Posted: June 16th, 2024

Treatment Plans for Hypertension, Hyperlipidemia, Asthma and COPD

Title: Treatment Plans for Hypertension, Hyperlipidemia, Asthma and COPD

This paper presents treatment plans for four different patients presenting with hypertension, hyperlipidemia, asthma and chronic obstructive pulmonary disease (COPD). The treatment recommendations are based on current clinical practice guidelines and consider each patient’s unique characteristics and comorbidities. Appropriate prescriptions are provided along with plans for patient education and monitoring treatment effectiveness.

Case 1: Hypertension
Sara, a 45-year-old female, presents with stage 2 hypertension based on blood pressure readings of 160/90 mmHg and 156/92 mmHg. Her body mass index of 37.4 kg/m2 indicates class 2 obesity. The goal blood pressure for Sara is <130/80 mmHg (Whelton et al., 2018). The recommended initial treatment is lifestyle modifications including weight loss, exercise, and the DASH diet. Pharmacologic therapy with an angiotensin converting enzyme (ACE) inhibitor such as lisinopril 10 mg once daily is indicated given her consistently elevated blood pressure (Unger et al., 2020). Lisinopril should be started at a low dose and titrated up as needed. Sara's use of ibuprofen may be contributing to her hypertension and should be re-evaluated. Patient education includes counseling on lifestyle changes, medication adherence, and regular blood pressure monitoring. Follow-up in 4 weeks is advised to assess her response to treatment. Rx: Lisinopril 10 mg PO daily #30, 1 refill Case 2: Hyperlipidemia Monty, a 52-year-old male smoker, has mixed hyperlipidemia with elevated total cholesterol (266 mg/dL), LDL-C (180 mg/dL), and triglycerides (185 mg/dL). His HDL-C is low at 40 mg/dL. Monty has multiple risk factors for atherosclerotic cardiovascular disease including hyperlipidemia, hypertension, age >45, and smoking.

