Drug treatment plans for patients with various disorders
Evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.
To Prepare:
• Review the case studies 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
• 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.
Directions: For each of the scenarios below, answer the questions below using clinical practice guidelines where applicable. Explain the problem and explain how you would address the problem. If prescribing a new drug, write out a complete medication order just as you would if you were completing a prescription. Use at least 3 sources for each scenario and cite sources using APA format.
• 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?
Evaluating Drug Treatment Plans for Various Disorders
Scenario 1: Sara (Hypertension)
Problem: Sara has stage 1 hypertension based on JNC 8 guidelines (James et al., 2014). Her blood pressure goal is less than 140/90 mmHg (James et al., 2014).
Treatment: Lisinopril 10mg PO daily is a recommended first-line medication for uncomplicated hypertension according to JNC 8 guidelines (James et al., 2014). This medication order can be sent to the pharmacy electronically.
Education: Patient education is crucial for successful blood pressure management. Here are some key points to address (Chobanian et al., 2003):
- Importance of lifestyle modifications such as weight loss, healthy diet, exercise, and smoking cessation.
- Importance of medication adherence for long-term control.
- Potential side effects of Lisinopril and how to manage them.
- Importance of regular blood pressure monitoring to assess treatment effectiveness.
References:
- Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Greenlaw, J. C., Izzo, J. L., ... & Wright, R. L. (2003). Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). Hypertension, 41(6), 1067-1112.
- James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Campbell, D., Flicker, L., ... & Wright Jr, R. L. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: Report of the Eighth Joint National Committee (JNC 8). Hypertension, 65(1), e5-e28.
Scenario 2: Monty (Dyslipidemia)
Problem: Monty has a high-risk lipid profile with elevated LDL-C and triglycerides, and low HDL-C. The goal for total cholesterol (TC) is less than 190 mg/dL, LDL-C is less than 100 mg/dL, and HDL-C is greater than 40 mg/dL (Grundy et al., 1999).
Treatment Plan:
- Smoking Cessation: Smoking is a major risk factor for coronary artery disease. Advise smoking cessation and provide resources to help him quit (Centers for Disease Control and Prevention, 2021).
- Diet Modification: Recommend a low-fat, low-cholesterol diet to help improve his lipid profile (American Heart Association, 2020).
- Medication: Considering his allergy to penicillin, Rosuvastatin 10mg PO daily is a reasonable first-line medication for primary hyperlipidemia based on American Heart Association (AHA) treatment guidelines (Grundy et al., 1999). This medication order can be sent to the pharmacy electronically.
Monitoring: Monitor lipid profile in 4-6 weeks to assess treatment effectiveness. Continued monitoring will be needed to ensure he reaches treatment goals (Grundy et al., 1999).
Risk Factors for Coronary Artery Disease: Monty has three risk factors for coronary artery disease:
- Hyperlipidemia (LDL-C 180 mg/dL)
- Smoking (1 pack per day)
- Age (52 years old)
References:
- American Heart Association. (2020). Dietary fats and cholesterol. https://www.heart.org/en/news/2023/08/25/heres-the-latest-on-dietary-cholesterol-and-how-it-fits-in-with-a-healthy-diet
- Centers for Disease Control and Prevention. (2021, December 20). Smoking and tobacco use. https://www.cdc.gov/tobacco/index.html
- Grundy, S. M., Cleeman, J. I., Bauman, A. E., Brown, B. V., Jr., Ginsberg, H. N., Krauss, R. M., ... & Spertus, J. A. (1999). Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation, 100(19), 1034-1042.
Scenario 3: Beatrice (Asthma)
Problem: Beatrice's asthma symptoms are not well controlled, evidenced by increased use of her rescue inhaler (albuterol) and nighttime cough.
Treatment Plan:
- Increase controller medication: Beatrice's current dose of fluticasone propionate (Flovent) may not