Antihypertensive and antilipidemic medications - Essay Example

Antihypertensive and Antilipidemics Angiotensin Receptor Blockers and Fibrates Angiotensin Receptor Blockers and Fibrates Angiotensin Receptor Blockers2. This class of drugs is not limited by race and gender. The ideal candidate is adult heart failure patients both acute and historical. They would have reduced ventricular injection fraction with tolerance to ACE inhibitors. Patients who have diabetic neuropathy with hypertension or hypertension alone.3. a. Contraindications would include those with renal artery stenosis, pregnancy in the second or third trimester, renal insufficiency or significant valvular disease and volume depletion. b. It is contraindicated in pregnancy because it may cause fetal injury.

There is a risk of tachycardia in some patients so should be given only weighing the risks in the patient with valvular disease. These drugs are cleared through the kidneys and patients with previous renal issues may not be able to clear this class of drugs. 4. The three most popular medication are Valartan (Diovan), Losartan (Cozaar), and Candsartan (Atacand). Diovan 80 mg. PO daily. 30 tabs5. Lab needed would be a renal panel, liver panel, and Hgb. as well as a sed rate. Potassium level is taking supplements. 6. Side effects include chest pain and ventricular dysrhythmias, fatigue, and cough, as well as anemia. 7. Follow up will include Re-appointment in one month for repeat labs and then in three months for follow up.

Labs to repeat will be renal panel, liver panel and Hgb. as well as K. If patient is diabetic HA1c. 8. Special education should include diet and exercise. However, adverse reactions are often chronic headache, dizziness, abdominal pain and nausea and URI symptoms. The patient will need to be aware of these. 9. Lifestyle changes are related to diet and exercise. Controlling blood pressure and blood sugar for those that have diabetes is important. Reducing stress and BMI is also very important.10. He will need to keep his appointments as scheduled, follow diet and exercise, change position slowly, and drink adequate amounts of fluid during the day.

He will need to take this drug for a lifetime, unless told by a primary provider to discontinue. Do not use any nonprescription drugs that might increase blood pressure. Do not drink alcohol. 11. Hypertension if left uncontrolled can cause stroke or heart attack. Chronic hypertension often causes renal failure and the need for dialysis. Untreated hypertension works the heart harder and contributes to atherosclerosis 12. Not all antihypertensives work equally well in any given patient. Vasodilating activity occurs with this class of drug.

Postural or orthostatic hypotension may occur in some patients causing falls. 1. Fibrates2. The ideal candidate for this drug is an non-diabetic adult with triglyceride levels approaching 500, a low HDL, and has had a six month trial on diet and exercise. Sex and gender are not considerations in the use of this drug. 3. a. These are contraindicated in patients with hypersensitivity to the drugs and those with significant hepatic or renal dysfunction or primary biliary cirrhosis. They should be used very cautiously in pregnancy.

and in patients with peptic ulcer disease or diabetes. b. Metablolism of these drugs in the liver and excretion is through the urinary tract. Therefore, the patient with hepatic or renal dysfunction may not clear the drug well and rhabodomylosis is more likely to occur. They are a known Class C drug in pregnancy and may decrease the effects of diabetic drugs. 4. Three drugs in this category include, clofibrate (Atromid-S), fenofibrate (Tricor), and gemfibrozil (Lopid). Lopid 600 mg twice daily 30 min before breakfast and 30 min before dinner.

Fill 305. Initial lab work will need to include hepatic and renal panels. Full cholesterol panel and triglycerides done fasting.6. Frequent side effects seen with this class of drugs includes nausea, vomiting, GI upset, impotence, myalgia (muscle cramping and aching) increased angina, fatigue, and rash. Rhabdomylosis is rare but so important that it cannot be forgotten here. 7. Follow up will include initial appointment in 1 month with continued follow up in 6 month intervals. Include in each appointment, renal panel and liver panel as well as lipids and triglyceride.

At follow up the patient should be questioned about symptoms that indicate rhabdomylosis such as severe muscle aches and pains, weakness, malaise and fever.8. Education for the patient will need to include drug interactions which includes diabetic medications. They need to know to be sure to take this medication before a meal and if GI upset becomes a problem, to make an appointment, not to just discontinue the drug. Dietary instruction on triglycerides is needed and an exercise program to improve HDL. 9. This patient will need to adjust their diet and be on a regular exercise program.

Other than those things and keeping regular appointments, these drugs should not easily affect lifestyle. 10. Health for this patient will depend on how well he follows instructions. Taking his medication, reducing weight and triglyceride levels and exercising regularly could lead to a much healthier life for this patient. 11. The patient with hyperlipedemia, if not controlled can look forward to heart disease, peripheral vascular disease, stroke, or dementia. Sudden death because of plaque formation in high triglycerides is not unusual. 12. In the case of Fibrates, even though it is a class of drugs, there are things that are quite different about each drug.

An example is that all three of these drugs may increase bile excretion which might lead to gallstones. However, fenofibrate may also result in abnormal liver function tests, respiratory problems, back pain, and headache. Gemfibrozil may cause dyspepsia, skin rash, vertigo, and headache. All of the Fibrates may contribute to the development of rhabdomylosis. ReferencesAbrams, A., & Pennington, S. (2008). Foundations of Clinical Drug Therapy. Lippincott Williams & WIlkins: Philadelphia.Abrams, A., Pennington, S.

, Lammon, C. (2007). Clinical Drug Therapy. Rationales for Nursing Practice. 9th ed. Lippincott Williams & Wilkins: Philidelphia.