Patient Case Study: Medication Management for Hypertension and Cholesterol

This patient case study discusses the medication management of a 55-year-old female patient with hypertension and cholesterol problems. The patient was using four different medications, including amlodipine, atorvastatin, ramipril, and aspirin. The study provides information on the medications used, their side effects, and their mechanisms of action. The patient was also prescribed modafinil to manage fatigue caused by atorvastatin. The study emphasizes the importance of lifestyle choices in managing hypertension and cholesterol problems.

My second patient that I started my patient case study with was also completed working on my
MMT rotation in the same ward as this was the most valuable time for me to speak to these
patients.
My second patient was a 55 year old female patient which was first admitted to a and e department
then later sent to the ward I was working in acute medical unit. She stayed over night at my ward to
oversee her condition. She was admitted to a and e cause of fatigue and contrast headaches which
the patient confirmed was getting worse. She was currently using 4 different medications for her
conditions. Her conditions was high blood pressure and also cholesterol problems. The patient was
currently using 4 different medications to control this condition. Amlodipine, atorvastatin, ramipril,
and aspirin.
The amlodipine and ramipril are both used to manage the patients blood pressure levels. When the
blood pressure problem sometimes patients are prescribed two different medications just to control
it. The atorvastatin is a medication which is used to control the cholesterol level. Aspirin is a
medication which is commonly used for thinning the blood for the patient. It can alternatively can be
used for short term pain but the doses are different. In this situation with the patent they are using
75mg once daily which is used to thin the blood which reduces risk of blood clots for the patient.
Even while using these medication to control the patients conditions. The lifestyle choices are also
very important when having this condition.
While doctors was accessing this patient it was difficult to make good communication with the
patient as they found it difficult for themselves to stay awake while staying on the ward due to their
headaches. I contacted their regular pharmacy which is a source where I confirmed all the
medication doses with the staff. I used this as a reliable source. They also confirmed the dose of the
atorvastatin uped to 40mg once at night which was changed by the patients regular gp.
The headaches is a side effect of the atorvastatin. Once I spoke to the patient about their medication
history and confirmed all of their doses everything seemed fine. The only recent change to their
medication was that the atorvastatin dose changed from 20mg at night to 40mg at night. They have
been using the higher dose 4 weeks prior to the patient being admitted to hospital.
Amlodipine refers to a class of medications called Calcium channel blocker which is
medication provide lowering of blood pressure through relaxing blood vessels for providing
heart not to pump hard. It also helps to increase supply of blood to the heart and provide
relief from chest pain. This is the medication that comes as a tablet and as suspension
through oral administration. It should be taken once a day and taken at same time everyday.
It works by improving blood supply to heart by widening the artery which allow oxygen to
get to heart and help in reducing the chest pain (Mito and et. al., 2019). It is taken by mouth
and have impact on study common side effect includes abdominal pain, feeling tired,
swelling and nausea. There are also some serious side effect which also includes heart attack
and low blood pressure. It is not clear that it is whether safe or not in breastfeeding or
pregnancy. Amlodipine is generally used for the hypertension management along with

coronary artery disease with an individual and also help in stable angina without heart
failure. It is generally used in combination therapy or monotherapy for hypertension
management. It can be admitted to adult and children between 6 to 17 years, It also provide
better protection against stroke. There is a combination therapy with a variety of
medication Amlodipine which is given for hypertension and atorvastatin prevents
cardiovascular events during cholesterol high level. There is a contraindication about the
Amlodipine which should be used in patients with cardiogenic shock where it provide
widening to the ventricles and exessive rate and situation of preventing calcium iron into
excess. There are also some common dose dependent adverse effect which can include
peripheral edema, flushing, palpitation, dizziness and vasodilator effect. It has adverse effect
include fatigue, nausea, abdominal pain. It also suffering from fatigue which includes the
side impact of using medication Amlodipine which is effective for lowering the blood
pressure. Due to using for the long-term, it create the issue of headache and patient that
lead to create high negative impact and they needed to get admitted in the a&e department
of hospital. Amlodipine refers to a long lasting Calcium channel antagonist which are
selectively airway, calcium iron influx within cell membrane (Dalmolin and et. al., 2019). It is
effective and targeting one type Calcium channel and N type Calcium channel within central
nervous system. It also have an inhibitory effect of calcium influx with in smooth muscle
cells to inhibit contraction. There is a mechanism of action of amlodipine which refers to a
Calcium channel blocker and having any vision of movement of calcium Ion with in cardiac
muscle cells and vascular smooth muscle cells is also help to any waiting cardiac muscle
contraction and vascular smooth muscle cells it also enabled calcium Ion influx within cell
membrane and cause vasodilation through reducing peripheral vascular resistance which
result in providing lowering blood pressure it also help to prevent excessive constitution of
coronary arteries (Hussan and et. al., 2018).
Atorvastatin refers to a class of medications called HMG-Coa reductase inhibitor
(statins). It is effective and help to slow the production of cholesterol with an individual and
decrease cholesterol amount. This can built up on arteries wall and block blood flow of
heart other body part and brain. It is used for lowering cholesterol when individual is
diagnosed with high blood pressure. It also help to prevent heart disease including a stroke
and heart attacks. Medical use of this drug is to lower cholesterol level. There is need to

