Advanced Pharmacology Sample Paper 2
What would you add to the current treatment plan? Why?
Based on Mr. EBR’s presenting symptoms and a history of CAD, he is most likely suffering from stable angina. In addition to the current treatment plan for the patient, I would recommend an ECG to evaluate his cardiac condition. The immediate intervention would be to reduce or eliminate the patient’s anginal chest pain. Further, I would refer him to a cardiologist for stress test and, possibly, cardiac catheterization if needed.
Would you discontinue any of the currently prescribed medication? Why or why not?
I would not recommend the discontinuation of any of Mr. EBR’s current prescriptions as they crucial in managing his blood pressure, type 2 diabetes and hyperlipidemia. The patient is already on beta blockers which serve to decrease myocardial contractility, in addition to decreasing both heart rate and conduction velocity. Beta blockers also work by reducing the systemic vascular resistance as well as blood pressure (Laurent, 2017). Put together, the medication serves to reduce myocardial oxygen demand, thus relieving the patient’s anginal pain. Aspirin, at a dose of between 81mg and 162 mg per day is recommended for patients with angina as it also serves to reduce mortality rates among those suffering from CAD.
How does the diagnosis stage 3 chronic kidney disease affect your choices?
Gabapentin is the preferred medication for diabetic neuropathy among patients with no chronic kidney disease (CKD). With Mr. EBR’s stage 3 CKD, gabapentin is discouraged due to the elevated risks of high toxicity. Further, as Lefebvre et al. (2020) observe, for patients with such comorbidities as CKD, CHF, liver cirrhosis, etc., drug combinations that include renin-angiotensin blockers, NSAIDS and diuretics can result in acute renal failure.
How is the patient prescribed more than one antihypertensive?
Current hypertension therapy guidelines recommend combined therapies with separate agents or fixed-dose combinations that are more effective in lowering blood pressure within a short time, while at the same time minimizing possible adverse effects. Further, studies have shown that different classes of hypertensive drugs can work to offset the adverse reactions associated with either. Additionally, the fact that most hypertensive patients require more than one antihypertensive agent, more so when there are comorbid conditions, makes it easier to understand Mr. EBR’s case. For instance, for hypertensive patients, particularly those at elevated risks of coronary disease, current treatment recommendation includes diuretics, beta-blockers, and angiotensin-converting enzyme inhibitors (Cuspidi et al., 2018).
What is the benefit of the aspirin therapy in this patient?
Aspirin, being an antiplatelet agent, reduces the ability of blood to clot. This makes blood flow easier in narrowed arteries. With Mr. EBR’s history of CAD and MI, reducing the risks of blood clot formation in his arteries is crucial to managing his conditions. For this, Aspirin is recommended.
References
- Cuspidi, C., Tadic, M., Grassi, G., & Mancia, G. (2017). Treatment of hypertension: The ESH/ESC guidelines recommendations. Pharmacological Research, 128(), 315-321. doi:10.1016/j.phrs.2017.10.003
- Laurent, S. (2017). Antihypertensive drugs. Pharmacological Research, 124(), 116-125. https://doi.org/10.1016/j.phrs.2017.07.026
- Lefebvre, C., Hindié, J., Zappitelli, M., Platt, R. W., & Filion, K. B. (2019). Non-steroidal anti-inflammatory drugs in chronic kidney disease: a systematic review of prescription practices and use in primary care. Clinical Kidney Journal, 13(1), 63-71. https://doi.org/10.1093/ckj/sfz054