SCENARIO:1
A 56 year old male bus driver came to neighborhood pharmacy for blood pressure checkup. On examination it was found to be160/95mmHg.After one week he again went for blood pressure monitoring, it was 165/95mmHg.The blood pressure values remained almost consistent for next few days(160/95mmHg).He was advised by the pharmacist to seek the advice of physician as his consistent blood pressure was a cause of concern for the bus driver.
After the visiting the physician he was advised to take RAMIPRIL10 mg daily, SIMVASTATIN 10 mg daily and ASPIRIN 300mg per day.
QUESTIONS
i. Comment on the consistent value of blood pressure.
Basically blood pressure is designed to vary depending on the circumstances facing a patient. These circumstances include physical activities of that patient, his physiological, pathological conditions… etc.
As he is bus driver and not suffering from any other chronic disease, it is concluded that no change in conditions of his daily routine impart no distinct effect on his blood pressure. That’s why blood pressure remained consistent.
ii. Comment on the use of Ramipril and dose.
Ramipril belongs to class “Angiotensin-converting enzyme (ACE) inhibitors”, pharmacologically and “Anti-hypertensive”, therapeutically. This drug shows its action by blocking ACE and produces its effect by
• Reducing risk of heart attack.
• Decreasing incidence of stroke.
Beside these effects, Ramipril is primary choice to treat hypertension. From given data, patient experiences initial stage of hypertension, that’s why it is prescribed with 10mg dose instead of 1.25mg, 2.5mg and 5mg.As prescription filling is without any other anti-hypertensive agent , maximum dose of Ramipril was suggested.
iii. Why was Simvastatin prescribed?
Semvistatin is an Anti-hyperlipidemic drug, reduces the level of LDL and triglyceroids and restores good fats (HDL) in body.
As the patient is a bus driver and also having a risk of hypertension. So that there is chance of take cholesterol level to up by him. That may lead to accelerate hypertensive incidence to greater degree. In order to prevent more complication, simvastatin is prescribed against to high cholesterol level.
iv. What do you understand about reason of prescribing Aspirin and its dose?
Patient has not any physical activity and he has to sit for longer duration. This work may cause many complications to him such as body pain, back-bone pain, muscular ache, joint’s swelling and stiffness.
To prevent these events, Aspirin (300mg) is recommended. As it is Analgesic at higher doses, that’s reason of selection of 300mg dose of it.
v. How would you counsel this patient?
Counseling of patient:
• Don’t use “grape fruit” with medicines.( because it decreases effect of Simvastatin).
• Avoid drinking alcohol.
• Avoid high fatty food intake.
• Follow cholesterol lowering diet plan.
• Avoid getting up very fast from sitting or lying position.
• Don’t drive car just after taking medicines.
• Simvastatin contain “lactose monohydrate”, if intolerance to sugar has been seen then contact to physician.
• Visit minimum twice in a week to pharmacy for blood pressure monitoring.
• Take medicines with plenty of water.
