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    Results in Bradycardia Therefore Not Effective: Diltiazem

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    Sittie Fahieda Aloyodan
    This patient is a 74-year-old man with type 2 diabetes, hypertension, dyslipidemia, and a history of peptic ulcer disease who is taking medications including Cardizem CD 240 mg, Glyburide 5 mg, and Niaspan 500 mg. His recent vital signs and lab results are unremarkable except for high total cholesterol and triglycerides. Niaspan is not recommended for this patient due to his history of peptic ulcer disease. An alternative such as atorvastatin should be considered.

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    Results in Bradycardia Therefore Not Effective: Diltiazem

    Uploaded by

    Sittie Fahieda Aloyodan
    80 views5 pages
    This patient is a 74-year-old man with type 2 diabetes, hypertension, dyslipidemia, and a history of peptic ulcer disease who is taking medications including Cardizem CD 240 mg, Glyburide 5 mg, and Niaspan 500 mg. His recent vital signs and lab results are unremarkable except for high total cholesterol and triglycerides. Niaspan is not recommended for this patient due to his history of peptic ulcer disease. An alternative such as atorvastatin should be considered.

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    Prescription Analysis

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    This patient is a 74-year-old man with type 2 diabetes, hypertension, dyslipidemia, and a history of peptic ulcer disease who is taking medications including Cardizem CD 240 mg, Glyburide 5 mg, and Niaspan 500 mg. His recent vital signs and lab results are unremarkable except for high total cholesterol and triglycerides. Niaspan is not recommended for this patient due to his history of peptic ulcer disease. An alternative such as atorvastatin should be considered.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    80 views5 pages

    Results in Bradycardia Therefore Not Effective: Diltiazem

    Uploaded by

    Sittie Fahieda Aloyodan
    This patient is a 74-year-old man with type 2 diabetes, hypertension, dyslipidemia, and a history of peptic ulcer disease who is taking medications including Cardizem CD 240 mg, Glyburide 5 mg, and Niaspan 500 mg. His recent vital signs and lab results are unremarkable except for high total cholesterol and triglycerides. Niaspan is not recommended for this patient due to his history of peptic ulcer disease. An alternative such as atorvastatin should be considered.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 5

     AA is a 74-year old, non-smoking, white man with a history

    of DM2, HTN, dyslipidemia, and peptic ulcer disease who


    comes to your community pharmacy to pick up his
    prescription. He was told by his doctor today that his
    physical exam was unremarkable. He shows you his vitals
    and fasting lab results obtained today.
     He said that he wants to take only oral medications at this
    time and is not ready for injections. He reports that he
    measures BP and HR at home and, for the past 3 months,
    they have run 142-156/73-78 mmHg and 52-62 bpm,
    respectively. He regularly eats 3 meals per day and reports
    100% adherence to his medications and TLC. He has no
    complaints and denies any hypoglycemic episodes,
    weakness, fatigue, dizziness, lightheadedness, abdominal
    pain, or muscle pain.
     Evaluate the medications AA is currently taking by viewing
    his patient profile. If you determine any of the medications to
    be inappropriate, identify them along with justification.
    Provide an alternative to any inappropriate medications you
    identified.
     
    1. Cardizem CD 240 mg cap
    Diltiazem is used to treat high blood pressure (hypertension)
    and prevent chest pain (angina). It is called a calcium channel
    blocker. It works by relaxing blood vessels in the body and
    heart so blood can flow more easily.
     
    Diltiazem is a drug that is used for treating heart pain (angina), high
    blood pressure, and abnormal heart rhythms.
     
    Results in bradycardia therefore not effective
     
    Alternative: Verapamil
    Verapamil is used to treat high blood pressure and to
    control angina (chest pain). The immediate-release tablets are also
    used alone or with other medications to prevent and treat irregular
    heartbeats. Verapamil is in a class of medications called calcium-
    channel blockers.
     

    2. Glyburide 5 mg tab
    Glyburide is used with a proper diet and exercise program to control
    high blood sugar in people with type 2 diabetes. It may also be used with
    other diabetes medications. Controlling high blood sugar helps prevent
    kidney damage, blindness, nerve problems, loss of limbs, and sexual
    function problems. Proper control of diabetes may also lessen your risk
    of a heart attack or stroke.

