Patient AO is currently treated with atenolol 12.5 mg daily with doxazosin (8 mg daily), hydralazine (10 mg qid), sertraline (25 mg daily), and simvastatin (80 mg daily) for hypertension and hyperlipidemia. The patient also has a medical history of obesity and has gained 9 pounds recently. According to Arcangelo and Peterson (2013), age is a significant factor in determining treatment for hypertension and hyperlipidemia. In adult patients, adverse events will be unlikely. However, decreased hepatic and renal functions in elderly patients may influence drug therapy recommendations.
It is recommended that the treatment starts with diuretics and beta blockers if possible because they have shown to decrease mortality and morbidity rates among the elderly population (Arcangelo & Peterson, 2013). However, because the patient suffered from obesity, it is important to consider the possibility of congestive heart failure. Therefore, beta-blockers, such as atenolol, should be reconsidered for elderly patients because they affect receptors located in the heart and kidneys, which causes them to affect heart rate, heart contractibility, and renin release (Arcangelo & Peterson, 2013). Both alpha-blockers and beta-blockers need to be carefully monitored because elderly patients have increased sensitivity to sympathetic inhibition medication, so they are at higher risk of volume depletion, and using half of the recommended dosage may be useful in preventing adverse events (Arcangelo & Peterson, 2013).
In order to improve the patient’s drug therapy plan, my first step would be to remove sertraline from the therapy plan because there is no documented usage of the substance in patients with hypertension or hyperlipidemia. Unless the patient is suffering from major depression disorder, social phobia, or panic disorder (American Society of Health-System Pharmacists [ASHSP], 2013b), there should be no valid reason to continue using that medication.
Also, it is important to consider that simvastatin is only a complimentary hypolipidemic drug that cannot be used effectively without exercise and effective dieting, and it should not be used for prolonged periods of time (ASHSP, 2013a). Patient education needs to be implemented in addition to the pharmacological treatment, and patient needs to be instructed to follow a heart-healthy diet, such as DASH, and engage in physical activity. Over time, drug dosage can be tapered gradually as the patient begins to manage the conditions with lifestyle changes.
References
Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
American Society of Health-System Pharmacists. (2013a, Jan. 11). Simvastatin. Retrieved from http://www.drugs.com/simvastatin.html
American Society of Health-System Pharmacists. (2013b, Feb. 15). Sertraline hydrochloride. Retrieved from http://www.drugs.com/monograph/sertraline-hydrochloride.html
