Introduction
Diseases of the cardiovascular system are among the most common and extremely dangerous. In addition, in many cases, the symptoms of these diseases are not noticeable without a thorough examination, as in the case of atherosclerosis (Mayo Clinic, 2021b). As a result, it is essential to analyze existing diseases and risk factors to prevent the development of these conditions. By controlling medical parameters, it is possible to significantly reduce the risks of developing abnormalities, such as coronary artery disease (CAD) (Centers for Disease Control and Prevention 2021). It can be achieved in the general case in two ways: through medication or non-pharmacological approaches. This paper confidently reviews the proposed case study of Mr. J. S. and analyzes his pharmacological history in the context of CAD. To accomplish this task, researchers may conduct a detailed analysis of the current situation, the impact of each drug, and an investigation of special considerations and interventions. Ultimately, the respected parties can form conclusions about the current situation and possible next steps in treatment.
Background
In the context of this patient’s ethnicity and history, the combination of his diseases and the medications taken are of the most outstanding value for analysis. According to the case study, Mr. S. has four problematic conditions: diabetes, hypertension, hyperlipidemia, and a long history of tobacco smoking. These items are among the significant risk factors for cardiovascular disease and CAD (Mayo Clinic, 2021b). Some of the other symptoms of the mentioned disease seen in the medical laboratories include high blood pressure and high cholesterol levels. However, only two medications are listed, not limited to amlodipine for hypertension and metformin for diabetes. Thus, there are currently no interventions to treat hyperlipidemia despite elevated LDL levels. There is also no mention of smoking cessation in the patient’s history. Both hyperlipidemia and frequent smoking are risk factors for developing cardiovascular diseases hence giving particular attention.
Finally, according to the situation presented, Mr. S. attended a CAD conducted by a physician, a risk factor data. Hence, he uses an ASCVD risk calculator to assess his overall CAD risk. Based on Mr. S.’s current performance, he has a 38.2% incidence, approximately 39.7% of cardiovascular disease. In addition, individuals should note that even with smoking cessation and increased drug treatment, the risk will remain high even after ten years. Thus, the current treatment method and the medications used urgently need revision to improve the patient’s health.
Discussion
Medication Analysis
Amlodipine Drug Analysis
The first drug under consideration is amlodipine, taken at 10 mg daily to treat hypertension. It is a widely used dihydropyridine calcium channel blocker, a group of drugs aimed at treating hypertension and CAD (Fares et al., 2016). The mechanism of action of amlodipine on the body is the organization of calcium influx to myocardial cells, reducing peripheral vascular resistance. Since the drug’s half-life is long, it is taken once a day, in the dosage of 2.5-10 mg. The drug should be taken by the elderly and people with liver failure cautiously, monitoring changes in blood pressure. The most common effect is peripheral edema, easily eliminated at a lower dosage or taken before bedtime. Finally, the drug is contraindicated in breastfeeding, unstable angina, and cardiogenic shock.
This medication is cheap enough for regular use; the cost varies depending on the dosage. A pack of amlodipine 10 mg containing 90 tablets ranges from $17.01 to $55.52 (Drugs.com, 2022). Since the drug is consumed once a day, the cost of its monthly intake will be from $5.67 to $18.5. In combination with its high level of efficacy, as evidenced by a reduction in the number of hospitalizations while taking the medication, amlodipine is highly beneficial as a first-line choice (Fares et al., 2016). It does not interact negatively with any other medicines, emphasizing its safety. Thus, the choice of amlodipine in this situation is fully justified; hence does not involve any risks. At the moment, I would not make any changes to the use of this drug since the pressure problem is unsolved.
The patient’s second medication closely related to their well-being and recovery is metformin- a widely used prescription. Metformin is the drug class of biguanides, and its mechanisms of action are complex. However, the drug is thought to increase insulin receptor sensitivity, thereby increasing peripheral cellular glucose uptake in the liver by decreasing hepatic glucose production and decreasing glucose absorption in the intestinal tract. (Rena et al., 2017). 20-30% of patients experience gastrointestinal side effects: nausea, vomiting, diarrhea (Rena et al., 2017). In addition, sometimes, an accumulation of metformin in the body leads to lactic acidosis, which is more likely in liver disease or chronic alcohol consumption (WebMD, 2020). The prescription is not dangerous in the case mentioned above since the client did not have such problems.
Dosages of the drug is 500-1000 mg per tablet and are taken 1-3 times a day for a month. The average price for a 60-tablet pack ranges from $13.58 to $30.86, and 90 tablet packs seem to range at 850 per month. TID metformin is a highly effective primary treatment option many healthcare practitioners use (Drugs.com, 2022d). This medicine often interacts with beta-blockers or medicines that affect blood sugar levels. Since the client does not have such drugs, taking metformin is not dangerous.
Moreover, the positives outweigh the risks: no effect on weight, low cost, high efficacy, and many studies confirm (Woo & Robinson, 2020). At the moment, the patient’s hemoglobin A1c levels are elevated but only slightly above pre-diabetic levels. Therefore, for the time being, it makes sense to increase the frequency of daily drug intake to a maximum of 3 (WebMD, 2020). If there is no improvement in the situation and a further decrease in A1c within three months, it will be necessary to move on to two-drug combinations, pravastatin, and Tylenol.
