Pharmaceutical Treatment Plan: Hypertension
Hypertension, commonly termed high blood pressure, is the most common cardiovascular condition that affects many individuals worldwide. Various reference exists to define it, however, the standard reference is persistently elevated blood pressure above 140 mmHg and 90mmHg of systolic and diastolic readings, respectively (Nakajima et al., 2021).
The pathophysiology of pressure elevation is attributed to an increase in the total peripheral resistance and increased afterload. As a result, various etiologies are implicated, including obesity, diabetes mellitus, alcohol drinking, smoking, and increased salt intake, among other factors.
However, the exact cause in many individuals remains unknown. Because hypertension is a silent disease that barely presents with typical symptoms, high index suspicion is paramount. Failure to diagnose and offer early treatment can lead to systemic deleterious effects, including heart failure, stroke, renal failure, and myocardial infarction. The subsequent will discuss the management of hypertension using pharmacological and non-pharmacological methods.
Management of Hypertension
The use of a non-prescription modality is among the basic and the initial plan in the management of hypertension before the initiation of medication. It applies to all patients with elevated blood pressure regardless of age, gender, or ethnicity (Nakajima et al., 2021). Luckily some individuals who use non-pharmacological methods manage to control blood pressure; however, some may fail. Non-pharmacological interventions majorly focus on lifestyle modifications while addressing the risk factors.
Common interventions include; reduction of dietary salt intake to reduce the reabsorption of salt and water in the kidneys; weight reduction in obese or overweight persons; quitting smoking cigarettes and reducing alcohol intake to reduce peripheral resistance; regular physical exercise; effective stress management techniques, and dietary modifications. Regarding diet, individuals are advised to take a healthy diet with a lot of water, more fruits and vegetables, and reduced fatty meal intake.
A combination of both ways is effective in managing blood pressure with an estimated reduction of between 5 and 20mmHg of blood pressure. When combined with pharmacological interventions, blood pressure control is adequate.
The use of prescription medications remains the mainstay of managing patients with hypertension. Various agents with different mechanisms of action are used. Among the most common ones include diuretics, angiotensin-converting enzyme inhibitors (ACE1), calcium channel blockers (CCB), angiotensin receptor blockers (ARB), and vasodilators, beta-blockers, and aldosterone antagonists, among others (Herman & Bashir, 2022).
The choice of a specific drug for a patient is dependent on various factors, including the stage of hypertension, age, race, comorbidities, liver function, and renal functioning. Either a single or a combination of more than one group of medications can be used while performing close monitoring of blood pressures and patient progress. After considering all patient factors, the common medications of choice are diuretics, preferably thiazides.
Hydrochlorothiazide is the most commonly used thiazide diuretics. It acts by inhibiting sodium reabsorption in the distal convoluted tubules, causing excretion of sodium and water and other ions such as hydrogen and potassium. Through its action, hydrochlorothiazide causes increased water loss that leads to a reduction in vascular volume (Nakajima et al., 2021).
As a result, apart from being used in managing hypertension, it can be used in various conditions, including edema, hypertension in heart failure, and mild fluid retention in heart failure. It is available as an oral tablet/capsule that comes in various strengths, including 12.5mg, 25mg, and 50mg (Herman & Bashir, 2022). The dosage depends on patient factors; however, an initial dose of 12.5mg once daily is preferred.
The medication is taken early in the morning to act during the day; late-night administration is discouraged due to fear of nocturia. In terms of pharmacokinetics, it is well absorbed, up to 68% protein bound, 75% bioavailability, minimally metabolized, and excreted via urine (Yeom et al., 2018).
Because hydrochlorothiazide is associated with various systemic side effects, it is necessary to be aware of such effects before prescribing them. To begin with, the increased loss of water and sodium can lead to hypotension, orthostatic hypotension, hypokalemia, hypomagnesemia, hyponatremia, and hyperchloremic alkalosis. In the central nervous system, it can cause dizziness, restlessness, headaches, vertigo, and restlessness. Impotence is a feared side effect that warrants stopping this medication when used by males.
Other manifestations of side effects are mentioned as follows: on the gastrointestinal, it causes anorexia, abnormal cramps, nausea, gastric irritation, diarrhea, constipation, vomiting, and sialadenitis; skin photosensitivity, skin rash, alopecia, exfoliative dermatitis, and urticaria are among dermatologic effects; in the respiratory system it may cause pneumonitis, pulmonary edema, and respiratory distress; renal insufficiency and renal failure may follow hypovolemia; muscles may become weak or have spasms; in the blood, it causes aplastic anemia, agranulocytosis, hemolytic anemia, leukopenia, and thrombocytopenia; anaphylaxis in hypersensitivity, and jaundice in the liver (Herman & Bashir, 2022). Understanding all the side effects is necessary for monitoring medication and understanding contraindications.