    3. Niaspan 500 mg tab


    Niacin is used with a proper diet and exercise program to help lower
    "bad" cholesterol and fats (LDL, triglycerides) and raise "good"
    cholesterol (HDL) in the blood. It is generally used after non-drug
    treatments have not been fully successful at lowering cholesterol. Niacin
    is also known as vitamin B-3 (nicotinic acid), one of the B-complex
    vitamins
     
    The patient has peptic ulcer disease! Therefore, not effective.
     
    For people with active peptic ulcer disease: You should not take niacin if you
    have active peptic ulcer disease. This drug can increase the amount of acid in
    your stomach. This may aggravate your ulcer.
     
    Consult the doctor
     

    From <https://www.google.com/search?
    safe=active&rlz=1C1ASVC_enPH918PH918&sxsrf=ALeKk00cOrZEM5pB
    63DcT54C8TtO6vxhHA
    %3A1607061711217&ei=z9DJX57fDL3WmAXplabIBg&q=taking+niasp
    an+with+peptic+ulcer&oq=taking+niaspan+with+peptic+&gs_lcp=CgZ
    wc3ktYWIQAxgAMgUIIRCgATIFCCEQoAE6BAgAEEc6BAgjECc6CAgAEM
    kDEJECOgUIABCRAjoECAAQQzoFCAAQsQM6BQguELEDOgIIADoOCC4Q
    sQMQgwEQxwEQowI6BwgjEOoCECc6CAgAELEDEIMBOggILhCxAxCDA
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    ggAELEDEMkDEAo6BAgAEAo6CQgAEMkDEBYQHjoGCAAQFhAeOgcIIR
    AKEKABOgQIIRAVUJzPIFiWpSFg5K8haAZwAngBgAGDA4gBziqSAQg1LjI
    xLjYuM5gBAKABAaoBB2d3cy13aXqwAQrIAQjAAQE&sclient=psy-ab>
     

    Normal
    Mababa or mataas sa patient

    Laboratory Results
    BP – 145/78 mmHg - normal 120/80
    The general pattern is that blood pressure rises with age, so normal
    variations tend to be higher for older adults.
     
    HR – 52 bpm - 60-100
    In general, for adults, a resting heart rate of fewer than 60 beats per minute
    (BPM) qualifies as bradycardia.
     
    Na – 138 mmol/L 135-145 mmol/L
    This test measures the levels of sodium in your blood. Sodium is a
    substance your body's cells need to work normally. Sodium helps make
    sure that your nerves and muscles can work as they should.
     
    K- 4.0 mmol/L 3.7-5.2 mmol/L
    Potassium is one mineral that plays an important role in controlling the
    amount of fluid in the body.
     
    BUN – 14 mg/dL 7-21 mg/dL
    A common blood test, the blood urea nitrogen (BUN) test reveals important
    information about how well your kidneys and liver are working. A BUN test
    measures the amount of urea nitrogen that's in your blood.
    Results of a BUN test are measured in milligrams per deciliter (mg/dL).
     
    Scr (Creatinine (Serum) Level)
    A serum creatinine test measures the amount of creatinine in your blood. Creatinine is a
    waste product that is produced from the normal wear and tear on muscles in your body.
     
    Spot urinary albumin – less than 30 microgram/mg creatinine
    Albumin is a major protein normally present in blood, but virtually no
    albumin is present in the urine when the kidneys are functioning properly.
     
    A1c 7.9 % (down from 8.7 % on 2/1/2014) below 5.7
    The hemoglobin A1c test tells you your average level of blood sugar over
    the past 2 to 3 months. It's also called HbA1c, glycated hemoglobin test,
    and glycohemoglobin.
    The A1c test is also used to diagnose diabetes.

    TC – 300 mg/dL 100-199 mg/dL for those over age 21


    Your total blood cholesterol is a measure of LDL cholesterol, HDL
    cholesterol, and other lipid components.
     
    HDL – 35 mg/ dL greater than 40 mg/dL for men
    When it comes to HDL cholesterol -- "good" cholesterol - a higher number
    means lower risk. This is because HDL cholesterol protects against heart
    disease by taking the "bad" cholesterol away
     
    TG – 650 mg/ dL below 150 mg/dL
    Triglycerides are a type of fat (lipid) found in your blood.
    Triglycerides store unused calories and provide your body with energy.
    Cholesterol is used to build cells and certain hormones.spor
     
    ALT- 30 U/L 29-33 for males
    An alanine aminotransferase (ALT) test measures the level of ALT in your
    blood. ALT is an enzyme made by cells in your liver.
    Measuring the level of ALT in a person’s blood can help doctors evaluate
    liver function

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