CLINICAL CASE APPLICATION Hypertension AntiHypertensive Agents Hyperlipidemia AntiLipemic

CLINICAL CASE APPLICATION Hypertension Anti-Hypertensive Agents Hyperlipidemia Anti-Lipemic Agents

QUIZ TIME

CONFUSED? LET’S TRY SOME QUESTIONS

A patient has just been diagnosed with stage 1 hypertension and has hydrochlorothiazide (HCTZ) ordered. This agent has which MOA? 1. Blocks stimulation of beta-1 adrenergic receptors 2. Decreases sympathetic outflow to heart, kidneys & blood vessels 3. Increases force of myocardial contraction 4. Inhibits Na reabsorption in distal tubules and produces arteriolar dilation

A patient has Capoten (captopril) an ace inhibitor ordered to treat hypertension. this agent ultimately reduces levels of 1. Catecholamines 2. Potassium 3. Calcium 4. Angiotension II

A patient has metoprolol/Lopressor, a betaadrenergic blocking agent ordered for treatment of stage 1 hypertension. Patient teaching the client about this agent should include: 1. This drug may cause sexual dysfunction 2. Monitor for signs of dehydration 3. Check pulse before taking drug 4. This drug may cause hyperactivity and difficulty sleeping

The nurse is counseling a patient with poorly controlled stage 2. the patient admits to taking his Nebivolol (bystolic) b/p only every other day because “i just can’t afford it. ” The nurse intervenes by asking the HCP to order a less expensive drug from the same class. Which beta blocker antihypertensives on the Walmart $4. 00 list that the HCP could consider prescribing for this patient?

Clinical Application: Case MEET MR. TY ABSHIRE

HISTORY OF PRESENT ILLNESS • 55 year old male of Asian descent present with acute onset of frontal headache about 2 hours ago. Rates as 8/1 -10. States has a h/o migraine headaches but this “one just feels different. ” Denies visual changes, light sensitivity , n/v. Does have some weakness in his left arm. Ambulating without difficulty. No speech deficits.

TY ABSHIRE PAST MEDICAL HISTORY: 1. HTN 2. ASTHMA 3. Peripheral Vascular Disease 4. h/o TIAs 5. Dyslipidemia 6. h/o coronary atherosclerosis 7. h/o carotid artery stenosis

TY ABSHIRE ALLERGIES: PCN - hives CURENT RX MEDICATIONS: S Albuterol MDI prn S ASA 81 mg daily S Lisinopril/Hctz 20/12. 5 mg daily S Neurontin 200 mg bid S Atorvastatin 20 mg daily S Metoprolol 50 mg daily

SOCIAL HISTORY Married with 2 children. Restaurant owner. Social drinker. Smokes 2 ppd since age 9.

PHYSICAL EXAM SVS: T 98. 6, P 110, BP 164/114, RR 22, Pulse ox: 98%, Pain: 10/10 General: Height 67 in. , Weight 165 lbs, Asian male appears in acute distress holding head with eyes closed and moaning HEENT: Normocephalic, atraumatic, PERRLA @ 7. 5 mm with sluggish response. NECK: Supple, No JVD LUNGS: Clear and equal breath sounds. No respiratory distress or retractions noted.

PE: (CONT) CV: S 1 S 2 regular rate and regular rhythm without murmurs, gallops, or rubs. ABDOMEN: Soft, nondistended. No guarding or rebound. EXTREMITIES: Left hand grip and foot push< right Pedal pulses diminished. Right 3/5 and left 4/5 Feet cool and without significant edema. NEUROLOGICAL: Alert and oriented x 4. Positive Romberg. Facial asymmetry with no aphasia. Left ulnar drift.

ASSESSMENT/PLAN Probable Acute thrombotic stroke Stat neurology consult Norco 325/5 mg 1 tablet Q 4 H prn MRI of the head (r/o thrombotic stroke) Admit to 5 Main with VS and neuro status monitoring q 4 hrs. NPO until dysphagia evaluation. Consult PT/OT Hypertension, poorly controlled: Start Lisinopril-Hctz 10/12. 5 mg daily

CASE STUDY QUESTIONS • 1. What risk factors does Mr. Abshire have for stroke? • 2. List the symptoms would are suggestive of stroke. Underline the sx Mr. Abshire is having that are indicative of probable stroke. • 3. Why was the MRI ordered? What would you expect the findings to be if Mr. Abshire was having a TIA and NOT a stroke? • 4 When you go in to assess Mr. Abshire after his admission you notice that he seems a little confused. Concerned he may be having another stroke, you act FAST. Describe how you would further assess Mr. Abshire to determine if he might indeed be having a stroke. • 6. What is the drug classification of Norco? Describe the MOA and major side effects of Norco. • 7. Based on Mr. Abshire’s initial B/P reading, is he having a hypertensive crisis? Explain. • 7. Why would Mr. Abshire be receiving the following meds? Be specific. • Neurontin • Atourvastatin • Metoprolol • Lisinopril/Hctz • ASA • Albuterol MDI