Woopharmacotherapeutics Page 1 Of 3 Chapter 13 Instructor Cs

Woopharmacotherapeutics 5epage 1 Of 3ch13 Instructor Cschapter 13 Dru

Woo Pharmacotherapeutics 5e Ch13 Instructor CS Chapter 13: Drugs Affecting the Cardiovascular and Renal Systems Instructor Case Study Jack is a 54-year-old patient who has difficulty coming in for primary care visits. He sees cardiology, pulmonary clinic, and endocrine clinic for his comorbid conditions of diabetes mellitus, postcoronary artery bypass grafting (CABG) 2 years ago, and mild chronic obstructive pulmonary disease issues from a 30-pack year history of smoking. His last visit with you was over a year ago. Today, your registered nurse brings you a telephone triage call requesting a refill of his Crestor prescription, which was ordered by cardiology soon after his CABG. Per the electronic links to the cardiology service within your facility, the medication was due to be renewed about 2 months ago.

His last lipid labs were a year ago and his last complete metabolic panel (CMP) was done at the same time. He was recently at the pulmonary clinic and his last recorded HgA1C was 9.0 from a visit to endocrine 4 months ago. Review of records include a prescription for his hypertension (Lisinopril 20 mg daily), metformin 1,000 mg twice a day for his diabetes, and no known medications for his pulmonary issues. The Crestor prescription appears to have multiple dosing levels over the past few refills. His last vital signs were blood pressure (BP) 170/110 mm Hg, pulse 88, and respirations 22.

His body mass index is 30 and he indicates a pain level of four out of five. His pulse oximetry was 92% on room air. 1. How do you respond to this telephonic request? Woo Pharmacotherapeutics 5e Ch13 Instructor CS 2.

What steps are required to get Jack’s therapeutic plan under control? 3. What is the role of the primary care provider (PCP) in this scenario?

Paper For Above instruction

In response to the telephonic request for a prescription refill of Crestor (rosuvastatin), a comprehensive clinical assessment is essential before making a decision. The patient's history indicates suboptimal management of cardiovascular risk factors, evidenced by elevated blood pressure of 170/110 mm Hg, a recent lipid profile, and a high HbA1c level of 9.0%. These factors suggest that Jack's current therapeutic regimen may require adjustment, and his blood pressure and glycemic control need urgent attention.

Initially, it is crucial to assess Jack’s current clinical status thoroughly. Despite the limitations of a telephone consultation, a detailed discussion should be initiated to understand his recent symptoms, adherence to medications, lifestyle factors, and any adverse effects experienced. Given his elevated blood pressure and poor glycemic control, immediate measures should be taken to address these issues. It is inadvisable to refill the Crestor prescription without evaluating recent lipid levels and renal function to determine the effectiveness and safety of ongoing statin therapy.

Furthermore, Jack’s elevated blood pressure (170/110 mm Hg) classifies as hypertensive crisis, necessitating prompt intervention to prevent end-organ damage. This may involve adjusting antihypertensive medications and scheduling an urgent in-person visit. The elevated blood pressure, high HbA1c, and obesity (BMI 30) collectively increase his cardiovascular risk, emphasizing the need for a multifaceted management plan targeting lipid levels, blood pressure, glycemic control, and lifestyle modifications.

To get Jack’s therapeutic plan under control, the following steps are recommended:

• Schedule an in-person evaluation: An in-office assessment is essential to measure current vital signs, obtain updated laboratory data (lipid profile, renal function, fasting glucose or HbA1c), and physically examine for signs of uncontrolled cardiovascular or pulmonary disease.
• Optimize pharmacotherapy: Based on recent labs and clinical findings, antihypertensive medications may need adjustment. Since his BP remains poorly controlled, options may include increasing dosage or adding additional agents such as thiazide diuretics, ACE inhibitors, or calcium channel blockers, aligned with current hypertension guidelines.
• Review and reinforce medication adherence: Understanding barriers to adherence, side effects, and patient education about medication importance is vital. For example, emphasizing the role of statins in secondary prevention after CABG is crucial.
• Address lifestyle factors: Counsel Jack on smoking cessation, weight management, diet, physical activity, and alcohol intake, which all impact cardiovascular and metabolic health.
• Coordinate care: Collaborate with cardiology, endocrinology, and pulmonary specialists to streamline care and consider possible medication adjustments or additional interventions based on recent assessments.
• Monitoring and follow-up: Establish regular follow-up appointments to monitor blood pressure, lipid levels, HbA1c, and overall health status, ensuring therapeutic goals are gradually achieved and sustained.

The primary care provider plays a pivotal role in this scenario by serving as the coordinator of care, ensuring continuity, and addressing gaps in management across multiple specialties. The PCP should interpret recent specialist reports, facilitate laboratory testing, and make necessary medication adjustments. They also serve as the patient's advocate, providing education and support to enhance adherence and lifestyle changes. Emphasizing the importance of comprehensive risk reduction strategies is crucial in lowering Jack’s likelihood of future cardiovascular events.

In conclusion, the telephonic refill request highlights the importance of thorough, holistic care in managing complex, multimorbid patients. Immediate assessment, pharmacologic optimization, lifestyle counseling, and coordinated multidisciplinary efforts are fundamental to improving Jack's health outcomes and preventing adverse events.

References

• American College of Cardiology/American Heart Association. (2018). 2017 ACC/AHA hypertension guideline. Circulation, 138(17), e484-e594.
• American Diabetes Association. (2023). Standards of medical care in diabetes—2023. Diabetes Care, 46(Supplement 1), S1–S212.
• Chobanian, A. V., et al. (2017). The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. JAMA, 289(19), 2560-2572.
• Whelton, P. K., et al. (2018). 2017 ACC/AHA Hypertension Guidelines. Hypertension, 71(6), e13–e115.
• Stone, N. J., et al. (2018). 2018 Guideline on the management of blood cholesterol. Journal of the American College of Cardiology, 73(24), e285–e350.
• American Diabetes Association. (2022). Medical management of hyperglycemia in type 2 diabetes. Diabetes Care, 45(Supplement 1), S88–S99.
• Fox, K. M., et al. (2015). ESC guidelines for the management of acute coronary syndromes. European Heart Journal, 36(3), 189-217.
• National Institutes of Health. (2020). Managing high blood pressure. NIH Publication.
• Varkey, P., et al. (2020). Multidisciplinary approach to complex patients: The key to success. Primary Care, 47(4), 591–601.
• American Heart Association. (2019). Lifestyle modifications for cardiovascular disease prevention. Circulation, 139(25), e104–e118.