Pharmacology Question

Week 4 Assignment 2: Hypertension, Diabetes, and CKD3 Case Study

Value: 100 points

Due: Day 7

Case Study Scenario

Rachel Jones, a 63-year-old woman (weight 184 lb.), is a new patient referred to your primary care clinic. Her medical history includes type 2 diabetes mellitus (diagnosed in 2016), hypertension (diagnosed in 2012), and CKD3 with albuminuria (diagnosed in 2018). Ms. Jones is also a former smoker (quit in 2010).

Ms. Jones’ current medications include:

Lisinopril/HCTZ 20/12.5 mg twice daily

Aspirin 81 mg daily

Metformin 1000 mg twice daily

Dulaglutide 0.75 mg weekly

Glipizide XL 5 mg daily.

• A baseline lipid panel returns with the following results:
• TC 183 mg/dL
• TG 123 mg/dL
• HDL-C 41 mg/dL
• LDL-C 115 mg/dL

Renal function test results include eGFR of 53 mL/min/1.73m2 and urine albumin-to-creatinine ratio of 74 mcg/mg. Ms. Jones’ BP today is 155/74 mm Hg and pulse 76 bpm. Her calculated 10-year ASCVD risk is 13.2%.

Assignment Instructions

• Part A: Which one of the following diabetes-specific risk enhancers do you think is the most relevant when initiating high-intensity statin therapy in Ms. Jones? Explain not only your decision, but also why the other choices are not as relevant. Please use the textbook, as well as any relevant guidelines or primary literature, to formulate your selection and explain your answer.
• Type 2 diabetes mellitus diagnosis within last 5 years
• Presence of albuminuria
• Baseline LDL-C above 100 mg/dL

Former smoker

Part B: You decide to initiate high-intensity statin therapy for Ms. Jones. Address each of the following:

Which drug do you choose?

Which one of the following is the best primary LDL blood work target for Ms. Jones according to the 2018 ACC/AHA guidelines?

Explain your decision about which medication to start, which target you will select, along with why the other choices are not optimal for Ms. Jones.

LDL Blood Work Target Choices:

• LDL-C reduction of 30% from baseline
• LDL-C reduction of at least 50% from baseline
• LDL-C of <70 mg/dL
• LDL-C of <100 mg/dL

Part C: Ms. Jones’ blood pressure is again high today when you see her in clinic. You check her home blood pressure monitoring log and see that her blood pressure fluctuates between 142-161/74-91, indicating poor control. You ask Ms. Jones if she has been compliant with her medications. She states she has been, but may have missed 3-4 doses per month. You note Ms. Jones is currently taking Lisinopril/HCTZ 20/12.5 mg.

Discuss Ms. Jones’ current hypertension regimen and explain what changes (if any) you would make and why. In addition to the textbook, please use the current AHA hypertension guidelines as a reference(s).