Question

A 68-year-old man, approaches the pharmacy counter looking for advice. Recently, he was seen by a cardiologist at the recommendation of his primary care physician, and after undergoing an electrocardiogram and an evaluation, he was told that he has mild mitral valve regurgitation. He says that his doctor did not initiate any new drugs to treat this disorder, and he is not completely sure what self-care measures are necessary for this condition. He is looking for advice on what lifestyle modifications, if any, he should consider making. Upon questioning, he says that he is a cigarette smoker and has a hypertension and hyperlipidemia, managed on a combination of amlodipine, valsartan, hydrochlorothiazide, and atorvastatin.

What information can you provide regarding self-care, non-pharmacologic approaches to manage this condition? Discuss the mechanism of action and possible adverse effect of drugs prescribed to the patient.

Answer 1

Information regarding self care and non pharmacological approaches to manage this condition.

Sedentary lifestyle and smoking are the main cause of life style diseases like hypertension and hyperlipidemia. Hyperlipidemia is the abnormal level of cholesterol in the blood. It increases LDL ( bad cholesterol) and decreases HDL( good cholesterol).But good news is that high cholesterol band hypertension can be lowered with some lifestyle changes. They are:

1) Quitting Smoking

Smoking compounds risk for heart disease and hypertension. By Quitting smoking you can lower cholesterol level and protect your heart.

2) Eating a healthy diet

Best way to lower your cholesterol is to reduce saturated fat and restrict salt intake. AHA recommends limiting saturated fat to 5 to 6 percent of daily calories. Reducing these fat means limiting your intake of the meat and dairy products with whole milk. It also means limiting fried food and cooking with healthy oils such as vegetable oil. Include fish which contain omega 3 fatty acids and lots of green leafy vegetables and fresh fruits.

3) Becoming more physically active.

Physical activity is more important in controlling this disease to certain extent. Brisk walking, swimming, bicycling and aerobic exercises.

4)Losing weight.

Obesity can increase bad cholesterol. By lowering even 5 to 10 pounds of weight can improve the condition.

Drugs

Drug name	Mechanism of action	Adverse effects
Amlodipine	Amlodipine is a dihydropyridine calcium antagonist that inhibits transmembrane influx of calcium ions into the vascular smooth muscle and cardiac muscle.	Headche Edema Flushing Dizziness Palpitations Nausea Male sexual dysfunction Abdominal pain Somnolence Vomiting
2Valsartan	Valsartan is an angiotensin all reception blocker with antihypertensive properties selectively blocking the binding of angiotensin all to the AT1receptor in many tissues such as vascular smooth muscle and the adrenal gland.	Dizziness Lightheadness Hyperkalemia symptoms like muscle weakness,slow irregular heartbeat. Serious allergic reactions
3)Atorvastin	Atorvastin completely inhibits 3-hydroxy-3-methylgluteryl-coenzyme A(HMG-COA) reductase. By preventing the conversion of HMG- COA to mevalonate , statin medications to decrease cholesterol production in liver.	Diarrhea Arthralgia Insomnia Muscle cramps Paraesthesia Pancreatitis Hepatitis Cholestatic jsundice
4)Hydrochloro thiazide	Hydrochlorothiazide belongs to thiazide class of diuretics. It reduces blood volume by acting on the kidneys to reduce sodium(Na+) reabsorption in distal convoluted tubules.	Nausea,vomiting,loss of appetite Diarrhea Constipation Muscle spasm Dizziness Headache