Mr. Tomkins will need to obtain a blood pressure monitor and take his blood pressure at least once a day and record the finding in a blood pressure journal. Mr. Tomkins should also indicate his position while taking his blood pressure (sitting/standing/laying down), as well as any significant data (sick, fever, missed dose of a medication). Lastly, the blood pressure should be taken on the same arm (left) each day. This blood pressure journal should accompany him to future appointments so dosing
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adjustments can be made. It is also important to remind him to take the blood pressure when he is at rest, and not immediately following strenuous activity. PharmacokineticsLisinopril is a long-acting angiotensin converting enzyme inhibitor (ACE). This medication prevents angiotensin I from converting to angiotensin II. Angiotensin II is a powerful vasoconstrictor, therefore when decreased, vasopressor activity is decreased. In addition to that there is also a decrease in aldosterone secretion (Micromedex, 2019). Lisinopril when taken orally is absorbed within 7 hours, it can be taken with or without food. It is excreted by the kidneys, with a half-life of 12 hours (Micromedex, 2019). While taking this medication Mr. Tomkins electrolytes must be monitored, especially his potassium, as this medication can lead to hyperkalemia, especially in patients with diabetes mellitus (Epocrates, 2019). Lipitor is an HMG-CoA reductase inhibitor. “HMG-CoA reductase catalyzes the conversion of HMG-CoA to mevalonate, a cholesterol precursor, in the liver” (Edmunds & Mayhew, p.295, 2014). Essentially, lovastatin works by reducing the liver’s production of cholesterol. This is done by blocking the enzyme (HMG-CoA reductase) that makes cholesterol. Oral lovastatin takes approximately two hoursto reach peak concentration. It has greater than 95% protein binding, and is primarily metabolized in theliver on the first-pass through hydrolysis (Micromedex, 2019).
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