Jack is a 54-year-old patient who has difficulty coming in for primary care visits. He sees cardiology. pulmonary clinic, and endocrine clinic for his comorbid conditions of diabetes mellitus. post—coronary artery bypass grafting (CABG) 2 years ago. and mild chronic obstructive pulmonary disease issues from a 30 year pack history of smoking. His last visit with yo was over a year ago. Today. your registered nurse brings you a telephone triage call requesting a refill of his Crestor prescription. which was ordered by cardiology soon after his CABO. Per the electronic links to the cardiology service within your facility. the medication was due to be renewed about 2 months ago. His last lipid labs were a year ago and his last complete metabolic panel (CMP) was done at the same time. He was recently at the pulmonary clinic and his last recorded HgA IC was 9.0 from a visit to endocrine 4 months ago. Review of records include a prescription for his hypertension (Lisinopril 20 mg daily). metformin 1.000 mg twice a day for his diabetes, and no known medications for his pulmonary issues. The Crestor prescription appears to have multiple dosing levels over the past few refills.
His last vital signs were blood pressure 170/110 min Hg. pulse 88. and respirations 22. His body mass index is 30 and he indicates a pain level of 4 out of 5. His pulse oximetry was 92% on room air.
4. What counseling would you provide regarding dietary and lifestyle changes?
In addition to the above questions, write a prescription for Mr Jack Ryan, a Caucasian patient age 54, DOB 1/13/1964, weight 200 lbs, 1) chlorthalidone 25mg daily.
5. If Mr. Ryan was African American, what other choices for antihypertensive might be more effective.
6. If Mr. Ryan developed a cough, what other adjustments might you make?
7. What class of antihypertensive medication should be avoided with Mr. Ryan’s medical history?
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