Is there a better medication than a Thiazide, and if so what dose should you initiate this medication?
Although Thiazide diuretics are among the drugs that have been used for a long time to address issues relating to hypertension, it is not recommended for the elderly. To address the issue presented before my clinic concerning Elliot, I will need to use several other drugs that, unlike Thiazide, work well with elderly individuals and display minimal side effects. Some of the drugs that I can utilize in the management of Elliot’s case include Calcium Channel Blockers (CCB), Angiotensin-Converting Enzyme Inhibitor (ACEI), as well as Angiotension Receptor Blocker (ARB).
Precisely, the classification of drugs that I will use includes Lisinopril (ACEI), Nifedipine (CCB), and Losartan in the class of ARBs. These drugs work well and can be useful in the management of hypertension among the elderly especially those who are older than 60. In the words of Allan, Ivers, and Padwal (2012), the effectiveness of Thiazide diuretics among the elderly is a matter that scholars and stakeholders in the medical sector are researching. The drugs are subjected to research due to the side effects that they cause.
Due to the controversy surrounding the use of Thiazide in the treatment of hypertension among the elderly, I will utilize drugs such as CCBs, ACEIs, and ARBs. Notably, CCBs are very effective as they lower the blood pressure by relaxing blood vessels through minimization of the stiffness common in large vessels. It is fundamental to explain that by curbing the issue of stiffness in large vessels, the drug reduces systolic BP.
On the other hand, ACEI is very vital in the treatment of hypertension especially among people who have a high susceptibility to diabetes mellitus (Wan, Ma, & Zhang, 2014). As such, it is very important in Elliot’s case. The functionality of the drug lies in its ability to render Renin Angiotensin Aldosterone System (RAAS) ineffective, thereby reducing the instances of hypertension among individuals suffering from diabetes mellitus. I will also use ARBs alongside a small dosage of Thiazide in the treatment and management of Elliot’s high blood pressure.
How would you proceed and how you would monitor for efficacy and toxicity?
The progress of my treatment will follow a systematic format. Remarkably, the essence of my systematic format emanates from the effectiveness and side effects associated with drugs used such as Thiazide. To ensure that the treatment yields productive results and becomes practical in the management of Elliot’s case, I will tabulate his results and monitor any changes in his sugar levels and blood pressure.
The relevance of closely monitoring the changes emanates from the use of drugs like Thiazide that have side effects. Notably, Thiazide can trigger a reduction in the amount of sodium and magnesium and an increase in the levels of calcium. An increase in the amounts of calcium and reduced levels of magnesium and sodium has side effects that include confusion and weakness. Moreover, the drug can also lead to the development of gout, a factor that has limited its efficiency in the treatment of hypertension among the elderly.
Consequently, other drugs that comprise CCBs, ACEIs, and ARBs also require scrutiny and follow-up in the aftermath of their use. Wan, Ma, and Zhang (2014) explain that CCBs can lead to side effects such as irregular heartbeat, dizziness, and constipation. Besides, ACEIs and ARBs are associated with complications that include hypotension, renal impairment, and dizziness. Therefore, to ensure that the prescription yields positive outcomes, there is a need to follow up closely on the progress of the medication. It is also paramount to encourage Elliot to engage in regular exercises and a healthy diet so that the effectiveness of the drugs augments.
References
Allan, G., Ivers, N., & Padwal, R. (2012). Best thiazide diuretic for hypertension. Canadian Family Physician, 58(6), 653-653.
Wan, X., Ma, P., & Zhang, X. (2014). A promising choice in hypertension treatment: Fixed-dose combinations. Asian Journal of Pharmaceutical Sciences, 9(1), 1-7.