Based on current guidelines, the LDL-C goal for Monty is <70 mg/dL (Grundy et al., 2019). Statin therapy with atorvastatin 40-80 mg daily in addition to lifestyle modifications is recommended as first-line treatment. Monty should be counseled on smoking cessation, which is crucial for reducing his cardiovascular risk. A lipid panel should be repeated in 4-12 weeks to assess the efficacy of treatment. Liver function tests should be monitored periodically. If Monty's LDL-C remains above goal, the statin dose may need to be increased or additional non-statin medications considered. Rx: Atorvastatin 40 mg PO daily #30, 3 refills Case 3: Asthma Beatrice, a 17-year-old female with mild persistent asthma, reports worsening symptoms over the past 2 months. Her current medication regimen includes fluticasone 88 mcg twice daily and albuterol as needed. She is also prescribed Yaz for contraception and propranolol for an unspecified indication. Based on her symptoms, Beatrice's asthma is not well-controlled on low-dose inhaled corticosteroids (ICS). Per the stepwise approach recommended in asthma guidelines, treatment should be escalated to Step 3 with the addition of a long-acting beta2-agonist (LABA) to her ICS (Global Initiative for Asthma, 2021). Switching Beatrice to a medium-dose ICS/LABA combination inhaler such as Advair HFA 115/21 two puffs twice daily is advised. The propranolol should be discontinued as beta-blockers can worsen asthma control. Beatrice should continue her albuterol inhaler as a quick-relief medication. Patient education includes proper inhaler technique, adherence to controller therapy, and avoidance of asthma triggers. A follow-up visit in 2-4 weeks is recommended to evaluate her response. If good control is achieved, the medication doses can be maintained. Spirometry and assessment of exacerbation history can further guide treatment. Rx: Advair HFA 115/21, 2 puffs BID #1 inhaler, 1 refill Albuterol HFA 90 mcg, 2 puffs q4-6hr PRN #1 inhaler, 1 refill Case 4: COPD Daute, a 56-year-old male smoker, presents with progressively worsening dyspnea for the past 3 years. He was previously prescribed Advair but has not been using it. His history is significant for chronic bronchitis with one recent exacerbation. Based on Daute's symptoms and smoking history, he likely has COPD. Spirometry should be performed to confirm the diagnosis and assess severity. Current guidelines recommend using the GOLD ABCD assessment tool to guide pharmacologic treatment (Global Initiative for Chronic Obstructive Lung Disease, 2022). Assuming Daute has moderate-severe COPD, treatment with a LABA/long-acting muscarinic antagonist (LAMA) combination inhaler is indicated. Anoro Ellipta (umeclidinium/vilanterol) one inhalation daily is an appropriate choice. Smoking cessation counseling and support are critical as this is the most effective intervention to slow COPD progression. Daute should be educated on proper inhaler use, exacerbation signs, and the importance of adherence to maintenance therapy. Influenza and pneumococcal vaccinations are also recommended. A follow-up visit in 4 weeks is advised to assess symptom control and inhaler technique. Pulmonary rehabilitation and supplemental oxygen may be considered in the future based on his functional status and disease severity. Rx: Anoro Ellipta 62.5/25 mcg, 1 inhalation daily #30, 3 refills Conclusion This paper presented evidence-based treatment plans for four patients with common chronic diseases. The recommendations considered each patient's unique presentation and followed current clinical practice guidelines. Appropriate prescriptions were provided along with patient education and monitoring plans. With proper treatment and follow-up, optimal disease control and improved quality of life can be achieved for these patients. References: Global Initiative for Asthma. (2021). Global Strategy for Asthma Management and Prevention. https://ginasthma.org/wp-content/uploads/2021/05/GINA-Main-Report-2021-V2-WMS.pdf Global Initiative for Chronic Obstructive Lung Disease. (2022). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. https://goldcopd.org/2022-gold-reports-2/ Grundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., Birtcher, K. K., Blumenthal, R. S., Braun, L. T., de Ferranti, S., Faiella-Tommasino, J., Forman, D. E., Goldberg, R., Heidenreich, P. A., Hlatky, M. A., Jones, D. W., Lloyd-Jones, D., Lopez-Pajares, N., Ndumele, C. E., Orringer, C. E., Peralta, C. A., . . . Yeboah, J. (2019). 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 139(25), e1082–e1143. https://doi.org/10.1161/CIR.0000000000000625 Unger, T., Borghi, C., Charchar, F., Khan, N. A., Poulter, N. R., Prabhakaran, D., Ramirez, A., Schlaich, M., Stergiou, G. S., Tomaszewski, M., Wainford, R. D., Williams, B., & Schutte, A. E. (2020). 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension, 75(6), 1334–1357. https://doi.org/10.1161/HYPERTENSIONAHA.120.15026 Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Jr, Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner, P., Ovbiagele, B., Smith, S. C., Jr, Spencer, C. C., Stafford, R. S., Taler, S. J., Thomas, R. J., Williams, K. A., Sr, Williamson, J. D., . . . Wright, J. T., Jr (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension, 71(6), 1269–1324. https://doi.org/10.1161/HYP.0000000000000066 =================== ASSIGNMENT: CASE STUDIES Case studies are a useful way for you to apply your knowledge of pharmacokinetics and pharmacodynamic aspects of pharmacology to specific patient cases and health histories. For this Assignment, you evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis. RESOURCES Be sure to review the Learning Resources before completing this activity. Click the weekly resources link to access the resources. WEEKLY RESOURCES To Prepare: • Review the case study posted in “Announcements” by your Instructor for this Assignment • Review the information provided and answer questions posed in the case study • When recommending a medication, write out a complete prescription for the medication • Whenever possible, use clinical practice guidelines in developing your answers when possible • Include at least three references to support your answer and cite them in APA format. BY DAY 7 OF WEEK 4 Submit the Assignment. SUBMISSION INFORMATION Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area. 1. To submit your completed assignment, save your Assignment as WK4Assgn_LastName_Firstinitial 2. Then, click on Start Assignment near the top of the page. 3. Next, click on Upload File and select Submit Assignment for review. Rubric NURS_6521_Week4_Assignment_Rubric NURS_6521_Week4_Assignment_Rubric Criteria Ratings Pts This criterion is linked to a Learning OutcomeScenario 1: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection. 15 to >11.0 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate. 11 to >7.0 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues. 7 to >3.0 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient. 3 to >0 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.
15 pts
This criterion is linked to a Learning OutcomeScenario 1: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. 3 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. 0 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.
3 pts
This criterion is linked to a Learning OutcomeScenario 1: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. 4 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used. 3 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors. 2 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors. 0 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.
4 pts
This criterion is linked to a Learning OutcomeScenario 1: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 3 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors. 2 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors. 1 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors. 0 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
3 pts
This criterion is linked to a Learning OutcomeScenario 2: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection. 15 to >11.0 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate. 11 to >7.0 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues. 7 to >3.0 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient. 3 to >0 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.
15 pts
This criterion is linked to a Learning OutcomeScenario 2: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. 3 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. 0 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.
3 pts
This criterion is linked to a Learning OutcomeScenario 2: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. 4 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used. 3 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors. 2 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors. 0 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.
4 pts
This criterion is linked to a Learning OutcomeScenario 2: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 3 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors. 2 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors. 1 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors. 0 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
3 pts
This criterion is linked to a Learning OutcomeScenario 3: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection. 15 to >11.0 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate. 11 to >7.0 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues. 7 to >3.0 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient. 3 to >0 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.
15 pts
This criterion is linked to a Learning OutcomeScenario 3: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. 3 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. 0 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.
3 pts
This criterion is linked to a Learning OutcomeScenario 3: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. 4 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used. 3 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors. 2 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors. 0 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.
4 pts
This criterion is linked to a Learning OutcomeScenario 3: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 3 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors. 2 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors. 1 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors. 0 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
3 pts
This criterion is linked to a Learning OutcomeScenario 4: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection. 15 to >11.0 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate. 11 to >7.0 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues. 7 to >3.0 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient. 3 to >0 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.
15 pts
This criterion is linked to a Learning OutcomeScenario 4: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. 3 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. 0 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.
3 pts
This criterion is linked to a Learning OutcomeScenario 4: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. 4 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used. 3 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors. 2 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors. 0 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.
4 pts
This criterion is linked to a Learning OutcomeScenario 4: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 3 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors. 2 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors. 1 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors. 0 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
3 pts
Total Points: 100
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Week 4 Cases
Thomas Panavelil
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Week 4 Cases
1. 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?
2. 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.
3. 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?
4. Daute is a 56-year-old man seeking evaluation for increasing shortness of breath. He noticed difficulty catching his breath about 3 years ago. Physical activity increases his symptoms. He avoids activity as much as possible to prevent any SOB. His previous physician had placed him on salmeterol/fluticasone (Advair Diskus) one inhalation twice daily 2 years ago. He thinks his physician initiated the medication for the shortness of breath, but he is not entirely sure. He did not refill the prescription and has not been taking it. Pertinent history – Chronic bronchitis X 8 years with one exacerbation in the last 12 months of treatment with oral antibiotics. He has a 40-pack-year smoking history. What treatment plan would you implement for this patient? What medication(s) would you prescribe? How would you monitor the effectiveness of this plan?

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Study Notes & Homework Samples: Jax is a 66-year-old Caucasian female whose wife has encouraged her to seek treatment »The presentation was on Addison’s Disease (Primary Adrenal Insufficiency)