Monitoring of hydrochlorothiazide requires both physical assessment and laboratory studies. Taking routine blood pressure is a vital assessment that helps to rule out hypotension. Regarding laboratory evaluation, the various test can be done: urea, electrolytes, and creatine levels to electrolyte levels; complete blood count with differentials to rule out hematologic side effects such as leukopenia and hemolytic anemia; uric acid levels to assess for the risk of faring a gouty attack (Yeom et al., 2018).
Due to the risk of skin cancer, patients should be instructed to cover their skin while in the sun and have regular skin cancer screening. In addition, warnings and precautions should be observed while using hydrochlorothiazide. For instance, a combination with ACEIs and ARBS can help in avoiding electrolyte imbalance; hypersensitivity reactions can occur in individuals allergic to sulfa-containing drugs; it can cause acute angle closure glaucoma; avoid the use of hydrochlorothiazide in patients with adrenal insufficiency, and caution should be taken when given in diabetic patients as it can alter with sugar control (Nakajima et al., 2021).
In special circumstances, there are absolute contraindications for the use of thiazides. They include anuria and documented hypersensitivity to its components. Relative contraindications include breastfeeding and progressive severe kidney disease that may lead to azotemia.
Finally, hydrochlorothiazide exhibits some drug-drug interactions with other medications; thus, it requires prompt recognition. For instance, regular monitoring is necessary if hydrochlorothiazide is administered with allopurinol due to an increase in the concentration of allopurinol. In addition, thiazides diminish the therapeutic effects of antidiabetics; barbiturates enhance the hypotensive effects of thiazide; thiazides cause hypokalemia that enhances digitalis toxicity.
Similarly, corticosteroids enhance hypokalemic effects; thiazides decrease the excretion of lithium which may cause toxicity (Carey et al., 2021)y. Nephrotoxic effects may be experienced if hydrochlorothiazide is administered with sodium phosphate. Therefore, understanding the dynamics of hydrochlorothiazide is essential in having full knowledge about the medication before administering it.
Hypertension remains the highest threat for cardiovascular conditions, including stroke, heart failure, and myocardial infarction. Early diagnosis and management are crucial to improving patient outcomes. Both pharmacological and non-pharmacological methods are used; however, the use of hydrochlorothiazide is the drug of choice in many circumstances. Therefore, it is paramount to understand the mechanism of action, side effects, drug interactions, and contraindications before administration.
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, 128(7), 827–846. https://doi.org/10.1161/CIRCRESAHA.121.318083
Herman, L. L., & Bashir, K. (2022). Hydrochlorothiazide. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430766/
Nakajima, K., Igata, M., Higuchi, R., Tanaka, K., Mizusawa, K., & Nakamura, T. (2021). Association of serum high-density lipoprotein cholesterol with high blood pressures at checkup: Results of Kanagawa investigation of total checkup data from the national database-9 (KITCHEN-9). Journal of Clinical Medicine, 10(21), 5118. https://doi.org/10.3390/jcm10215118
Yeom, H., Kim, H. C., Lee, J.-M., Jeon, Y., & Suh, I. (2018). Triglyceride to high-density lipoprotein cholesterol ratio among adolescents is associated with adult hypertension: the Kangwha study. Lipids in Health and Disease, 17(1), 212. https://doi.org/10.1186/s12944-018-0861-y
Pharmaceutical Treatment Plan: Hypertension Instructions
(For this assignment I choose hypertension for my focus) Assessment Description Select a disease or condition. For example, sepsis, CAD, HCAP, HAP, hypertension, CHF, atrial fibrillation, depression, Parkinson\'s disease, hyperlipidemia, COPD, asthma, or febrile neutropenia. Write a 750-1,000 word paper discussing prescription and nonprescription medications/therapies for the treatment of the disease. Discuss monitoring and identify significant adverse effects and drug-drug interactions, as well as desired outcomes of the pharmacological agents used in the treatment of the disease. Determine an appropriate pharmaceutical treatment plan for the disease or condition. Incorporate considerations for various populations (geriatrics, pediatrics) depending on the disease you have selected. You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. This assignment uses a rubric. Review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.