Description
Week 3, Discussion 2: Cardiac
Q1. Please briefly discuss the first-line treatment recommendations from JNC8, and the AHA/ACC for a patient with no other major comorbidities.
For an individual between the ages 18-59 who does not have any comorbidities should have a target blood pressure of 140/90. First line treatment should include lifestyle changes such as the DASH diet, weight loss, exercise and smoking cessation. Other recommendations would include education on how to monitor at home (2020 International Society of Hypertension Global Hypertension Practice Guidelines, 2020).
Q2. What are the recommended medications to start this specific patient on? Please provide the drug class, generic & trade name, and initial starting dose.
It is recommended that African Americans that does not have any kidney insufficiency be treated with Calcium Channel Blockers and thiazides. I would start with amlodipine 5mg PO and then increase if needed. Max dose is 10mg. Trade name for amlodipine is Norvasc. I would also add a thiazide, sodium hydrochlorothiazide 12.5 mg PO. Trade name for sodium hydrochlorothiazide is Mircozide (Effective Diagnosis, Treatment,and Monitoring of Hypertension in Primary Care, 2023).
Q3. Please discuss the mechanism of action of each of the drugs you listed.
Calcium Channel Blockers such as Amlodipine work by decreasing peripheral vascular resistance and blood pressure by relaxing coronary vascular smooth muscle and increasing coronary vasodilation by blocking Ca ion transmembrane input into cardiac vascular smooth muscles. Hydrochlorothiazide works by stopping sodium reabsorption in the distal tubules, resulting in increased excretion of sodium, potassium, magnesium hydrogen ions and water (Drug cabinet, 2023).
Q4. Please discuss the side effect profile of each medication you listed.
The side effects of the dihydropyridine CCBs are ankle swelling, flushing and palpitations. The non-dihydropyridines can cause constipation and may slow your heart rate. Both classes of CCBs may also cause blood pressure to drop, which can result in dizziness. Thiazides can cause hyperglycemia, hyperuricemia, dizziness, headaches, and restlessness (Drug cabinet, 2023).
Q5. Are there any interactions between any of the medications you prescribed?
Make sure to check the patients current home medications to for other blood pressure medications that can interact with amlodipine by lowering the blood pressure too much. Also ask if they are taking any antibiotics or antifungals, immune suppressive, medication that treat hepatitis C or HIV or high dose simvastatin (Taking amlodipine with other medicines and herbal supplements, 2022).
Hydrochlorothiazide should not be combined with alcohol for it may increase toxicity. It should not be used with barbiturates and opioids for risk of hypostatic hypotension. Ace inhibitors may cause an additive affect (Drug cabinet, 2023).
Q6. What other non-pharmacological interventions would be suggested?
Non pharmacological interventions would include Dash diet, exercise, weight loss, smoking cessation.
References
(2020, May 6). 2020 International society of hypertension global hypertension practice guidelines. American Heart Association Journals:. Retrieved January 16, 2024, from https://www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.120.15026
British Heart Foundation (n.d.).Drug cabinet: calcium channel blockers. Drug Cabinet. Retrieved January 16, 2024, from https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/drug-cabinet/calcium-channel-blockers
(n.d.).Effective diagnosis, treatment, and monitoring of hypertension in primary care. Centers for Disease Control and Prevention. Retrieved January 16, 2024, from https://www.cdc.gov/globalhealth/healthprotection/ncd/training/files/Session3_ParticipantGuide.pdf
(2022, February 18).Taking amlodipine with other medicines and herbal supplements. NHS. Retrieved January 16, 2024, from https://www.nhs.uk/medicines/amlodipine/taking-aml…/