Pravastatin is another drug that can be utilized to help treat hyperlipidemia. It is designed to lower lipid levels and functions by inhibiting HMG-CoA reductase (DrugBank Online, 2022c). With this, cholesterol production is reduced for the patient in question. Existing studies note a deficient number of risks associated with the prescription: memory problems or a 0.1-0.2% increase in the risk of diabetes (Adhyaru & Jacobson, 2018). Additionally, muscle pain and weakness are possible (WebMD, 2022b). However, there is practically no risk of serious problems, contraindications, and interactions with other medicines.
Comprehensively, pravastatin, which aims to change to Atorvastatin 20-40mg or Lipitor, helps act as a moderate-intensity statin at this stage. As a dosage, 40 mg tablets are taken daily for a month. The mentioned drug is economical (Drugs.com, 2022e). In addition, compared with other medications in this group, pravastatin has a lower risk of developing diabetes (Adhyaru & Jacobson, 2018). This prescription will allow for the primary therapy of hyperlipidemia, reducing LDL-C levels by 50-75% (Bibbins-Domingo et al., 2016). It is possible to add additional drugs or increase the dosage in the future.
Patient Analysis
The drugs used and prescribed have a minimal list of side effects, do not conflict with each other, and do not have any specific conditions for taking them. Therefore, information regarding medicines should consist only of a description of the principles of use and dosages. The study did not reveal any particular relationship between the patient population and the current pharmacological approach. The next visit is preferably one month after the appointment for a new treatment. After this period, it will be possible to track the effectiveness of the prescribed treatment in the form of pravastatin and changes in metformin dosages and adjust if necessary.
The most serious issue is non-pharmacological interventions. Many considered prescriptions are not recommended for use with alcohol or constant smoking. In addition, the risk calculator shows that these elements significantly undermine the patient’s health. Based on the patient’s ASCVD, they can be placed on a lower dosage of aspirin to help lower the intensity of the pravastatin’s side effects. Therefore, smoking cessation should accompany medication, recommending Tylenol replacement therapy with a full workup.
Conclusion
As the analysis shows, the client has a high risk of developing cardiovascular diseases, including CAD. The medicines prescribed adequately addressed the two existing problems but did not cover the entire spectrum of risks. Therefore, in addition to a slight adjustment in metformin dosages, using pravastatin as part of statin therapy is suggested to reduce LDL-C levels and attenuate hyperlipidemia. Finally, the patient’s health is significantly undermined by an unhealthy lifestyle: smoking, alcohol, and an unbalanced diet. Therefore, it is necessary to make substantial adjustments in these areas in the framework of non-pharmacological interventions. However, even with the full implementation of all instructions, all these measures will not be able to reduce the high risk significantly. The patient is advised to monitor his health very carefully and undergo regular examinations to identify possible complications.
References
Adhyaru, B. B., & Jacobson, T. A. (2018). Safety and efficacy of statin therapy. Nature Reviews Cardiology, 15(12), 757-769. Web.
Bibbins-Domingo, K., Grossman, D. C., Curry, S. J., Davidson, K. W., Epling, J. W., GarcÃa, F. A., Gillman, M. W., Kemper, A. R., Krist, A. H., Kurth, A. E, & Landefeld, C. S. (2016). Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task Force recommendation statement. JAMA, 316(19), 1997-2007, Web.
Centers for Disease Control and Prevention. (2021). Coronary artery disease (CAD). Web.
DrugBank Online. (2022a). Amoxicillin. Web.
DrugBank Online. (2022b). Epinephrine: Uses, interactions, mechanism of action. Web.
DrugBank Online. (2022c). Pravastatin: Uses, interactions, mechanism of action. Web.
Drugs.com (2022d). Metformin prices, coupons, and patient assistance programs. Web.
Drugs.com. (2022a). Amlodipine prices, coupons, and patient assistance programs. Web.
Drugs.com. (2022b). Amoxicillin prices, coupons, and patient assistance programs. Web.
Drugs.com. (2022c). Asmanex HFA prices, coupons, and patient assistance programs. Web.
Drugs.com. (2022e). Pravastatin prices, coupons, and patient assistance programs. Web.
Drugs.com. (2022f). Ventolin HFA prices, coupons, and patient assistance programs. Web.
Fares, H., DiNicolantonio, J. J., O’Keefe, J. H., & Lavie, C. J. (2016). Amlodipine in hypertension: A first-line agent with efficacy for improving blood pressure and patient outcomes. Open Heart, 3(2), Article e000473. Web.
Mayo Clinic. (2020). Asthma. Web.
Mayo Clinic. (2021a). Amoxicillin (oral route). Web.
Mayo Clinic. (2021b). Arteriosclerosis/atherosclerosis. Web.
Mayo Clinic. (2022). Mometasone (inhalation route). Web.
Rena, G., Hardie, D. G., & Pearson, E. R. (2017). The mechanisms of action of metformin. Diabetologia, 60(9), 1577-1585. Web.
WebMD. (2022a). Metformin HCL – Uses, side effects, and more. Web.
WebMD. (2022b). Pravastatin SODIUM – Uses, Side effects, and more. Web.
Woo, T. M, & Robinson, M. V. (2020). Pharmacotherapeutics for advanced practice nurse prescribers (5th ed.). F. A. Davis Company.