Two references per each replies
Laura Rosa Alonso Salido
2 hours
ago, at 4:54 PM
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Mrs. Allen should be given Bidil, ACE inhibitors, beta-blockers, statins, and diuretics, according to
th
e ACC/AHA guidelines. For African Americans with heart failure, hydralazine and isosorbide dinitrate (Bidil) are commonly recommended (Arnett et al., 2019). Other ACE inhibitors like captopril, lisinopril, ramipril, and others can be used. Given Mrs. Allen’s age and weight, starting high-dose therapy would be preferable, as patients who take large dosages of drugs had a “much-decreased risk of hospitalization and fatality” (Berliner & Bauersachs, 2017). Angiotensin II receptor blockers, such as Losartan or Valsartan, are used in conjunction with ACEIS to reduce peripheral vascular resistance, stimulate the sympathetic nervous system, and increase the release of ADH and aldosterone. Bisoprolol and other beta-blockers are commonly prescribed. The use of beta-blockers like Bisoprolol or Carvedilol will activate the sympathetic nervous system, resulting in an increase in “heart rate and myocardial contractility” (Berliner & Bauersachs, 2017). Finally, due to the patient’s obesity, diuretics are advised. These drugs will aid in the removal of excess fluids from the body.
Angiotensin Receptor Blockers (ARBs) can be used to treat people with cardiovascular issues who are intolerant to angiotensin-converting enzyme inhibitors (ACE). The drug is fully safe for this patient and has a high effectiveness rate, especially among African-Americans. Furthermore, when compared to Angiotensin-Converting Enzyme Inhibitors, the medications are favored because they lessen cough side effects. According to Woo and Robinson (2015), the amount of ARB dosage has no effect because efficacy remains strong even at greater doses. Valsartan is one of the two most often used Angiotensin Receptor Blockers in the treatment of heart failure, according to the FDA.Mrs. Allen should also be given Spironolactone as a second medicine. It is a medicine that can be used in conjunction with other medications to treat hypertension and high blood pressure because it improves vascular remodeling (Funder, 2017). Because the patient does not have kidney failure, the correct dosage of Valsartan can be used to manage the symptoms and side effects.
References
Woo, T. M., & Robinson, M. V. (2015).
Pharmacotherapeutics for advanced practice nurse prescribers
(4
th
ed.). F.A. Davis.
Arnett, D.K., Blumenthal, R.S., Albert, M.A., Buroker, A.B., & Golberger, Z. V. (2019). 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 140(11), e596-e646.
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Luanda Gan Bedoya
The AHA and ACC guidelines require that patients at risk of cardiovascular complications need medication to improve their cardiovascular health. Therefore, Valsartan should be given to Mrs. Allen as the angiotensin antagonist of choice. The drug has been proven to be an effective treatment for cardiovascular diseases (Pascual-Figal et al., 2021). Furthermore, the drug has been associated with minimal hospitalization for heart failure or mortality from cardiovascular complications.
In patients with cardiovascular health problems, the Angiotensin Receptor Blockers (ARBs) can be substituted for patients intolerant to the Angiotensin-Converting Enzyme Inhibitors (ACE). The medication is completely safe for this patient and has high efficacy, especially among African American patients. Additionally, the drugs are preferred compared to the Angiotensin-Converting Enzyme Inhibitors as they reduce adverse reactions of cough. According to Woo and Robinson (2015), the amount of dosage of ARBs has little impact, as even in higher doses, the efficacy is still very high. The FDA has approved Valsartan as one of the two most common Angiotensin Receptor Blockers used in treating heart failure.
The second medication that should be administered to Mrs. Allen is Spironolactone. It is a medication that can be used alongside other drugs to treat hypertension and high blood pressure as it has a favorable effect on vascular remodeling (Funder, 2017). Since the patient has no problem with kidney failure, administering the correct dosage of Valsartan can control the condition and regulate the side effects.
As mentioned above, treatment coupled with controlling hypertension and heart failure will act as a cardioprotective option for the patient. Since these are safe methods to manage the risk of heart failure, the client will not need additional medicine to treat the condition. In addition, the procedures are safely proven to prevent myocardial infractions, which Mrs. Allen has suffered in the past. Therefore, based on the patient’s history, the recommended treatments will help without additional medications.
References
Funder, J. W. (2017). Spironolactone in cardiovascular disease: An expanding universe? F1000Research, 6, 1738.
https://doi.org/10.12688/f1000research.11887.1
Pascual-Figal, D., Bayés-Genis, A., Beltrán-Troncoso, P., Caravaca-Pérez, P., Conde-Martel, A., Crespo-Leiro, M. G., Delgado, J. F., Díez, J., Formiga, F., & Manito, N. (2021). Sacubitril-valsartan, clinical benefits and related mechanisms of action in heart failure with reduced ejection fraction. A review. Frontiers in Cardiovascular Medicine, 8.
https://doi.org/10.3389/fcvm.2021.754499
Woo, T. M., & Robinson, M. V. (2015).
Pharmacotherapeutics for advanced practice nurse prescribers
(4
th
ed.). F.A. Davis.
Gioconda A. Orellana
The Patient Need: Determine the Medications for CHF/ASCVD
1. Following the ACC/AHA guidelines, Mrs. Allen should be prescribed Bidil, ACE inhibitors, beta blockers, statins, and diuretics. Hydralazine and isosorbide dinitrate (Bidil) is usually prescribed for African Americans with heart failure (Arnett et al., 2019, p. e600). Captopril, Lisinopril, Ramipril, or other ACE inhibitors can be chosen as well. Considering Mrs. Allen’s age and obesity, it would be better to start the high-dose therapy, as patients that take high doses of medications have a “significantly lower risk for hospitalization and mortality” (Berliner & Bauersachs, 2017, p. 545). Angiotensin II receptor blockers, such as Losartan or Valsartan, are prescribed in parallel with ACEIS, as they improve peripheral vascular resistance, activate the sympathetic nervous system, and increase ADH and aldosterone release. The prescription of such beta-blockers as Bisoprolol or Carvedilol will result in the activation of the sympathetic system, with a forthcoming rise in “heart rate and myocardial contractility” (Berliner & Bauersachs, 2017, p. 550). Finally, diuretics are recommended because of the patient’s obesity. These medications will help remove excessive fluids from the body.
2. From Mrs. Allen’s family medical history it is clear that she is in the high-risk group, because her father and brother had MI. At present, the woman has health-related risk factors that might cause MI such as obesity, shortness of breath, leg edema, and primary hypertension. Besides, (Berliner et. al, 2019) “HF increases the risk of thromboembolism” (p. 551). Special attention should be paid to her smoking history and alcohol consumption. The patient’s symptoms listed above might simultaneously indicate CHF and MI. For this reason, it is expedient to give her medications for MI prevention
3. As the future FNP, I would prescribe Bidil, diuretics, and statins to Mrs. Allen. In addition to these medications, Lisinopril and Losartan would mitigate symptoms of the disease and improve the patient’s life quality. Diuretics will help regulate the patient’s hypertension (Ghimire & Dhungana, 2019, p. 79). These medications are prescribed with the consideration of the patient’s ethnic group, age, and current medical and family history. Many risk factors are present; for this reason, she should be stabilized as soon as possible.
References
Arnett, D.K., Blumenthal, R.S., Albert, M.A., Buroker, A.B., & Golberger, Z. V. (2019). 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 140(11), e596-e646. https:doi.org/10.1161/CIR.00000000000678