take medication regularly to get benefit from it and should be taken same time each day.
This should be taken even when patient is feeling well because there is a chance that
individual with high cholesterol are not feeling sick. There are some of the side effect of
Atorvastatin which generally prescribed by doctor and should be taken into consideration.
Many patients use the medication and serious side effect that medication cause liver
problems. There are some of serious allergic reaction of Atorvastatin which can be rare and
seek immediate medical attention. There are some of the symptoms like Rash, allergic
reaction, swelling, trouble breathing, dizziness and others. This medication should not be
used during pregnancy where atorvastatin can have negative health impact for unborn baby
and needed to get prevented from the pregnancy through taking the medication
(Sarkeshikian and et. al., 2020). Drug interaction may include medication and risk of serious
side effect. There are some of the drug interactions which can include to provide better
treatment and safety against it. There are some of the drug which may interact with drug
can include gemfibrozil, daptomycin.
Individual should not consume red yeast rice product and while taking atorvastatin
taking medication and red yeast rice product together can lead to create serious muscles
and liver problem. There is change in dose of atorvastatin which can lead to create serious
symptoms like travelling breathing can be experienced by the individual. There are server
side affect which includes type 2 Diabetes mellitus, myopathy with the elevation of creatine
kinase and persistent Liver enzyme abnormality. There are some common side effect which
may include muscle pain, nausea, loose stool, joint pain, hyperglycemia with the higher dose
of atorvastatin and lead to create high blood sugar level (Özdoğan and et. al., 2018).
Mechanism of action of atorvastatin refers to competitive inhibitor which is completely
synthetic compound. It also help in hepatic cholesterol biosynthesis and a repeat enzyme
through decreasing cholesterol synthesis. Liver is the primary site of action of atorvastatin
which have the principal site for both cholesterol synthesis and LDL clearance.
Ramipril refers to the prodrug which belongs to the Angiotensin-converting enzymen
(ACE) inhibitor class of medication. It metablises in liver and is responsible for conversion of
angiotension-I to angiotension-II. Ramipril is using management of hypertension and help
to reduction of cardiovascular mortality. It helps treat high blood pressure and deliver to

