MSN 571 SEC2 WEEK 3 DQ1.edited
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MSN 571 SEC2 WEEK 3 DQ1 (IN PROGRESS)
Q1. Please briefly discuss the first-line treatment recommendations from JNC8 and the
AHA/ACC for a patient with no other major comorbidities.
With the 2033 Joint National Committee's seventh report (JNC 7) turning obsolete and
the 2011 Institute of Medicine report requesting a better, evidence-based guiding principle. 7, 8,
(the Right Joint National Committee (JNC 8) was at first selected to develop an up-to-date
treatment guideline for high blood pressure (HTN) under the indications of the National
Institutes of Health (NIH). The NIH eventually withdrew from the regulation development
practice at the end of the JNC 8’s development; nevertheless, the panel determined to make
public their proposals autonomously.
Worldwide, hypertension (HTN) is the leading risk factor for cardiovascular disease
(CVD) mortality and morbidity. In this Nation, hypertension is placed first among modifiable
risk factors in the populace due to CVD risk, accountable for the most significant part of
coronary heart disease (CHD), heart failure (HF), and stroke incidents. In adults with HTN, the
control of HTP with antihypertensive treatment reduces the chances of CVD and mortality from
all causes (Carey et al., 2021).
The panel members selected for the Eight Joint National Committee (JNC-8) revealed a
report proposing a higher BP goal SBP/DBP<150/90 mm Hg for adults >
60 years in comparison
with the 2003 JNC-7 recommended target SBP/DBP <140/90 MM Hg. A small group report
from five out of 17 JNC-8 panel participants informed that relaxation of the blood pressure target
could decrease the amount of antihypertensive medication and the level of control of blood
pressure (Carey et al., 2021).
The panel members selected for the Eight Joint National Committee (JNC-8) revealed a
report proposing a higher BP goal SBP/DBP<150/90 mm Hg for adults >
60 years in comparison
with the 2003 JNC-7 recommended target SBP/DBP <140/90 MM Hg. A small group report
from five out of 17 JNC-8 panel participants informed that relaxation of the blood pressure target
could decrease the amount of antihypertensive medication and the level of control of blood
pressure (Carey et al., 2021).
Q2. What are the recommended medications to start this specific patient on? Please
provide the drug class, generic and trade name, and initial starting dose.
For African-origin patients who do not have a history of chronic kidney disease (CKD),
the treatment must start with thiazides and CCBs. Norvasc is a marketing name, and amlodipine
is a generic name. This medication is classified as a calcium channel blocker; this medication
dose should start in Adults with 5 mg once a day for the first week. The dose is established in
each individual and can be increased once at least one to two weeks of use. The highest dose is
10 mg daily. For the elderly, the dose for the first week is 2.5 mg once daily for the first week
too.
Microzide is the commercial name for Sodium hydrochlorothiazide, a generic name. The
medicine class is thiazides, and the initial dose recommended is 12.5 mg daily, gradually
increasing up to 50 mg daily as needed. It can be taken by itself or in combination with other
hypertensive medication. The dose is adapted to the specific needs of the patient and could be
titrated in reaction to their illness and condition. The highest dose is 100 mg daily. For patients
65 and older, initially 12.5 daily, it can be titrated as needed until the desired effect is reached.
Q3. Please discuss the mechanism of action of each of the drugs you listed.
Hydrochlorothiazide inhibits sodium chloride reabsorption in the distal tubule. It results
in more Na excretion in the kidney with fluid. The pharmacological effect starts 2 hours after the
oral has been taken and peaks in four hours; it lasts approximately six to 12 hours. This
mentioned medication is not metabolized, and most is excreted in the urine unaffected. It causes
hypokalemia and loss of bicarbonate (Herman & Bashir, 2023).
