For These Questions Please Read The Following Case Study ✓ Solved

For These Questions Please Read the Following Case Study And Then Res

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 20/12.5mg by mouth twice a day, and GERD controlled on Bismuth Subsalicylate 262mg 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 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, the 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?

Sample Paper For Above instruction

Introduction

The management of pregnant women with comorbid conditions such as hypertension and gastrointestinal disorders requires careful consideration of medication safety, potential complications, and preventive strategies. In this case study, Ms. BD, a 33-year-old pregnant woman, presents with symptoms indicating possible pregnancy progression and underlying health concerns. The following discussion explores additional questions to gather comprehensive clinical information, evaluates the safety profiles of her current medications during pregnancy, assesses potential fetal and maternal complications, and outlines appropriate management and health education strategies.

Additional Questions for the Patient

When assessing Ms. BD, additional inquiries should focus on her obstetric history, medication adherence, lifestyle factors, and symptom specifics. Key questions include:

• Have you experienced similar symptoms in previous pregnancies?
• Are you taking any other medications, supplements, or herbal remedies?
• Do you have any history of preeclampsia or other pregnancy-related complications?
• Are you experiencing any vaginal bleeding or uterine contractions?
• What is your current fluid intake and dietary habits?
• Have you noticed any swelling or vision changes?
• Are you currently experiencing any abdominal pain or cramping?
• Have you had any recent infections or illnesses?

These questions help clarify the clinical picture, assess risks for pregnancy complications, and inform tailored management strategies.

Safety Profile of Current Medications During Pregnancy

Lisinopril-Hydrochlorothiazide, an ACE inhibitor combined with a thiazide diuretic, is generally contraindicated in pregnancy due to significant fetal risks, such as oligohydramnios, renal dysgenesis, pulmonary hypoplasia, and neonatal hypotension (Khalil et al., 2018). Its use during the second and third trimesters is associated with fetal renal impairment and death (Marelli et al., 2017). Conversely, in early pregnancy, potential teratogenic effects are still a concern, making it unsafe for use.

Bismuth Subsalicylate, used for GERD, is classified as category C by the FDA. It contains salicylates, which pose risks of fetal bleeding, premature closure of the ductus arteriosus, and other adverse effects, especially if used in high doses or for prolonged periods (Koren et al., 2012). Therefore, its use during pregnancy should be cautious, and safer alternatives should be considered.

Possible Maternal and Fetal Complications

Potential complications from medication exposure include:

• For the mother: Worsening hypertension, electrolyte disturbances, or adverse reactions to medications.
• For the fetus: Renal dysgenesis, oligohydramnios leading to limb contractures, pulmonary hypoplasia, and neonatal hypotension if exposed to ACE inhibitors during the second and third trimesters (Khalil et al., 2018; Marelli et al., 2017).

In addition, untreated hypertension can lead to preeclampsia, placental abruption, and intrauterine growth restriction (IUGR) (Zhao et al., 2020).

Laboratory Values and Treatment Planning

Assessing laboratory values such as renal function (BUN, creatinine), electrolytes (potassium), liver function (ALT), and hemogram is vital in guiding safe medication use and monitoring for adverse effects. For instance, elevated creatinine or abnormal electrolytes may necessitate medication adjustments or switches. In Ms. BD’s case, her lab values within normal ranges suggest that her current medications have not caused adverse effects yet, but caution remains necessary.

Given her controlled hypertension, any medication adjustment must prioritize fetal safety and maintain maternal blood pressure control. Discontinuing or replacing teratogenic drugs like Lisinopril is essential to prevent fetal harm.

Medication Adjustments and Management

Considering her pregnancy, alternative antihypertensive medications such as methyldopa, labetalol, or nifedipine are safer choices (Zhao et al., 2020). For her GERD, medications such as omeprazole or other proton pump inhibitors, which are classified as category B, would be safer replacements for Bismuth Subsalicylate (Koren et al., 2012).

In consultation with her obstetric provider, I would recommend discontinuing Lisinopril-hydrochlorothiazide and Bismuth Subsalicylate, while introducing methyldopa or labetalol for blood pressure management and a proton pump inhibitor for GERD. These choices have established safety profiles during pregnancy, with minimal teratogenic risk.

Role of Ethnopharmacology

If Ms. BD were not pregnant, ethnopharmacology could inform the choice of herbal and traditional remedies culturally acceptable and relevant. For example, African-American populations may use herbal preparations for hypertension and gastrointestinal ailments (Oladele et al., 2020). Recognizing cultural practices allows healthcare providers to guide safe use, avoid harmful interactions, and incorporate culturally sensitive education.

Health Maintenance and Preventive Education

Health education should emphasize medication adherence, monitoring blood pressure regularly, maintaining a balanced diet, and avoiding harmful substances like NSAIDs or certain herbal remedies. Educating her about the importance of prenatal care, recognizing warning signs (e.g., severe headaches, vision changes, swelling), and understanding medication safety helps optimize pregnancy outcomes.

Vaccination updates, folic acid supplementation, and screening for infections are also essential components.

Treatment or Referral Decision

Given her complex medical history and current presentation, a multidisciplinary approach involving obstetrics, maternal-fetal medicine, and pharmacology specialists is advisable. I would prefer to refer Ms. BD to an obstetrician experienced in high-risk pregnancies for comprehensive management. This ensures safe medication adjustments, close fetal monitoring, and addressing any potential complications.

Conclusion

The management of pregnant patients with chronic health conditions necessitates careful consideration of medication safety, potential fetal risks, and comprehensive patient education. Adjusting her medications to safer alternatives minimizes teratogenic and toxic risks while maintaining effective control of her hypertension and GERD. Regular laboratory monitoring, patient counseling, and interdisciplinary collaboration are essential to optimize outcomes for both mother and fetus.

References

• Khalil, A., et al. (2018). Hypertension in pregnancy. The Lancet, 392(10155), 430-441.
• Marelli, S., et al. (2017). Management of hypertension during pregnancy. Hypertension, 70(2), 173-179.
• Koren, G., et al. (2012). Medication use during pregnancy. The New England Journal of Medicine, 366(20), 1829-1837.
• Zhao, Y., et al. (2020). Hypertensive disorders of pregnancy and adverse outcomes. BMC Pregnancy and Childbirth, 20, 278.
• Oladele, O., et al. (2020). Ethnopharmacology in African populations: a review. Journal of Ethnopharmacology, 259, 112968.
• Khalil, A., et al. (2018). Hypertension in pregnancy. The Lancet, 392(10155), 430–441.
• Marelli, S., et al. (2017). Management of hypertension during pregnancy. Hypertension, 70(2), 173–179.
• Koren, G., et al. (2012). Medication use during pregnancy. NEJM, 366(20), 1829–1837.
• Zhao, Y., et al. (2020). Hypertensive disorders of pregnancy. BMC Pregnancy Childbirth, 20, 278.
• Oladele, O., et al. (2020). Ethnopharmacology and traditional medicine in Africa. Journal of Ethnopharmacology, 259, 112968.