Discussion Question 1: Please Read These Questions

Discussion Question 1for These Questions Please Read The Following Ca

For these questions, please read the following case study and then respond to the questions noted below. Ms. BD is a 33-year-old G2P1 African-American female who presents to your clinic today complaining of unusual fatigue, nausea, and vomiting for the last five days. She has a medical history of chronic hypertension (HTN) that was diagnosed shortly after her first pregnancy two years ago and GERD. Ms. BD's blood pressure is controlled on Lisinopril-Hydrochlorothiazide 20/12.5 mg by mouth twice a day, and GERD is controlled on Bismuth Subsalicylate 262 mg by mouth every 6 hours as needed. During the interview, you learn that she is single, sexually active, has one partner, and that her menses is ten days late. She performed a home pregnancy test three days after missing her menstrual cycle, and the results were inconclusive. She states she feels terrible and needs relief. She has no other medical problems, symptoms, or concerns.

Assessment: Physical examination is unremarkable. BP 128/68, HR is 74, urine human chorionic gonadotropin (HCG) positive, beta HCG sent, potassium 4.2, blood urea nitrogen (BUN) 14, creatinine 0.6, alanine aminotransferase (ALT) 29, white blood cells (WBCs) 6.5, hemoglobin (Hgb) 12.8, hematocrit (Hct) 39, and platelets 330,000. List the additional questions you would need to ask this patient. Explain. What is the safety profile of Lisinopril-hydrochlorothiazide and bismuth subsalicylate in pregnant women?

What are the possible complications to the pregnant woman and her fetus? What is the importance of assessing laboratory values when prescribing medications? How might the laboratory values, in this case, impact your treatment plan? Would you make any changes to Ms. BD’s blood pressure and GERD medications? Explain. If yes, what would you prescribe? Discuss the medications' safety in pregnancy, mechanism of action, route, half-life; how it is metabolized in and eliminated from the body; and contraindications and black box warnings. How does ethnopharmacology apply to this patient if she were not pregnant? Explain.

What health maintenance or preventive education do you provide in this client case based on your choice of medications/treatment? Would you treat this patient or refer her? Explain. If you refer, where would you refer this patient? Use APA style with references.

Paper For Above instruction

The presented case of Ms. BD, a 33-year-old pregnant woman with chronic hypertension and GERD, necessitates careful assessment and management due to her pregnancy status and current symptoms. Key questions to ask include detailed ones about her pregnancy history, current medication use, dietary habits, and any additional symptoms such as visual changes, edema, or pain (American College of Obstetricians and Gynecologists, 2018). Further inquiry into her lifestyle, compliance with medication, prior pregnancy outcomes, and detailed obstetric history would provide a clearer clinical picture.

Regarding medication safety profiles during pregnancy, Lisinopril-Hydrochlorothiazide and Bismuth Subsalicylate pose significant concerns. Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is contraindicated during pregnancy due to its association with fetal renal dysgenesis, oligohydramnios, pulmonary hypoplasia, and neonatal renal failure (Khalil & Hill, 2020). Thiazide diuretics, while generally considered safe in pregnancy, can decrease plasma volume and placental perfusion when used in high doses (Schaefer et al., 2022). Bismuth Subsalicylate, a salicylate compound, carries a risk of fetal bleeding, deafness, and kernicterus if used excessively or in the third trimester (American College of Obstetricians and Gynecologists, 2014).

Potential maternal and fetal complications include preeclampsia, preterm birth, intrauterine growth restriction (IUGR), and congenital anomalies. The safety concerns mandate avoiding teratogenic medications like ACE inhibitors and carefully monitoring laboratory values such as serum electrolytes, renal function, and blood pressure (Williams et al., 2019). Elevated serum creatinine and potassium disturbances could signal worsening renal function or electrolyte imbalance; thus, medication adjustments are essential.

Considering her current medication regimen and pregnancy status, modifications are necessary. For her hypertension, replacing Lisinopril with a pregnancy-safe antihypertensive, such as labetalol or methyldopa, is advisable. Both drugs have well-established safety profiles and are recommended by guidelines for hypertensive management in pregnancy (American College of Obstetricians and Gynecologists, 2018). A typical initial dose of labetalol (e.g., 200 mg orally twice daily) or methyldopa (starting at 250 mg 3-4 times daily) can be considered, with titration based on blood pressure response.

Regarding her GERD, Bismuth Subsalicylate can be continued with caution, but alternatives like calcium carbonate (antacids) are preferred due to fewer risks. Proton pump inhibitors such as omeprazole are generally considered safe in pregnancy but should be used judiciously, especially when symptomatic relief is inadequate (Khan et al., 2021).

The pharmacodynamics and pharmacokinetics of these medications are important to understanding their safety. Labetalol, a beta-adrenergic blocker, is metabolized hepatically and excreted renally, with a half-life of around 6-8 hours (Kharbanda et al., 2017). It acts by reducing adrenergic stimulation, thereby decreasing blood pressure without significantly affecting uterine blood flow. Methyldopa, a centrally acting agent, is similarly liver-metabolized with a half-life of 1-3 hours, and it lowers blood pressure via central adrenergic inhibition.

In terms of ethnopharmacology, if Ms. BD were not pregnant, cultural considerations regarding medication preferences or traditional remedies might influence her acceptance of treatment. For African-American women, cultural health beliefs and access to care can impact treatment adherence (Bates et al., 2019). Understanding these factors can improve patient-centered care and medication compliance.

Preventively, education on the importance of adherence to antihypertensive therapy, avoiding teratogens, regular prenatal visits, and monitoring fetal growth are vital. Counseling on lifestyle modifications, such as diet and stress management, should also be emphasized (American College of Obstetricians and Gynecologists, 2018).

The decision to treat versus refer depends on the complexity of management. In this case, modification of antihypertensive therapy within the primary care setting is appropriate, but ongoing obstetric evaluation is essential. If complications or severe hypertension develop, referral to a maternal-fetal medicine specialist is recommended (Khalil et al., 2020).

References

• American College of Obstetricians and Gynecologists. (2014). Use of medications during pregnancy. ACOG Practice Bulletin No. 115.
• American College of Obstetricians and Gynecologists. (2018). Hypertension in pregnancy. Obstetrics & Gynecology, 131(2), e77-e89. https://doi.org/10.1097/AOG.0000000000002586
• Bates, C., Barnabe, C., & Barr, G. (2019). Cultural considerations in management of hypertension in African-American women. Journal of Women's Health, 28(6), 844–851.
• Khalil, A., & Hill, C. (2020). Management of hypertension in pregnancy. BMJ Evidence-Based Medicine, 25(3), 101-107.
• Kharbanda, A. K., et al. (2017). Pharmacology of antihypertensive agents in pregnancy. Therapeutic Advances in Cardiovascular Disease, 11(7), 185-194.
• Khan, S., et al. (2021). Safety of antacid medications during pregnancy. Obstetrics & Gynecology Clinics, 48(4), 583-595.
• Schaefer, B. N., et al. (2022). Thiazide diuretics: safety profiles in pregnancy. Journal of Clinical Pharmacology, 62(2), 365-370.
• Williams, D., et al. (2019). Laboratory monitoring in hypertensive pregnancy. Hypertension, 74(3), 742-749.