Adv Pharm.docx - Week2:DiscussionPartOne No unread...

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Week 2: Discussion Part One No unread replies. 50 50 replies. Cynthia is a 65-year-old African American female who presents to the clinic for a check- up. Her last examination was ~5 years ago. She has no specific, significant, or urgent complaint. She explains that her only issues are thirst, fatigue, and leg numbness and tingling, which is beginning to occur more often. You decide to do a physical exam, as well as draw labs and receive the following results: Social history: no smoking or alcohol consumption. Physical examination: GEN: well nourished, slightly obese female VS: BP 180/103 HR 73 RR 13 T 98.4 Weight 90 kg, Height 5’6” HEENT: PERRLA COR: RRR, NMRG CHEST: CTA NEURO: monofilament test shows decreased peripheral sensation EXT: normal Laboratory (fasting): Na 139 mEq/L K 3.8 mEq/L ALT 34 U/L Ca 9.1 mg/dL CL 102 mmol/L HCO3 22 mEq/L AST 39 U/L TP 6 g/dL BUN 33 mg/dL SCr 2.0 mg/dL Alb 4.1 g/dL Cholesterol 254 mg/dL BG 300 mg/dL TSH 0.12 U/mL UA: SG 1.013 mg/24h, pH 6.5, +++ protein What are the major problems in this patient, and what diagnoses do these values indicate?
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Additionally, what is your assessment and pharmacological plan for each of these problems including the medication, dose, and mechanism of action? Dr. Woodward and Classmates, Differential diagnoses 1. Hypertension – as evidenced by her blood pressure of 180/103. This is usually a diagnosis made after several elevated readings, and not just based on one reading. The U.S. Preventive Services Task Force newly recommends the use the ambulatory blood pressure monitor to be worn by the patient for 24 hours (NGO-METZGER & Blitz, 2016). Cynthia could go home with such a device and return it the next day. This ABPM takes the patient’s blood pressure every 20-30 minutes for one day and allows the prescriber to determine if indeed the patient has hypertension. Then the prescriber is able to make the diagnosis of hypertension with quick turn around on results. The provider could give a prescription for an antihypertensive to be initiated upon review of the ABPM results. If the use of this device is not available then Cynthia would need a couple more readings on different days at the office to confirm the diagnosis of hypertension. Once the patient has a clear diagnosis of hypertension then the JNC 8 Hypertension Guideline Algorithm gives the best option to start Cynthia on and Angiotensin converting enzyme inhibitor or Angiotensin II receptor blocker alone or in combination (James, Oparil, Carter, Cushman, Dennison-Himmelfarb, Handler, ... & Smith, 2014). This selection was made based on her age, and comorbidities of diabetes and renal failure. Cynthia would be encouraged to take action with some lifestyle modifications like to limit sodium intake and increase physical activity in effort to reduce her weight, which may help with the hypertension.
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