Thiazide Case Study

Hypertension is the leading cause of cardiovascular diseases, and its prevalence rate is approximately 1 billion in 2000 people around the world (Hanus, Simões, Amboni, Ceretta, & Tuon, 2015). Additionally, HTN is a major risk factor for kidney, brain, and eye complications. Complications from HTN cause an estimated 9.4 million deaths per year (Kjeldsen et al., 2014). To reduce high morbidity rates and complications related to uncontrolled high blood pressure, pharmacological therapy is warranted. Despite available medications, the compliance with HTN medications remains subpar (Polinski, Kesselheim, Frolkis, Wescott, Allen-Coleman, & Fischer, 2014).

The concern on whether anti-hypertensive’s should be withheld in patients who are hypertensive has been debatable in the recent past. Generally, the treatment of hypertension among hospitalized patients is basically an opportunity to enhance the recognition and treatment of blood pressure (Axon, Nietert & Egan, 2011, p.246). This is mainly because hypertension is a basic risk factor for heart diseases, stroke, and death whose impact is widespread to nearly 70 million adults in America. There have been numerous educational initiatives and publication of treatment processes to address this condition in the past few decades. Despite these measures, nearly 39 million Americans are at risk of hypertension because they have not reached their desired or optimal blood pressure.

I am concerned with the drug to drug interaction with Mrs. Cynthia. She has hypertension, type II diabetes, and she is old. Her body mechanism metabolism the medication at a slower rate or it may metabolism too quickly. Cynthia labs result closely because she is also diabetic and is taking Lisinopril. I am concerned with her taking a potassium-sparing diuretic, potassium supplement, and aspirin. Patients who are taking potassium-sparing diuretics, potassium supplements, potassium-containing salt substitutes should not be placed on Lisinopril (mmm ) Lisinopril is

Mr. S is a 29-year-old male with past medical history of (PMH) hypertension (HTN) and obesity who presented to local emergency room (ER) with headache and chest and back pain. Mr. s had been seen at urgent care three days prior for a headache and near syncope and was told to hold his metoprolol due to bradycardia. Due to health insurance related problem, he has been off amlodipine and lisinopril for a month.

Patients who have congestive heart failure and do not respond to diuretics may benefit from a combination of several types of diuretic medication, each with a different system of action. Another medication for someone that has congestive heart failure can take Beta-blockers. Side effects include fatigue, cold hands, headache, upset stomach, constipation, diarrhea, dizziness, and shortness of breath. Data reported from 17 studies, researchers came to the conclusion that the risk of death from all causes was 31 percent lower in patients with heart failure who were treated with beta-blockers than in those not receiving such medications. Aldosterone blockers is a form of medication one may take to help slow down the rate of congestive heart failure.This medication can sometimes affect kidney function and can also increase potassium levels. Aldosterone blockers are prescribed to individuals who develop heart failure after a heart attack. Studies show that these medications can reduce the risk of hospitalization and death from cardiovascular disease. The last form of medication is BiDil (isosorbide

The potential complications if you do not stay compliant with the regimen are; low potassium which can lead to muscle cramps, weakness and fatigue, constipation, difficulty breathing, or an abnormal heart rhythm; Acute kidney failure

According to JNC 8 guidelines, close monitoring is essential when patients start on new hypertensive medication. Therefore, Mr. Hightower will require frequent visits to the clinic to ensure improvement in his health condition. His blood pressure will be monitored at each visit and blood work will be done to monitor his kidney and liver functions and to determine his adherence to treatment. In case of noncompliance, a third category of antihypertensive must be added to improve hypertension outcomes and prevent cardiovascular disease.

Lisinopril – This is a medication that lowers your blood pressure by relaxing the blood vessels in your body so that your heart does not have to work so hard.

In addition, Sharon has hypotension, which could also be related to the side effects of medications such as enalarapril, digoxin and frusemide (Skidmore-Roth, 2013).

Relevant interactions: Diuretics - hypokalemia, predisposing patient to digitalis toxicity. Antacids - decreased absorption of oral digoxin.

Hypertension is a very serious problem that, if left untreated, can lead to heart attacks, strokes, and other organ failure. Not

Treatment for aloprazalam drug toxicity consists of cardiac monitoring and oxygen. Naloxone can be administered at a lower dose with a gradual increase if needed to reverse respiratory depression which happens in most patients. Another treatment is the use of flumazenil which is the specific antidote for benzodiazepines. (Gershman, 2014). However, the use of this drug is controversial and does have some contraindications. It is contraindicated in patients with long-term benzodiazepines, patients who have ingested a substance that lowers the seizure threshold, or in patients who have tachycardia. The contraindications increase risk of seizures, cardiac arrest and possibly death. Because of the contraindications, most of the time flumazenil is not used for the treatment of benzodiazepine overdose. Although flumazenil is contraindicated and not used often, it can be very effective in reversing central nervous system depression associated with benzodiazepine toxicity but not effective in reversing respiratory depression. Flumazenil has a short half life of less than one hour and multiple doses may be needed for treatment. When flumazenil is used risk can be reduced by a slow dose titration of the drug

The need for evolving guidelines has stemmed from groundbreaking research on the topic of hypertension and antihypertensive medications. In the last two decades, there has been a change

During the first few weeks of treatment, plasma volume returns to slightly less that pretreatment levels, despite the continued administration of a diuretic. In the chronic phase of treatment, the vasodepressor influence of a diuretic emerges as a process driven by a reduction in total peripheral resistance (Sica, 2004). According to Woo & Robinson (2015), thiazide and loop diuretics decrease the renal excretion of lithium and may induce lithium toxicity. Thiazide diuretic is one of the drugs that have been there for many years to treat high blood pressure. This drug works in such of way that it excretes sodium and chloride out of the body; it lowers arterial pressure resulting in vasodilation and reduces cardiac output by decreasing extracellular fluid and plasma volume (American Heart Association, 2016). One of the major problems associated with thiazide diuretic is hypokalemia which can in result effect the kidneys (American Heart Association, 2016). It is important to ensure that patients who are taking thiazide diuretics that their potassium level is within range. Low potassium can lead to abnormal rhythms in the heart and can even cause the heart to stop beating

The new study released by Zogenix shows that the new drug fenfluramine reduced monthly seizures by a median 72.4% vs. a 17.4% reduction in patients treated with a placebo (Gatlin, IBD, 2017). This challenges GW Pharma's drug dubbed Epidiolex which reduced monthly seizures by a median 39% compared with a 13% reduction when treated with a placebo (Gatlin, IBD, 2017).