Week 10 Pharm HF

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Wilkes University *

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533

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Medicine

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Dec 6, 2023

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Heart failure can be classified into various stages and types based on several factors. The most used classification systems for heart failure are the New York Heart Association (NYHA) functional classification and the American College of Cardiology/American Heart Association (ACC/AHA) staging system. According to the NYHA Functional Classification system, this patient would be Class III. Patients diagnosed with heart failure are markedly limited in their abilities to carry out physical activity. Patients classified as class III are comfortable at rest but symptomatically short of breath with less than ordinary physical activity. The AHA classifies heart failure into four stages based on structural heart damage. This patient would be classified as Stage C, which is broken into two categories— heart failure with a preserved ejection fraction (HFpEF, ejection fraction > 45%) and heart failure with reduced ejection fraction (HFrEF, ejection fraction < 45%) (Pattison, 2019). These patients can be placed into these categories based on their left ventricle’s ability to pump or relax and fill with blood. To improve this patient’s symptoms, discontinue ibuprofen. The American College of Cardiology Foundation/American Heart Association HF guidelines recommend that this class of drugs should be avoided or withdrawn whenever possible (Pagell et al., 2016). HCTZ can also be increased to 25 mg daily to help control her edema if her blood pressure is not too low. The monitoring parameters I recommend include degree of breathlessness, heart rate, blood pressure and weight gain. It is important to have patients with heart failure weigh themselves wearing the same clothes they slept in each morning after urinating and prior to eating or drinking anything. The non-pharmacologic recommendations I have for this patient are to limit their sodium intake by following a heart-healthy, DASH diet, performing light physical activity as tolerated, not drinking alcohol or smoking, limiting caffeine consumption, and practicing stress relief activities including meditation, guided imagery, or mindful breathing (Chisholm-Burns et al., 2022)\. To manage this 79-year-old African American woman with a history of hypertension, transient ischemic attack (TIA) and gout uncontrolled hypertension, a comprehensive treatment plan should be implemented. Gout is a type of arthritis caused by the buildup of uric acid crystals in the joints of the body. A diagnosis of gout is correlated with a higher risk of hypertension and cardiovascular disease. The diagnosis of gout in this patient underlines the necessity for efficacious blood pressure control because uncontrolled hypertension can worsen the symptoms of gout, increasing the risk of gout flares (Chisholm-Burns, 2022). In addition to pharmacotherapy, this patient should implement lifestyle modifications such as adopting a healthy diet low in sodium and high in fruits, vegetables, and whole grains, getting regular exercise, managing weight, and limiting alcohol consumption (Chisholm-Burns, 2). According to the American College of Cardiology/American Heart Association hypertension guidelines, combination drug therapy for most African Americans diagnosed with hypertension, in addition to those with blood pressure >20/10 mm Hg above target blood pressure and those with stage 2 hypertension. However, thiazide-like diuretics for example chlorthalidone, indapamide are preferred over thiazide-type diuretics for example, hydrochlorothiazide, and there is a single-pill combination available that combines an ACE inhibitor with a thiazide-like diuretic, for example perindopril-indapamide (Flack & Buhnerkempe, 2022). Tracking blood pressure regularly is important to ensure it is well-controlled. The patient should also be educated about the importance of adhering to the treatment plan and attending regular follow-up appointments with her healthcare provider. Overall, managing uncontrolled hypertension in this African American

female patient with a history of TIA and gout requires a comprehensive approach that includes lifestyle modifications, medication management, and regular monitoring to reduce the risk of complications and improve her overall health. It is recommended that if you are taking benazepril you should be advised to avoid moderately high or high potassium dietary intake. This can cause elevated serum potassium levels. Additionally, the patient should be educated not to use salt substitutes or potassium supplements while taking benazepril unless your doctor has told you to. When taking benazepril with aspirin, you should check your blood pressure regularly and may need your kidney function monitored. References Chisholm-Burns, M. A., Schwinghammer, T. L., Malone, P. M., Kolesar, J. M., Lee, K. C., Bookstaver, P.B. (2022). Pharmacotherapy: Principles and practices (6th edition). McGraw-Hill Education. ISBN 978-1-260-46027-8 Flack, J. M., Buhnerkempe, M. G. (2022). ace and antihypertensive drug therapy: Edging closer to a new paradigm. https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.121.18545 Pattison, K. H. (2019). Medications for heart failure management: What nurses need to know: Learn about heart failure medications to ensure improved outcomes. American Nurse Today , 14(2), 20–23. Pagell, R. L., O’Bryant, C. L., Cheng, D., Dow, T. J., Ky, B., Stein, C. M., Spencer, A. P. Trupp, R. J., Lindenfeld, J. (2016). Drugs that may cause or exacerbate heart failure | circulation. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000426

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Week 10 Pharm HF

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