"Hypertension Treatment: ARB and Diuretics" is a great example of a paper on drug therapy. The patient under study is suffering from hypertension— the drugs of choice fall in the class of ARB and diuretics. I have selected this medication in this situation as the patent’ s kidneys need help with eliminating sodium and salt from the body; thus decreases blood volume, which decreases blood pressure. An evidence-based article written by EMH Swiss Medical Publishers Ltd determined that a drug combination of ARB and diuretics were most effective with a rate of 30.1% as compared to other drug combinations (Brenner et al. , 2011).
Data from this evidence-based article prompted my medical selection. Pharmacodynamics action of ARB and diuretics is the blocking of angiotensin II from constricting the blood vessels and triggering salt and water retention in ARBs. Diuretics aid in the expulsion of sodium and water from the body and this makes the heart pump with each beat which lowers blood volume and pressure (Messerli, 2011). Question 2 Instructional points I would include in educating the patient include: Start with lifestyle changes, i.e. increase physical activity, lose and maintain a healthy weight, lower salt intake to less than 2g/ day, limit caffeine, reduce high-LDL cholesterol Do not mix any other medications unless instructed Reduce stress and drink more fluids Always take medication and any change may be done under the medical practitioner supervision Question 3 Potential side effects and/or adverse drug reactions include potassium depletion, fatigue, muscle cramps, frequent urination, lightheadedness, and constipation (Gradman et al. , 2010).
To manage this, potassium supplements are to be taken, massages, taking the drug before 6 PM and plenty of rest. These side effects are expected.
Worst-case scenarios include gout or an elevated blood sugar level to cause diabetes. If these happen, the patient is expected to go for blood sugar level tests constantly to monitor the blood sugar and control the uric acid levels. Question 4 A potential drug interaction is that Hypokalaemia is opposed. This is because there is the dual blockade of the rennin-angiotensin system with angiotensin receptor blockers (O’ Brien et al. , 2007). This action is better as compared to using diuretics only, which result in hypokalaemia and can be made worse by steroid co-therapy.
Thus, the drug combination of ARB and diuretics is favourable for the patient, as potassium will be retained. Question 5 I prescribed a generic name irbesartan + HCTZ (hydrochlorothiazide). The brand name is Avalide. My rationale for prescribing a generic preparation is to ensure the patient buys a drug that is less expensive and also for the patient to find the drug easily, sometimes brand names differ according to the area. Question 6 150mg/12.5mg dosage of generic irbesartan + HCTZ costs $0.80 per unit, while Brand Avalide costs $1.51 per unit. This medication is available at area stores. Question 7 I would want to see this patient after 30 days to measure the progress.
Lab tests must be done in ensuring progress. They include organ damage test, i.e. blood test to check kidney function, EKG to look for thickening heart muscles and reduced blood flow in the heart and irregular heart rhythms, eye examination, and cholesterol check. I would know the medication is efficacious if the patient’ s vitals are progressing fine. Question 8 Should this option fail, an alternative treatment plan include the following drug combinations Potassium-sparing and thiazide diuretics, Alpha-blocker and diuretics, Calcium-channel blocker and ACE inhibitor, and Calcium-channel blocker and ARB.
Moreover, an extensive lifestyle change must be ensured. Question 9 If the patient is pregnant, this drug cannot be used since it has been proven to cause fetal and neonatal morbidity and mortality (Black, & Elliott, 2013).
Black, H. R., & Elliott, W. J. (2013). Hypertension: A companion to Braunwald's heart disease. Philadelphia: Elsevier/Saunders.
Brenner R, Waeber B, Allemann Y. Medical treatment of hypertension in Switzerland: The 2009 Swiss Hypertension Survey (SWISSHYPE). Cochrane Database of Systematic Reviews 2011, Issue March. Art. No.: EMBASE 2011258428. DOI: 10.4414/smw.2011.13169. ID CN-00894915. Volume 141. http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/915/CN-00894915/frame.html
Gradman, A. H., Basile, J. N., Carter, B. L., & Bakris, G. L. (2010). Combination therapy in hypertension. Journal of the American Society of Hypertension, 4(1), 42-50.
Messerli, F. H. (2011). Clinician's manual: Treatment of hypertension. London: Springer Healthcare Ltd.
O’Brien, E., Barton, J., Nussberger, J., Mulcahy, D., Jensen, C., Dicker, P., & Stanton, A.(2007). Aliskiren reduces blood pressure and suppresses plasma renin activity in combination with a thiazide diuretic, an angiotensin-converting enzyme inhibitor, or an angiotensin receptor blocker. Hypertension, 49(2), 276-284.