Patient Scenario:
Subjective:  Mrs. Smith is a 52 year old African American female.  She presents for follow up for elevated BP at her last visit 160/94.  She was to trial lifestyle

modifications by limiting salt, eating low fat, sugar and high fiber and replaced fried foods with baked or broiled chicken or lean meats.  She presents today with her

BP diary 164/98; 170/100.

Current meds:  asa 81mg qd, Mylanta
Allergies:  NKDA
PMH:  Heart burn

FamHx:  Mother DM II and HTN;  Father  MI age 60 deceased

Social:  smokes 1ppd x 30 yrs.

Objective:        Wt:  195 lbs.  Ht 5’6”
Vitals:  BP 172/104  HR 82     RR 12
Waist circum: 38 in.
Exam: unremarkable

Assessment: High Blood Pressure
Plan:  What medication will you prescribe for your patient?  What education will you provide for your patient?

Critical Thinking Questions Portion (19 pts)-  Answers the questions in the format presented.

Include a research article and evidenced based guideline that supports your decision making and selection process.   Give rationale and reference your information.

1.    To start Review JNCVIII guidelines [can be found under this cardiac module] and Chapters 16 and 40 they will guide you to the best choice for your patient.
(a)    Why have you selected this medication in this special patient population?  Explain your critical thinking.  What class is this medication in?
(b)    What is the pharmacodynamic action of the medication you choose?  Explain how it will lower your patient’s BP.
(c)    Identify your concerns or “red flags” in the Subjective – this is what the patient tells you.  How has this impacted your choice in medications?
1. ______________
2. ______________
3. ______________
5. _______________
(d)    What concerns you about the patient exam?  How has this impacted your medication choice?
1. _______________
(e)    What other medication did you consider prescribing?  What is the
pharmacodynamic action?  [5pts.]

2.List 3-5 instructional points you would include in educating the patient. (Note: There are probably many things you could include in your instruction but do not

exceed 5 points. Select the most important points relative to this medication and this case.  Don’t just copy and paste into this section.  Make it meaningful to this

(a)    What education will you include about the medication you prescribed?
(b)    What other education needs to be included that is non-pharmacological education that is pertinent to this patient?  [5 pts.]

3.What are the potential side effects and/or adverse drug reactions and how should they be managed?
(a) What are the most common side effects/adverse reactions can patients
Experience list the top 5?
2. _______
3. ________
4. ________

(b)What side effects/adverse drug reactions are your worst case  scenarios?
(c) If these occur, what would you want your patient to do?  What will your
education include in those side effects that patient can trial a treatment
before calling office or seeking medical attention.     [1 pts.]

4.What are potential drug interactions for your patient and what would your education and management include? (Note: This answer may be none.)  Don’t just copy and

paste drug interactions into this area.
(a)What is applicable for this patient?  The medication(s) she is taking is
there a risk for a potential drug interaction(s) with the medication you have
(b)Does she need education about OTCs that may interact with the med you
have prescribed?   [1 pts.]

5.Did you prescribe a generic or a brand/trade name?
(a) What is the generic name?  What is the brand name?
(b)Is there a generic version of this medication available?
(c) Is there a brand/trade version of this medication?  What is an example of
this, if so what is it called?
(d)What is your rationale for prescribing or not prescribing a generic
preparation? [0.5 pts.]

6.What is the cost of this medication?
(a)How does it compare to other options available for this patient?  What is
the cost of the other medication you considered prescribing to this patient?
(b)Is the medication as you prescribe it on the $4 lists available at Walmart,
Costco, Fred Meyers, Target, etc?   [0.5 pts.]

7.How would you monitor the efficacy of this medication?
(a) Specifically, when would you expect this medication to work?
(b)When would you want to see this patient again?
(b)At the follow up visit how will you determine efficacy?

(1) What questions will help you determine if this medication is
helping your patient?
(2)How will your exam help you determine if this medication is helping your patient?
(d)Are there lab tests or other information that you would need to gather to see if this medication is efficacious?  Are there any labs that need monitoring with this

medication?   [2.5 pts.]

8.What are alternative treatment plans should this option fail? The medication you choose initially is not meeting BP goals at 6 month follow-up.
(a) Will you increase the dose of initial med prescribed?  If so what will you
increase to?
(b) Will you choose to add another medication? What will you choose?
Explain.  Will you stop the initial med you choose?
(c) What dose will you start patient at?  [2.5pts.]

9.Include at least three references, including one Internet resource URL with a very brief explanation of what was used from the site.  Use MD Consult located under

On-line data bases.    [1pts.]

You prescribe medication today for her Diagnosis of Hypertension using the blank prescription form.  Fill it out completely.  Using the critical thinking questions,

justify your selection(s).

Seven Required Aspects:
•    Date prescription is written.
•    Name, birthdate and address of patient.
•    Inscription (name of drug and strength).
•    Subscription (quantity to be dispensed and administration aids).
•    Transcription (label instructions for patient) – dose, frequency, route of administration, duration of therapy, indications for medication.
•    Refill information.
•    Prescriber’s informations



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