prevent heart attack stroke and kidney problem. It also help in improving survival after heart
attack. It works by relaxing blood vessels that allow blood to flow more easily. Some of the
side effect of Ramipril includes chest pain and low blood pressure, headache, nausea,
fainting, vomiting, diarrhoea, tired, feeling fatigue and stomach discomfort and others.
There is contraindication of Ramipril includes hypersensitivity of drug. It also includes
diabetic mellitus within renal impairment. Ramipril refers to RAAS system through binding
and inhibition ACE show the prevention of angiotensin I and angiotensin II when angiotensin
to fall in plasma level then there is less activation of G protein-coupled receptor and
angiotensin receptor I and angiotensin receptor II occurs (Amat-Santos and et. al., 2020).
Modafinil refers to a prescription drug which is effective in wakefulness and help to
reduce the fatigue. It also cause sleep problem when taken too late in a day. This is a drug
which have the brand name provigil, It is well tailored and have side effect including trouble
sleeping headache and nausea. There are also serious rare side effect that may include a
anaphylaxis, allergic reaction and Steven Johnson Syndrome. It also can create hallucination
within people with history of psychosis. This is the new medication which deliver to patient
to provide relief from fatigue which is generally caused due to taking medication of
atorvastatin. This is highly effective and can create a more better impact on individual
health. It also help to reduce the fatigue and help in providing relief (Saager and et. al.,
2020). It can also provide better relaxation to patient. Modafinil have a therapeutic
mechanism of action for sleep wake disorder. It also act as selective a typical and indirectly
activate neuropeptides along with histamine from to nucleus and lateral hypothalamus
which can contribute in arousal. This is the effective drug that can help to reduce the cause
of fatigue and can provide better health. Co-administration with hydrocodone, methadone,
Sentinel and oxycodone can may result in decrease in plasma concentration. It can also have
adverse effect on hormonal contraceptives after discontinuation up to a month (Assi and et.
al., 2020). It also can decrease in blood prolactin level which can affect human growth
hormone and thyroid-stimulating hormone which can affect human growth hormone our
thyroid-stimulating hormone.
It may also create addiction and dependence which is very low level. It is a
biochemical mechanism with adaptive simulated stimulant drug which can have similar

mood elevation property. It is different from caffeine but have similar impact. Overdose can
create a negative health impact and can lead to create incident of acute life-threatening
effect like and anxiety, Insomnia, irritability, nervousness, confusion, palpitation, nausea,
diarrhoea and others.
This medication help in change in the patient condition and provide relief from
fatigue. Patient has been prescribed this medication through following the national
guideline. This impact on patient and understanding about the benefit of using this
medication. There are some side effect of this medication for which patient it prepared and
have the consent. In this, there is a need to provide some information to the patient which
are related with action and intervention from getting disease and provide better health
(Omidi-Ardali and et. al., 2021). There is need to provide mechanism of action of medication
and help to provide a better benefit to his health. In this patient concern is highly effective
which help to identify the medication review. There is also need to provide appropriate
information about the medication which can be effective and medication in appropriate
way. Issues can be resolved and managed by taking care about the medication and proper
dose. This can also help through counselling of patient by providing information about
managing fatigue and headache with the help of medication, meditation and some self-
management. There is need to provide some information related with non-medical advice
which includes meditation and different exercise which can enable patient to take control
on fatigue and able to maintain blood pressure which can help in reducing worsening of
patient health.

REFERENCES
Amat-Santos and et. al., 2020. Ramipril in high-risk patients with COVID-19. Journal of the
American College of Cardiology, 76(3), pp.268-276.
Assi and et. al., 2020. On-spot quantification of modafinil in generic medicines purchased
from the Internet using handheld Fourier transform-infrared, near-infrared and
Raman spectroscopy. Journal of Analytical Science and Technology, 11(1), pp.1-9.
Dalmolin and et. al., 2019. Modified β-cyclodextrin/amlodipine inclusion complexes:
preparation and application in aqueous systems. Journal of Molecular Liquids, 276,
pp.531-540.
Hussan and et. al., 2018. Molecular dynamics, physical and thermal stability of neat
amorphous amlodipine besylate and in binary mixture. European Journal of
Pharmaceutical Sciences, 119, pp.268-278.
Mito and et. al., 2019. Safety of amlodipine in early pregnancy. Journal of the American
Heart Association, 8(15), p.e012093.
Omidi-Ardali and et. al., 2021. Nitric oxide mediates the antidepressant-like effect of
modafinil in mouse forced swimming and tail suspension tests. Journal of Basic and
Clinical Physiology and Pharmacology, 32(2), pp.25-31.
Özdoğan and et. al., 2018. Development and in vitro evaluation of chitosan based system for
local delivery of atorvastatin for treatment of periodontitis. European Journal of
Pharmaceutical Sciences, 124, pp.208-216.
Saager and et. al., 2020. Ramipril reduces incidence and prolongates latency time of
radiation-induced rat myelopathy after photon and carbon ion irradiation. Journal
of Radiation Research, 61(5), pp.791-798.
Sarkeshikian and et. al., 2020. Atorvastatin in combination with conventional antimicrobial
treatment of Helicobacter pylori eradication: A randomized controlled clinical
trial. Journal of gastroenterology and hepatology, 35(1), pp.71-75.