Pharmacology, COPD, And Congestive Heart Failure Discussion

Pharmacology, COPD, And Congestive Heart Failure Discussion

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5. What patient education would you include when starting a patient on ace-inhibitor medication?

6. Johnathan is a 72-year-old Asian male who presents to the clinic for evaluation due to symptoms of dyspnea, wheezing and a productive cough with white, frothy sputum. He is a 1 Pack Per day (PDD) smoker for the last 40 years.
Vital signs: Temperature 98.0 F, BP 135/78, Pulse 88, R 22, Oxygen Saturation: 91% on Room Air. His postbronchodilator pulmonary function test today revealed FEV1/FVC at 55% of the predicted value.
Is there enough information given for Johnathan to be diagnosed with COPD? If not, what is missing? If so, what stage of COPD is Johnathan in?
What pharmacologic treatment plan would you formulate for Johnathan?
7. Discuss the first-line pharmacologic management of a patient with COPD.

8. Discuss the diagnostic criteria needed to make a diagnosis of Congestive Heart Failure (CHF)Pharmacology, COPD, And Congestive Heart Failure Discussion .
What diagnostic /lab studies would you need to help confirm a diagnosis of CHF?

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Discussion Questions: Pharmacology, COPD, and Congestive Heart Failure 

5. What patient education would you include when starting a patient on ace-inhibitor medication?

They should avoid taking over-the-counter nn-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) and naproxen sodium (Aleve). These reduce the therapeutic efficacy of ACE inhibitors. The patient must also tell the clinician if they are taking other medications already such as water pills (diuretics) or potassium tablets. The diuretics of concern here are potassium-sparing diuretics such as spironolactone (Aldactone). This is because combining potassium-sparing diuretics with ACE inhibitors presents the risk of hyperkalemia and hence deadly arrhythmias. The patient must also reveal if they are already taking a salt substitute because ACE inhibitors affect how kidneys retain sodium. Lastly, they must not take an ACE inhibitor if they are pregnant or are planning to become pregnant (Katzung, 2018; Rosenthal & Burchum, 2018)Pharmacology, COPD, And Congestive Heart Failure Discussion .

6. Johnathan is a 72-year-old Asian male who presents to the clinic for evaluation due to symptoms of dyspnea, wheezing and a productive cough with white, frothy sputum. He is a 1 Pack Per day (PDD) smoker for the last 40 years. Vital signs: Temperature 98.0 F, BP 135/78, Pulse 88, R 22, Oxygen Saturation: 91% on Room Air. His postbronchodilator pulmonary function test today revealed FEV1/FVC at 55% of the predicted value.

Is there enough information given for Johnathan to be diagnosed with COPD? If not, what is missing? If so, what stage of COPD is Johnathan in? What pharmacologic treatment plan would you formulate for Johnathan?

The GOLD recommendations state that a diagnosis of COPD is made when the patient exhibits dyspnea, a chronic productive cough, and a history of smoking cigarettes (GOLD, 2017). All of these conditions apply to this case. Thus there is enough information for him to be diagnosed with COPD. The GOLD (2017) guidelines state that if the forced expiratory ratio (FEV1/FVC) post-bronchodilator is less than 0.7 or 70%, COPD is verified as a diagnosis. The FER post-bronchodilator in this patient’s spirometry findings is actually 55%, or 0.55. This demonstrates that the patient has mild GOLD stage II (moderate) COPD (FEV₁/FVC < 70%; predicted 50% ≤ FEV₁ < 80%). All three of the patient’s other favorable COPD symptoms are now strengthened by this. These are dyspnea, a productive cough, and a 40-pack-year smoking background.

The pharmacological treatment plan I would offer will involve a long-acting anticholinergic (muscarinic antagonist) and empirical antibiotics as: Pharmacology, COPD, And Congestive Heart Failure Discussion

• Tiotropium (Spiriva) 18 mcg (2 inhalations) orally OD using an inhaler for one month.
• Azithromycin 500 mg BD orally for seven days (Katzung, 2018; Rosenthal & Burchum, 2018).

7. Discuss the first-line pharmacologic management of a patient with COPD.

A long-acting muscarinic antagonist (LAMA) or a long-acting beta-2 agonist (LABA) as monotherapy for the majority of patients, or dual bronchodilator therapy (LABA/ LAMA) in patients with more serious symptoms, irrespective of worsening history, is advised in the Global Initiative for Chronic Obstructive Lung Disease 2022 report (Miravitlles et al., 2022). These are the updated GOLD guidelines.

8. Discuss the diagnostic criteria needed to make a diagnosis of Congestive Heart Failure (CHF). What diagnostic /lab studies would you need to help confirm a diagnosis of CHF?

A physiological or anatomical heart disorder that impairs ventricular filling or blood ejection to the systemic circulation causes heart failure, a complicated clinical illness. By definition, it is an inability to satisfy the underlying needs of blood transportation. According to the widely accepted Framingham Diagnostic Criteria for Heart Failure, a patient must meet either two main criteria, or one major and two minor criteria, in order to be diagnosed as having heart failure (Malik et al., 2022). Acute pulmonary edema, neck vein distention, cardiomegaly, the hepatojugular reflex, paroxysmal nocturnal dyspnea (orthopnea)Pharmacology, COPD, And Congestive Heart Failure Discussion , a third heart sound, pulmonary rales, a weight loss of at least 4.5 kg in response to treatment in five days, a central venous pressure >16 cm of water, and radiographic cardiomegaly are among the major criteria. On the other hand, the minor criteria include hepatomegaly, ankle edema, dyspnea with effort, pleural effusion, tachycardia or a heart rate >120 beats per minute, nocturnal cough, and a reduction in vital capacity by one-third of the maximum figure observed.

References

Global Initiative for Chronic Obstructive Lung Disease [GOLD] (2017). Pocket guide to COPD diagnosis, management, and prevention: A guide for health care professionals. https://goldcopd.org/wp-content/uploads/2016/12/wms-GOLD-2017-Pocket-Guide.pdf

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Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8^th ed. McGraw-Hill Education.

Kennedy-Malone, L., Plank, L.M., & Duffy, E.G. (2019). Advanced practice nursing in the care of older adults, 2^nd ed. Davis Company.

Katzung, B.G. (Ed) (2018). Basic and clinical pharmacology, 14^th ed. McGraw-Hill Education.

Rosenthal, L.D., & Burchum, J.R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. Elsevier.

Miravitlles, M., Kawayama, T., & Dreher, M. (2022). LABA/LAMA as first-line therapy for COPD: A summary of the evidence and guideline recommendations. Journal of Clinical Medicine, 11(22), 1-19. https://doi.org/10.3390/jcm11226623 Pharmacology, COPD, And Congestive Heart Failure Discussion