bloody/dark stools. An endoscopy may need to be done to look for any bleeding ulcers. Therapeutic RegimenAs a team based on the diagnosis mentioned above we came up with this therapeutic regimen for Henry. For the diagnosis of Stage 2 hypertension due to his diastolic being greater than or equal to 100, we would prescribe Hydrochlorothiazide HCTZ 25mg oral daily and Losartan 25mg oral daily. We chose an Angiotensin I Receptor Blocker (ARB) over an Angiotensin-Converting Enzyme Inhibitor (ACE inhibitor) due to the patient already having a dry cough, since ACE inhibitors can cause a dry cough for patients. The HCTZ at 25mg daily canalso help with the peripheral leg edema due to it also being a diuretic. To address the patient’s complaint of a dry cough keeping him up at night we are prescribing Benzonatate 100mg three times a day as needed for cough. He should stop taking the Robitussin due to the likely hood it not the one for diabetics and has sugar in it. It could be causing his blood sugars to be elevated. According to the ASCVD risk estimator plus when the patient’s blood results, blood pressure, age, and ethnicity are plugged in it gives advice for treatment. With the Cholesterol, HDL, and LDL levels the patient should be placed on a high intensity statin such as Atorvastatin 40mg by mouth daily. This is for the diagnosis of hypercholesterolemia. Another prescription based on this information the patient should be placed on is Aspirin 81mg daily. We will hold off
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5on this for now due to Henry having a low hemoglobin and hematocrit. We will look into causes for this such as gastrointestinal bleed (GI bleed), and ask the patient if he has seen any blood in his stool. Looking at the AACE algorithm for diabetes he also needs to be on dual therapy for his diabetes. He is already taking metformin 1,000mg bid for 1 month. Henry’s A1C is also 9%. According to the algorithm an SGLT2i would be best along with metformin such as Dapagliflozin 5 mg daily. Lastly, we would like to add Levothyroxine 50mcg by mouth every morning. The patient’s lab results show an elevated TSH, a low T3, and borderline low T4. These results are consistent with hypothyroidism. Starting at a lower dose is appropriate for Henry’s age, and othermedical history. Response and ComplianceHydrochlorothiazide 25 mg is an antihypertensive medication. Patient is being prescribed this medication daily. It can be taken with or without food. It is recommended to take the medication in the morning, but if the patient decides to take it at night education will be given to take it at least 4 hours before bedtime to avoid frequent urination during the night. If a dose is missed patient should take it as soon as he remembers. If it is too close to the next dose skip the dose and continue taking as normal. Patient educated not to take two doses at a time.
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