How does the diagnosis of stage 3 chronic kidney disease affect your choices?
Discussion Question 1
1. What would you add to the current treatment plan? Why?
As per the case study, the prevalent symptoms, and physical examination, the patient is suffering from stable angina. The main problem associated with stable angina is chest pain (Rousan and Thadani, 2019). In the case study, Mr. EBR came complaining of substernal chest pain for the past 3 months. However, it occurs with exertion, approximately one to two times a day, and is mostly relieved with rest and sublingual nitroglycerin (NTG) tabs. Thus, the objective of managing Mr. EBR is to eliminate and treat chest pain to make him go back to his normal work life. The patient has already been prescribed a beta-blocker, an angiotensin-converting enzyme (ACE) inhibitor, aspirin, and statin. Thus, the focus should be on the management of pain. On this, therefore, some of the medication that can be given to Mr. EBR include acetaminophen 100 mg PO BID twice per day to be taken for 30 days and amitriptyline 50 mg PO QHS, once per day for 30 days.
2. Would you discontinue any of the currently prescribed medication? Why or why not?
Mr. EBR has pre-existing health problems, including blood pressure, hyperlipidemia, and diabetes. The prescribed drugs are okay for the patient, including beta-blockers. Further, aspirins are critical for the management of chest pain or stable angina. On this, therefore, I would not discontinue any medication given to the patient.
3. How does the diagnosis of stage 3 chronic kidney disease affect your choices?
Patient suffering from chronic kidney disease is at risk for toxicity (Fevrier-Paul et al, 2018). The patient too is suffering from diabetic neuropathy and blood pressure. It is, therefore, critical that the choice of drugs to manage stable angina consider the pre-existing conditions, especially stage 3 CKD. Specifically, significant renal exposure to potential nephrotoxins is dangerous and should not be recommended. For example, it would have been easier to choose gabapentin, but as analyzed by Zand et al. (2018), the drug can occasion overt toxicity.
4. Why is the patient prescribed more than one antihypertensive?
Mr. EBR is prescribed more than one antihypertensive because current guidelines prefer a combination of therapy for blood pressure. Additionally, antihypertensive drugs drawn from various classes are known to offset adverse reactions from each other.
5. What is the benefit of aspirin therapy in this patient?
Aspirins fall under the category of antiplatelet agents and are used in the reduction of the blood to clot. Thus, it is essential in making blood flow through narrowed heart arteries. The prevention of blood clots is critical in the reduction of risks associated with strokes and heart attacks.
Fevrier-Paul, A., Soyibo, A. K., Mitchell, S., & Voutchkov, M. (2018). Role of toxic elements in chronic kidney disease. Journal of Health and Pollution, 8(20). https://doi.org/10.5696/2156-9614-8.20.181202
Zand, L., McKian, K. P., & Qian, Q. (2018). Gabapentin toxicity in patients with chronic kidney disease: A preventable cause of morbidity. The American Journal of Medicine, 123(4), 367-373. https://doi.org/10.1016/j.amjmed.2009.09.030