low and LDL is high, and the Atorvastatin given to him will help increase his HDL and decrease his LDL. Monitoring his cholesterol levels would help ensure that they are within normal parameters. His BMI and alcohol intake should also be regularly monitored in order to ensure that they are within normal and acceptable levels. I would also ask him to monitor his sodium intake because this can potentially increase his blood pressure. The treatments that I would exclude in my treatment options in Jack’s case would be advice on quitting smoking because he is not a smoker. I would also no longer include treatment options for lowering blood sugar levels because he is not a diabetic. Since his kidney functions are not impaired, I would also exclude treatment options for treatment of kidney disease. Jack’s tests indicate that he does not have any organ damage or impairment which may be contributory to the hypertension. Therefore, there is no need to include treatment options for any damaged or impaired organs. “The risk for cardiovascular disease in patients with hypertension is determined not only by the level of blood pressure but also by the presence or absence of target organ damage or other risk factors such as smoking, dyslipidemia and diabetes” (National Guideline Clearing House, 2009). Absent any of these impairments in his system, I may exclude these options involving these systems in his treatment. I would instead advice him to increase his physical activities and to exercise. Regular physical activity is an effective therapy for hypertensive patients. Regular exercise and physical activity “eases the work of the heart, reduces stress, strengthens the heart muscle, helps to reduce or control weight, and reduces cholesterol level” (Canobbio, 2005, p. 454). Moderate-intensity activities are best for hypertensive patients because they do not strain the patients too much. I would also advise the patient about his alcohol intake. Studies have revealed that there is a relationship between hypertension and alcohol intake. “Among hypertensive patients, a reduction of alcohol intake or even total cessation is associated with a drop in blood pressure” (Battegay, et.al., 2005, p. 191). I would recommend that Jack minimize further or even entirely stop his alcohol intake in order to decrease his risk for CVD and to stabilize his blood pressure. I would also advise Jack to reduce his salt intake. Reducing salt intake “is cheaper than antihypertensive medications and probably has markedly fewer side effects, especially in older persons” (Woods, et.al., 2004, p. 871). Studies have revealed that reducing salt intake can help keep Jack’s blood pressure down and decrease his risk for CVD. After five years of working in Hongkong and after Jack’s blood pressure has gone down to stable and normal levels, I would recommend that he stop his intake of Atorvastatin. His lipid levels are within normal range, therefore, there is no reason for him to take medications that would further reduce his cholesterol. I would also advise that he stop his intake of Aspirin. Aspirin is indicated for prevention of strokes and is a major analgesic. Since he does not experience chest pains anymore, then he should stop his intake of this medication. Extended aspirin intake is not advisable because studies reveal that aspirin and other non-steroidal anti-inflammatory medications can potentially cause gastrointestinal bleeding (Bandolier, 2007). My new regimen for Jack would be to maintain his Ramipril (5mg) once a day and his Verapamil (240 mg) once a day. I would point out to him that these would be his maintenance medications and that he should not fail in taking these medications every day. I would also advice him to exercise regularly for at least 15 minutes in order to maintain his blood pressure and to keep down his weight. I would also point out to him that his medications should not be taken with alcohol because “Verapamil has been found to significantly inhibit ethanol elimination resulting in elevated blood ethanol concentrations that may prolong the intoxicating effects of alcohol” (Drugs.com, 2009). I would also point out to Jack that he should not take alcohol with Ramipril because studies have shown that “alcohol may enhance the blood pressure lowering effect of this medicine, which can increase dizziness and may increase the risk of fainting (NetDoctor, 2008). Finally, I would point out to Jack that he needs to be conscious about his diet, to avoid fatty foods and those with high cholesterol content. I would advise him to eat more fruits and vegetables and engage in a healthy lifestyle. Works Cited Aspirin (2007) Bandolier.net, viewed 14 March 2009 from http://www.medicine.ox.ac.uk/bandolier/booth/booths/aspirin.htm Battegay, E., et.al., (2005) Hypertension: Principles and Practice, Boca Raton: taylor & Francis Publishers Canobbio, M. (2005) Mosby’s Handbook of Patient Teaching, St Louis: Mosby Publications. De Vries, M. & Bouma, G. (2009) Cardiovascular Risk Calculator, HP Calculator Archive, viewed 14 March 2009 from http://www.hpcalc.org/details.php?id=6074 Hypertension Diagnosis and Treatment (July 2004) National Guideline Clearing House, viewed 14 March 2009 from http://www.guideline.gov/summary/summary.aspx?doc_id=10225 Izzo, J., et.al., (2007), The Essentials of High Blood Pressure: Basic Science, Population Science and Clinical Management. Philadelphia: J.B. Lippincott Company New Zealand Cardiovascular Risk Calculator (February 2004) National Prescribing Service Limited, viewed 14 March 2009 from http://www.qml.com.au/Files/CardioRiskCalc.pdf Noble, A., et.al., (2005) The Cardiovascular System, Philadelphia: Elsevier Health Science, Ltd. Ogbru, O. (2009) Beta Blockers, Medicine.net, viewed 14 March 2009 from http://www.medicinenet.com/beta_blockers/article.htm Roy, B. (2009) Exercise and Hypertension, American Council on Exercise, viewed 14 March 2009 from http://www.acefitness.org/FITFACTS/fitfacts_display.aspx?itemid=110 Thiazide Diuretics (July 2004) Patient.co.UK. viewed 14 March 2009 from http://www.patient.co.uk/showdoc/27000315 Tritace (Ramipril), (11 June 2008) NetDoctor.co, viewed 14 March 2009 from http://www.netdoctor.co.uk/medicines/100002657.html Verapamil (2009) Drugs.com, viewed 14 March 2009 from http://www.drugs.com/pro/verapamil-extended-release-capsules.html Woods, S., et.al., (2004) Cardiac Nursing, Philadelphia: J.B. Lippincott Company. Read More