Reply to my peers

Peer 2

Discussion Questions

What would you add to the current treatment plan? Why?

In addition to his current treatment plan, I would also add acetaminophen to help in the management of the patient’s pain.  The correct dosage that would guarantee the effectiveness of the aforementioned medication in the management of the patient's pain is 1 gm TDS. However, since the patient also has diabetic neuropathy, I would also use Amitriptyline as a positive treatment action to reduce the ill effects of the diabetic aspect of the patient's condition.

Would you discontinue any of the currently prescribed medications? Why or why not?

Given that the patient has not presented any side effects from the previous medications, I see no need to discontinue any of them. Moreover, the physical examination of the patient indicates significant progress and no apparent signs of deterioration. This is a clear indication that the medications have effectively helped in maintaining the patient’s health. 

How does the diagnosis stage 3 chronic kidney disease affect your choices?

Some prescription medications the patient uses are lisinopril and atenolol. They are all eliminated by the kidney. If a person is suffering from chronic renal disease (CKD), careful consideration must be given to the choice of drug prescribed to the patient. As discussed by Narva et al. (2016), these conditions alter the function of the kidney, and the medication that is disposed of via the kidney is therefore not effectively eliminated. The patient also has diabetes and high blood pressure, which make the function of the kidney worse. So I would consider swapping Lisinopril and Atenolol for drugs that do not rely on the kidney for disposal. 

Why is the patient prescribed more than one antihypertensive?

The risk of high blood pressure in patients with type II diabetes is increased and usually requires more aggressive methods of hypertension management. The patient, therefore, receives more than one blood pressure antihypertensive. For patients with comorbidity like diabetes mellitus, De Boer et al. (2017) outline that the use of multiple antihypertensive agents is designed to reduce the clinical cardiovascular effects as much as possible.

What is the benefit of aspirin therapy in this patient?

According to Peters and Mutharasan (2020), Aspirin reduces the risk of cardiac attacks, blood pressure, and stroke and is, therefore, a crucial form of treatment in this case. Aspirin also reduces the chance of clotting blood, which is crucial to Mr. EBR. Aspirin should be taken at bedtime to ensure proper efficiency. However, caution is required, as Aspirin may cause bleeding in the intestines and increase the risk of bleeding. Aspirin may also be harmful to the health of some patients if used every day. Aspirin is particularly useful for people with coronary artery disease (CAD) or atherosclerosis, people with a cardiac attack, people with bypass operations, angioplasty or stent treatments, and for people with a transient ischemic attack before. Aspirin is particularly useful (TIA). In these groups of people, taking Aspirin may prevent fatal results. Aspirin should not be taken on an empty stomach to prevent adverse effects from aspirin consumption. In order to prevent stomach upsets, the patient should take Aspirin after foods with a full glass of water. Aspirin should not be consumed with alcohol as the risk of gastrointestinal bleeding increases.

References

De Boer, I. H., Bangalore, S., Benetos, A., Davis, A. M., Michos, E. D., Muntner, P., Rossing, P., Zoungas, S., & Bakris, G. (2017). Diabetes and hypertension: A position statement by the American Diabetes Association. Diabetes Care, 40(9), 1273-1284. https://doi.org/10.2337/dci17-0026

Narva, A. S., Norton, J. M., & Boulware, L. E. (2016). Educating patients about CKD: The path to self-management and patient-centered care. Clinical Journal of the American Society of Nephrology, 11(4), 694-703. https://doi.org/10.2215/cjn.07680715

Peters, A. T., & Mutharasan, R. K. (2020). Aspirin for prevention of cardiovascular disease. JAMA, 323(7), 676. https://doi.org/10.1001/jama.2019.18425