The long-term actions of HCTZ once decreasing blood pressure have yet to be entirely
understood. When HCTZ is given acutely, the medication decreases blood pressure by triggering
diuresis and lowering plasma volume. Nevertheless, for chronic use, HCTZ decreases blood
pressure by reducing peripheral resistance. It is not clear how the drug causes vasodilation;
however, lab evidence implies that it could be inhibiting the enzyme carbonic anhydrase,
inactivating the smooth muscle receptors to the rice in Ca, or inhibiting the kidneys'
autoregulation (Herman & Bashir, 2023).
Amlodipine decreases blood pressure and peripheral vascular resistance by relaxing
coronary vascular smooth muscle. It helps increase coronary vasodilation by blocking Ca ion
transmembrane participation in vascular and cardiac smooth muscles. Amlodipine blocks the
voltage-dependent L-type calcium channels, thus preventing the first influx of calcium. The
result of decreased intracellular calcium is decreased vascular smooth muscle contractility,
resultant vasodilation, and increased smooth muscle relaxation. Also, amlodipine has enhanced
vascular endothelial function in patients with HTN. Amlodipine decreases blood pressure when
stimulating smooth muscle vasodilation and relaxation (Bulsara & Cassagnol, 2023).
The function of amlodipine in relieving stable angina is because of the lowering afterload
due to its hypertensive and vasodilatory properties. It decreases afterload, which results in
lowering myocardial oxygen demand at exertion level, while the heart does need to work as
much to pump blood in the systemic circulation. Amlodipine can relieve Prinzmetal or variant
angina, blocking coronary spasms and restoring the coronary arteries’ blood flow (Bulsara &
Cassagnol, 2023).
Q4. Please discuss the side effect profile of each medication you listed.
Possible side effects of hydrochlorothiazide are hyperuricemia, dyslipidemia, dizziness,
headaches, hyperglycemia, restlessness, rash, and erectile dysfunctions (Papadaskis et al.,
2022). Amlodipine side effects include edema, dizziness, headaches, palpitations, flushing,
hypotension, tachycardia, urinary frequency, constipation, and bloating (Papadaskis et al., 2022).
Q5. Are there any interactions between any of the medications you prescribed?
Hydrochlorothiazide interactions, when taken with alcohol, could increase chances of
toxicity of lithium, and when taken with drugs that cause torsades de pointes, like astemizole,
digitalis glycoside, sotalol, pimozide, and terfenadine, it can increase the chances of
hypokalemia, as well as increasing the risk of orthostatic hypotension once combined with
opioids and barbiturates, it can also have an additive effect on first dose hypotension after
combined with an ACE inhibitor.
Amlodipine interactions when taking grapefruit or grapefruit juice, the plasma
concentration is elevated; when administered St. John’s wort, the plasma concentrations were
low. Immunosuppressive medications increase systemic plasma concentration, whereas
simvastatin triggers an increase in serum concentration. Additionally, CYP3A4 enzyme
inhibitors generate an increase in exposure. There is a reduction in plasma concentration in the
case of CYP3A4.
Q6. What other non-pharmacological interventions would be suggested?
Lifestyle changes are recommended for patients with HTN (Papadaskis et al., 2022).
Eating fruits and vegetables, low-fat dairy food and low saturated and total fats (DASH
diet) has decreased blood pressure.
Increase dietary fiber; for 7 g of dietary fiber consumed, cardiovascular risks can
decrease by 9%
Reduce or stop taking alcohol.
Exercise aerobics 30 minutes daily, dynamic 90 to 150 minutes weekly, and isometrics;
hand grip four repetitions three times a week.
Medication and breathing control
References
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Bulsara KG, Cassagnol M. Amlodipine. [Updated 2023 Jan 22]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK519508/
Carey, R. M., Wright, J. T., Jr, Taler, S. J., & Whelton, P. K. (2021). Guideline-Driven
Management of Hypertension: An Evidence-Based Update.
Circulation research
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128
(7), 827–846. https://doi.org/10.1161/CIRCRESAHA.121.318083
Herman LL, Bashir K. Hydrochlorothiazide. [Updated 2023 Jul 17]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK430766/