How to address a pharmacotherapeutics case study (Solved)

How to address a pharmacotherapeutics case study (Solved)

Case prompt: OU is a 72 yo male with new onset angina. A decision was made to medically manage the case.
What medication(s) would you prescribe for the patient to abort an acute angina episode?
What medication(s) would you prescribe to prevent angina episodes and decrease mortality?
Would a history of asthma or COPD alter your initial therapy and if so how?
For all medications discussed please discuss the medications mechanism of action in treating HTN.
For all medications discussed please explain the monitoring parameters of efficacy and side effects

SOLUTION TO CASE STUDY

Discussion 1: Angina is a symptom that indicates an individual has an underlying coronary artery disease. The best treatment for angina depends on the type of angina with acute angina requiring immediate treatment (Ziff et al., 2020). The medication that I would prescribe to OU is nitroglycerine. Nitroglycerine is a vasodilator that is used to widen the coronary arteries and improve blood circulation to the heart. I will prescribe nitroglycerine sublingual tablets to give relief to angina in approximately 1 to 5 minutes.

The pharmacological management of angina aims at reducing the frequency of symptoms and reducing the risk of heart attacks. The drugs that I would use to prevent angina episodes and decrease mortality include beta-blockers, calcium channel blockers, and nitrates (Rosenthal & Burchum, 2020). Beta-blockers like propranolol remain the first-line medications for the long-term prevention of angina. Calcium channel blockers like nifedipine are effective in angina prevention, especially in vasospastic angina (Rosenthal & Burchum, 2020). Nitrate act directly on the vascular smooth muscles to produce arterial dilation. An example is a long-acting nitroglycerine to prevent ischemic episodes.

In patients with a history of asthma or COPD, I will alter my initial therapy, especially the use of beta blockers. These patients already have narrowed airways and the use of beta-blockers like propranolol may cause further vasoconstriction (Rosenthal & Burchum, 2020). However, I will only avoid using beta blockers for severe asthma.

The medications discussed include nitroglycerine, propranolol, and Nifedipine. Nitroglycerine can help reduce hypertension by reducing cardiac oxygen demand and increasing blood flow through coronary vessels (Todoroski et al., 2021). The monitoring parameters for this drug include relief of angina within a few minutes and side effects like dizziness, weakness, and hypersensitivity. Propranolol prevents HTN by down-regulating the rennin-angiotensin-aldosterone system (Rosenthal & Burchum, 2020). The parameters to monitor will include blood pressure, relief of angina, and side effects like palpitations, dizziness, and abdominal pain. Nifedipine acts by blocking L-type calcium channels that help to reduce vascular resistance while improving blood flow to the heart (Rosenthal & Burchum, 2020). Parameters to monitor in patients include stabilization of angina, blood pressure, and adverse effects like peripheral edema and dizziness.

References

Rosenthal, L., & Burchum, J. (2020). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants-E-Book. Elsevier Health Sciences.

Todoroski, K. B. (2021). The timing of administering aspirin and nitroglycerin in patients with STEMI ECG changes alter patient outcome. BMC Emergency Medicine, 21(1), 1-15. https://doi.org/10.1186/s12873-021-00523-2

Ziff, O. J., Samra, M., Howard, J. P., Bromage, D. I., Ruschitzka, F., Francis, D. P., & Kotecha, D. (2020). Beta-blocker efficacy across different cardiovascular indications: An umbrella review and meta-analytic assessment. BMC Medicine, 18(1), 1-11.
https://doi.org/10.1186/s12916-020-01564-3

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