Medication Options
Mr. Navaro has a history of type 2 diabetes, hypertension, hyperlipidemia, and coronary artery disease (CAD), which resulted in a cardiac stent placement six months ago. The choice of medications plays an important role in his course of treatment as it affects complications prediction. CAD is when coronary arteries cannot supply the heart with blood and oxygen due to high cholesterol deposits and plaques (Murphy et al., 2021).
Dual antiplatelet therapy (DAPT) with Aspirin and P2Y12 inhibitors (Clopidogrel) is a commonly prescribed intervention for one year (Howard & Khot, 2021). This approach is characterized by a high possibility of decreasing the risks of ischemia, bleeding, and stent thrombosis (Howard & Khot, 2021). Following the guidelines of the U.S. Preventive Services Task Force (USPSTF) (as cited by Murphy et al., 2021), a daily aspirin dose is between 75 and 100 mg for the next 12 months (81 mg tablet for the patient). Clopidogrel is prescribed for the next six months, with a dose of 75 mg once a day (“Clopidogrel,” 2022). If there is a risk of acute coronary syndrome, its intake duration will be increased for one year.
There are also several medications to control the patient’s diabetes and high levels of blood pressure and cholesterol. Atorvastatin (Lipitor) is a regularly taken statin to reduce cholesterol levels by at least 45% (10 mg per day) (“Atorvastatin,” 2022). The chosen drug slows cholesterol production in the body, improves arteries’ walls, and stabilizes blood flow.
Lisinopril is effective in treating high blood pressure and improving the work of the heart (“Lisinopril (Oral route),” 2022). The initial dose of Lisinopril for adults with hypertension is 10 mg daily (“Lisinopril,” 2022).
Finally, Mr. Navaro is a diabetic patient, and the use of Metformin is obligatory. Taken alone, Metformin (1000 mg – Fortamet or 500 mg – Glucophage/Glumetza) once a day is prescribed to adult patients to achieve A1C levels of 6-7% (Croke, 2018; Mohammed et al., 2021). The change of a drug or its dosage depends on the vital signs and the presence/absence of side effects.
Side Effects
Despite the expected improvements in the patient’s health, all medications have certain side effects, and it is important to provide clear explanations and preventive measures. According to the UpToDate guidelines and recommendations, the chosen medications can be combined without worsening the patient’s well-being but promoting pharmacological benefits like the reduction of heart complications (“Atorvastatin,” 2022; “Clopidogrel,” 2022; “Lisinopril,” 2022).
At the same time, diarrhea, nausea, and dizziness are the adverse effects of most of the offered medications. Lisinopril might provoke confusion and blurred vision, which affects the quality of life (“Lisinopril,” 2022). The patients may experience a lack of appetite and abdominal discomfort due to Metformin being taken irregularly or muscle pain because of improved insulin sensitivity (Mohammed et al., 2021). If the patient reports some of these changes, medication dosage should be reduced to check its effectiveness.
The prescription of DAPT with Aspirin and Clopidogrel is usually effective for patients after stent placement. However, doctors should educate the patient on what systems may be negatively affected. According to Howard and Khot (2021), gastrointestinal bleeding occurs during the last six months of the drug course because this risk is directly proportional to the therapy’s length. The point is that the protective benefit is noticeable during the first several months and lowers over time, shifting to other system parts. Mortality rates after stent placement change due to cardiovascular and non-cardiovascular causes (Howard & Khot, 2021). All these side effects can be possible, but their progress is usually regulated by regular doctors’ assessments and recommendations.
Patient Education
In addition to discussing the side effects of the chosen treatment plan, patient education should be promoted to underline the role of the patient in his healing process. On the one hand, much attention is paid to what healthcare providers talk about and decide and how patients follow the recommendations offered. On the other hand, instead of blindly trusting personal health to someone’s hands, it is obligatory to take responsibility and constantly improve knowledge. Thus, patient education is a good way for ordinary people without medical awareness to strengthen their contributions to well-being and healing.
Mr. Navaro is a Hispanic male patient who needs to memorize medications and follow the offered treatment plans. Hispanics introduce a fast-growing, diverse community whose cultural and demographic factors should be ignored. First, it is necessary to ensure the man clearly understands all aspects of his treatment plan in terms of the chosen language and dosage. Secondly, many Hispanics have financial problems and cannot afford to buy all medications. Therefore, the healthcare provider should gently ask about the possibility of having all prescribed medications and insurance coverage. For example, ten hours of free diabetes education is available for patients with Medicare (Centers for Disease Control and Prevention [CDC], 2022).
Diabetes self-management education and support focus on promoting a healthy life with diabetes, monitoring blood sugar levels, and assessing physiological changes (CDC, 2022). Hypertension/hyperlipidemia education covers diet, physical exercises, and excluding smoking and alcohol habits. The patient should reduce the risks of heart attacks (due to his CAD) by checking the symptoms like chest discomfort and shortness of breath. Communication and cooperation between the patient and his doctor/nurse are highly recommended not to miss a new health concern.
References
Atorvastatin: Drug information. (2022). UpToDate. Web.
Centers for Disease Control and Prevention. (2022). Education and support. CDC. Web.
Clopidogrel: Drug information. (2022). UpToDate. Web.
Croke, L. (2018). Type 2 diabetes mellitus: ACP releases updated guidance statement on A1C targets for pharmacologic glycemic control. American Family Physician, 98(9), 613-614. Web.
Howard, T. M., & Khot, U. N. (2021). Dual antiplatelet therapy after percutaneous coronary intervention: Personalize the duration. Cleveland Clinic Journal of Medicine, 88(6), 325-332. Web.
Lisinopril (Oral route). (2022). Mayo Clinic. Web.
Lisinopril: Drug information. (2022). UpToDate. Web.
Mohammed, I., Hollenberg, M. D., Ding, H., & Triggle, C. R. (2021). A critical review of the evidence that metformin is a putative anti-aging drug that enhances healthspan and extends lifespan. Frontiers in Endocrinology, 12. Web.
Murphy, E., Curneen, J. M., & McEvoy, J. W. (2021). Aspirin in the modern era of cardiovascular disease prevention. Methodist DeBakey Cardiovascular Journal, 17(4), 36-47. Web.