Nova Southeastern University Coronary Artery Disease Discussion Post

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Nova Southeastern University

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Discussion Question 1

For this questions, please read the following case study and then respond to the questions noted below.

Mr. EBR is a 74-year-old retired Hispanic gentleman with known coronary artery disease (CAD), who presents to your clinic with substernal chest pain for the past 3 months. It is not positional; it reliably occurs with exertion, approximately one to two times daily, and is relieved with rest, or one or two sublingual nitroglycerin (NTG) tabs. It is similar in quality, but is much less severe, than the chest pain that occurred with his previous inferior myocardial infarction (MI) 3 years ago. Until the past 3 months, he has felt well.

The chest pain is accompanied by diaphoresis and nausea, but no shortness of breath (SOB) or palpitations. He does not vomit. He denies orthopnea, paroxysmal nocturnal dyspnea (PND), syncope, presyncope, dizziness, lightheadedness, and symptoms of stroke or transient ischemic attack (TIA). An echocardiogram done after his MI demonstrated a preserved left ventricular ejection fraction (LVEF). Other medical problems include well-controlled type 2 diabetes mellitus (DM), well-controlled hypertension (HTN), and hyperlipidemia, with low-density lipoprotein (LDL) at goal. He also has stage 3 chronic kidney disease (CKD) and diabetic neuropathy. He no longer smokes and does not use alcohol or recreational drugs. His daily medications include: Atenolol 25 mg PO bid, Lisinopril 20 mg PO bid, aspirin 81 mg PO daily, Simvastatin 80 mg PO each evening, and metformin 500 mg PO bid.

Mr. EBR's physical examination includes the following: height 68 inches, weight 185 lb, Blood pressure (BP) 126/78, heart rate (HR) 64, Respiratory rate (RR) 16, and temperature 98.6°F orally. He is alert and oriented, and in no apparent distress (NAD). His neck is without jugular venous distention (JVD) or carotid bruits. Lungs are clear to auscultation bilaterally. Cardiovascular: normal S1 & S2, RRR, without rubs, murmurs or gallops. Abdomen has active bowel tones and is soft, nontender, and nondistended (NTND). Extremities are without clubbing, cyanosis, or edema. Distal pedal pulses are 2+ bilaterally

What would you add to the current treatment plan? Why?

Would you discontinue any of the currently prescribed medication? Why or why not?

How does the diagnosis stage 3 chronic kidney disease affect your choices?

Why is the patient prescribed more than one antihypertensive?

What is the benefit of the aspirin therapy in this patient?

Discussion Question 2

List three classes of drugs affecting the Hematopoietic System. List the mechanism of action for each class of drug. Choose one medication from the three classes and discuss what disorder the drug is used to treat? How often the medication is given? What labs should get monitored while the patient is taking this medication? Your response should be at least 350 words. @@@ 3 peer-reviewed articles. APA format.

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Explanation & Answer

Attached. Please let me know if you have any questions or need revisions.

1

Coronary Artery Disease

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2

Discussion 1
What would you add to the current treatment plan? Why?
With the symptoms exhibited by Mr. ERB, our aim would be to treat and eradicate angina
chest pains to help him regain his normal activities but at the same time observing the
Canadian Cardiovascular Society (CCS) symptom level, a classification for angina class I
while ensuring minimized adverse effects, and maintaining the blood pressure of below
130/85mm Hg with a pulse rate of 70 beats per minute (Ben-Dor et al., 2007).
Would you discontinue any of the currently prescribed medication? Why or why not?
I will maintain all Mr. EBRs medication because they are performing well in the management
of hyperlipidemia, blood pressure, and diabetes well.
How does the diagnosis stage 3 chronic kidney disease affect your choices?
Diagnosing a patient with stage 3 chronic kidney disease becomes important because it gives
information on what drugs to administer and which should not. For instance, Mr. EBR canno...


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