Case Study I

You may use one of the following databases to complete Case Study I. All are located in the HS/HSL database collection. You may also choose your own reference. You must indicate your reference so your faculty can grade your assignment.

• Micromedex
• Facts & Comparisons
• Lexi-Comp

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Mr. Johnson, a 64-year-old black man presents to your clinic for routine follow up of his medical conditions. His blood pressure is poorly controlled. The patient states he struggles to adhere to a low sodium diet. He has a 60-pack year smoking history. He quit smoking five years ago. His 10-year atherosclerotic cardiovascular disease (ASCVD) risk is 37.9%. His only complaint today is “feeling dizzy in the morning.” Your physical exam reveals evidence of target organ damage:

• Eyes: AV nicking
• Kidney: (+) proteinuria, elevated serum creatinine
• Heart: Left ventricular hypertrophy, ejection fraction 45%

Vital Signs:

• BP 164/94 mm Hg (second time BP has been elevated)
• Pulse 72/minute
• Respirations 20/minute
• Body Mass Index (BMI) is 29.4 (Overweight)
• O₂ saturation on room air 96%

Recent lab work (BMP)

• Glucose – 138
• Calcium – 9.6 mg/dL
• Sodium – 141 mEq/dL
• Potassium – 4.4 mEq/dL
• Bicarbonate – 28 mEq/dL
• Chloride – 104 mEq/dL
• Blood Urea Nitrogen (BUN) – 32 mg/dL
• Creatinine – 1.78 mg/dL (normal range 0.6 – 1.2 mg/dL)

Past Medical History

• Hypertension
• Chronic Obstructive Pulmonary Disease
• Type 2 Diabetes Mellitus
• Benign Prostatic Hypertrophy

Medications

• Doxazosin 8mg once daily – he takes every AM
• Hydrochlorothiazide 25mg once daily – he takes every AM
• Carvedilol 25 mg twice daily – he takes every AM and PM
• Tiotropium 2 puffs once daily – he takes every AM
• Fluticasone/Salmeterol 1 puff twice daily – he takes every AM and PM
• Albuterol as needed – he has been using his rescue inhaler 3-4 times/week for the past 2 weeks.

Based on your exam today, you have decided to add an Angiotensin Converting Enzyme (ACE) inhibitor. You prescribe Lisinopril 5 mg by mouth once daily. You ask the patient to return in 2 weeks to assess BP control. You may decide to make other changes in his medications. Please follow the instructions below to guide you in your medication treatment plan for Mr. Johnson.

Complete the table on the following medications for Mr. Johnson. Be sure to review his health history.

Drug Reference Used (APA Formatting, 10 pts):

Discuss the following three considerations.

1. Describe why adding an ACE inhibitor may be beneficial for this patient. (10 pts)
2. Carvedilol is not the best choice for Mr. Johnson. Why? Which medication in this class may be safe to prescribe based on the drug’s selectivity? (10 pts)
3. Discuss how his medications may be causing him to feel dizzy. (10 pts)

Discuss two educational considerations to review with Mr. Johnson today regarding his medications. (10 pts each)

Case Study Rubric