NUR 302 Concepts In Nursing
Question:
Prinzide is a combination drug that comprises of Lisinopril an angiotensin-converting enzyme inhibitor (ACEI) and Hydrochlorothiazide (HCTZ) is a diuretic. ACEIs can cause fetal and neonatal morbidity and mortality, and is a Pregnancy Category C in the first trimester of pregnancy and Pregnancy Category D in the second and third trimesters and during lactation. Hydrochlorothiazide is a Pregnancy Category B (Woo & Wynne, 2011). In this case, it is contraindicated for BD to continue the current therapy of Prinzide.
By shyRhonda:
Given that BD is pregnant, would there be any contraindications pharmcalogically with treating her HTN?
Yes, according to James & Nelson-Piercy (2004), ACE inhibitors and Angiotension II Receptor blockers (ARB) are fetotoxic and should be discontinued within the first trimester of pregnancy. The greatest risk to the fetus is during the third trimester however the earlier they are discontinued the better. Such malformations to the fetus include: oligohydramnios, joint contractures, pulmonary hypoplasia, hypocalvaria, fetal renal tubular dysplasia or neonatal renal failure.
Depending on the severity of BD’s hypertension, it maybe she can be removed from her hypertensive medications and monitored closely during the first trimester half of her pregnancy due to the physiological fall in blood pressure during this time (James & Nelson-Piercy, 2004). If need be, therapy can be started when blood pressure reaches mild-hypertension at 140/90 (Podymow, T. & August, P., 2008).
The first line drug for chronic hypertension during pregnancy is Aldomet/methyldopa which is a centrally acting alpha agonist. This drug works at the site of the brain stem to decrease mental alertness leading to impaired sleep which may lead to fatigue and/or depression. For this reason, it should be used in caution in women who have a history of depression. Aldomet has not demonstrated to have had adverse effects on uteroplactal fetal hemodynamics or development (Podymow, T. & August, P., 2008).
Answer:
According to the three articles, the overarching theme is the high blood pressure. According to the Whelton PK et al. (2017 High Blood Pressure Clinical Practice Guideline), I have been able to learn that the establishment of the guideline to help tackle the BP as a source for both clinical and public health practice communities. From this guideline, I have been able to recognize that it was designed to be comprehensive yet succinct as well as providing in the provision of guidance for preventing, detecting, evaluating, and managing hypertensions. I have further learned that this guideline is a more effective one in dealing with BP as compared to the JNC7 because it has incorporated novel info from researches of office-oriented BP-linked risks of cardiovascular disease, ambulatory BP monitoring, home BP monitoring, telemedicine alongside a range of areas. However, I have as well understood that the guideline doesn’t address the utilization of BP-decreasing medication for repeated CVD events prevention in stable ischemic heart illness and chronic heart failure patients without hypertensions. The guideline has shown effectively how to apply class of recommendations alongside level of evidence to clinical strategies, interventions, treatment and diagnostic testing in caring for BP patients (James et al. 2014).
According to the discussion by Susannah, it can be clearly seen how she used the guideline in addressing the treatment of BP patient. It is through the application of the guideline that Susannah is able to conclude that it remains contraindicated for BP to continue the present Prinzide therapy because as provided for in the guideline, hydrochlorothiazide remains a pregnancy category B. I have as well learned that the discussion by Susannah is anchored on the use of the guideline to inform her recommendation that antihypertensive medication could be safely withheld in women with chronic hypertension history. Just as provided for in the guideline, Susannah seems to have strictly adhered to its provision. This is why she says that she would start by assessing the BD for any history of depression since it is suggested in the guideline that methyldopa might be prevented in women with past history due to potential augmented risk of postnatal depression.
According to the discussion by Rhonda, she also based argument on the provision of the guideline. This is seen when she identifies BD as a pregnant women and hence saying that there might be contraindications pharmacology in her BP treatment (Go et al., 2014). Thus, she says correctly that based on BD’s high BP, she is able to be removed from her hypertensive medications as well as monitored closely in the course of 1st trimester half of pregnancy because of physiological fall in BP (Egan, 2015). In essence, this is what the guideline has provided for and hence it can be said that Rhonda has strictly followed the provision of the guideline in her argument. It is, therefore, right for Rhonda to conclude that it remains significant to monitor BUN and Creatinine alongside electrolyte when BD is taking ACE inhibitors.
References:
Egan, B. M. (2015). Treatment resistant hypertension. Ethnicity & disease, 25(4), 495.
Go, A. S., Bauman, M. A., King, S. M. C., Fonarow, G. C., Lawrence, W., Williams, K. A., & Sanchez, E. (2014). An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. Hypertension, 63(4), 878-885.
James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., … & Smith, S. C. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Jama, 311(5), 507-520.
Use the following coupon code :
SAVE10