Week 1 Case Study You have a 58 year old African American male that is coming in for a follow-up visit after recently having a Myocardial infarction which was successfully treated via angioplasty
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SOUTH UNIVERSITY
Week 1 Case Study You have a 58 year old African American male that is coming in for a follow-up visit after recently having a Myocardial infarction which was successfully treated via angioplasty
Paper Instructions
You have a 58 year old African American male that is coming in for a follow-up visit after recently having a Myocardial infarction which was successfully treated via angioplasty. He was started on Metoprolol for his consistently elevated high blood pressure during his hospital stay.
His primary diagnoses include:
- Coronary Artery Disease
- Type 2 diabetes controlled with Metformin 1,000 mg BID and HgA1C of 6.7.
- Asthma- Mild Intermittent- with no recent episodes of wheezing. Albuterol INH as needed.
All other pertinent labs Within Normal Limits
First consider what clinical guidelines noted below can help us choose the best medication treatment for this patient with diabetes, CAD, Asthma and Hypertension.
- Joint National Committee JNC 8 – https //thepafp.org/website/wp-content/uploads/2017/05/2014-JNC-8-Hypertension.pdf
- National Center for Biotechnology Information – https //www.ncbi.nlm.nih.gov/pmc/articles/PMC6092891/table/T1/?report=objectonly
- American Heart Association – https //www.ahajournals.org/doi/epub/10.1161/HYPERTENSIONAHA.120.15026 IHS
- Division of Diabetes https //www.ihs.gov/sites/diabetes/themes/responsive2017/display_objects/documents/algorithms/AlgorithmHypertension.pdf
Please answer each questions citing your response from evidence based clinical guidelines. Your response should not be post as “I would recommend”. Example of appropriate reference The 2020 international Society of Hypertension Global Hypertension Practice Guidelines – recommend the use of selective ß1-receptor agonists in patients diagnosed with coronary heart disease and or heart failure ( Unger, T, et al, 2020).
Reference
- Unger T;Borghi C;Charchar F;Khan NA;Poulter NR;Prabhakaran D;Ramirez A;Schlaich M;Stergiou GS;Tomaszewski M;Wainford RD;Williams B;Schutte AE; (n.d.). 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension (Dallas, Tex. 1979). Retrieved August 1, 2022, from https //pubmed.ncbi.nlm.nih.gov/32370572/
Metoprolol is selective for which adrenoceptor? ( pharmacodynamics)
What effects do agents such as metoprolol have on the cardiovascular system? ( pharmacodynamics)
In which organ is metoprolol primarily metabolized? (Pharmacokinetics)
Why would a provider be cautious when ordering a Beta Blocker in a patient with Asthma?
Submission Details
- Name your file W1_CaseStudy_LastName_FirstName
- Submit this assignment to the Submission Area by the due date assigned.
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Sample Answer
Week 1 Case Study
Metoprolol is selective for which adrenoceptor? ( pharmacodynamics)
The 2020 International Society of Hypertension (ISH) Global Hypertension Practice Guidelines explain that metoprolol is a cardioselective for β1-receptor antagonist. It has an affinity for β1-receptors that is 30 fold greater than its affinity for β2-receptors (Unger et al., 2020).
What effects do agents such as metoprolol have on the cardiovascular system? ( pharmacodynamics)
Beta-1 blockers like metoprolol exert their effect on the cardiovascular system by selectively binding to the beta-1 receptor sites and blocking the action of epinephrine and norepinephrine. The 2020 ISH Global Hypertension Practice Guidelines explain that activating the beta-1 receptor in the heart increases sinoatrial nodal, atrioventricular nodal, and ventricular muscular firing.
This results in an increased heart rate and contractility, causing an increase in stroke volume and cardiac output (Unger et al., 2020). Thus, metoprolol is indicated to treat supraventricular and ventricular arrhythmias.
In which organ is metoprolol primarily metabolized? (Pharmacokinetics)
Metoprolol is extensively metabolized by the liver. Thus, Hepatic impairment usually impacts the drug’s pharmacokinetics by prolonging the elimination half-life (Unger et al., 2020).
Why would a provider be cautious when ordering a Beta Blocker in a patient with Asthma?
Beta-1 blockers are normally contraindicated in persons with moderate to severe asthma due to the potential to cause bronchospasm. Acute bronchoconstriction has been documented as the most critical side effect of beta-blockers that lead to asthma exacerbation (Unger et al., 2020).
Reference
- Unger, T., Borghi, C., Charchar, F., Khan, N. A., Poulter, N. R., Prabhakaran, D., … & Schutte, A. E. (2020). 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension, 75(6), 1334-1357.
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