Thiazide Diuretics



Thiazide Diuretics
QUESTION
Lorraine is a 64-year-old African American female who has been monitoring her blood pressure at home. She brings a log of home readings with the following ranges: 150-222/102-88. Her blood pressure in the office today is 160/92. She has her BP monitor with her and the reading on the monitor is similar to today’s office reading. She states that she has swelling in both ankles at night, but the swelling usually resolves overnight. She wears compression hose at work as she is on her feet for most of her 10-hour shift. She has no comorbid conditions and no known allergies at present . Her mother and sister have hypertension and encouraged Lorraine to seek care.

Initial treatment of an African American patient will be lifestyle changes and a diuretic. Choose a diuretic and discuss the mechanism of action, monitoring, and side effects. In addition, share a time when the use of this medication resulted in a positive or negative outcome in a patient for whom you were caring. Discuss evidence and treatment guidelines to determine appropriate therapeutic options for this patient. Include the name of the medication in the subject line so that the medications can be followed. Include references using APA format.
Thiazide Diuretics

ANSWER
Topic 5 DQ 1

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Introduction
A 64-year-old African-American woman keeps track of her blood pressure at home. The patient presents her recordings ranging from 150-222/102-88, and in the office, the BP recorded was at 160/92. A nurse diagnostic is the evidence of Uncontrolled Hypertension. Symptoms presented include swelling in both ankles at night, but the edema typically goes away overnight. She wears a compression hose at work since she is on her feet for most of her 10-hour workday. This paper discusses the application of Thiazide diuretics in the management of Hypertension for the patient among the lifestyle change intervention.
Thiazide Diuretics
The thiazide-type diuretics are drugs that enhance urine flow and are considered a suitable alternative treatment for the management of hypertension. Most often used Thiazide Diuretics include hydrochlorothiazide (HCTZ), chlorthalidone, and indapamide. Mechanisms of Action: Diuretics work directly on the kidneys, promoting diuresis (urine flow) by blocking the sodium/chloride cotransporter found in the kidney’s distal convoluted tubule. They restrict the reabsorption of 3% to 5% of luminal sodium in the nephron’s distal convoluted tubule (Akbari & Khorasani-Zadeh, 2022). Monitoring: The application of Thiazide diuretics is monitored through electrolytes. The frequency of monitoring is between 4-6 weeks on initial treatment followed by 6-12 months. The variables include potassium and serum creatinine: Potassium levels for patients should be less than three mmol/L (or < 4 mmol/L in high-risk patients). For serum creatinine, levels should rise at >20%, or eGFR falls at >15%. Side Effects: The potential side effects of the diuretics include; an increase in blood sugar levels and an increase in uric acid levels. The imbalance of salt in the bloodstream causes low potassium, sodium, and magnesium and a high level of calcium which may cause weaknesses and irregular heart rhythm. Upset stomach. Dizziness while standing and skin sensitivity are also considered side effects of the diuretics.
Evidence and Treatment
The 64-year-old patient who presented with Uncontrolled Hypertension will have better health outcomes with the application of the diuretics. According to a study by Grossman et al, (2011), Chlorthalidone was reported to lower the risk of total stroke by 36%, major Cardiovascular events by 32%, and all-cause mortality by 13% in older individuals with isolated systolic hypertension. indapamide lowered the risk of cardiovascular events in elderly hypertensive patients by 64%. In the prevention of nonfatal heart failure, diuretics were more effective than nifedipine. For avoiding heart failure, chlorthalidone outperformed doxazosin, lisinopril, and amlodipine. The associated treatment guidelines for the patient include two or more antihypertensive drugs to attain a blood pressure (BP) goal of less than 130/80 mm Hg, especially for African Americans (Alexande, 2019). High blood pressure or stage 1 hypertension should be treated non-pharmacological through lifestyle changes and have their blood pressure checked again in 3 to 6 months and if individual is at risk of Cardiovascular Events, BP-lowering medicines are advised for secondary prevention of recurrent CVD episodes.

References
Akbari, P., and Khorasani-Zadeh, A. (2022) Thiazide Diuretics. In: StatPearls. Treasure Island (FL): StatPearls. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532918/
Alexander, M.R. (2019). Hypertension Treatment & Management. Medscape, The Heart ORG. Accessed from: https://emedicine.medscape.com/article/241381-treatment
Grossman, E., Verdecchia, P., Shamiss, A., Angeli, F., & Reboldi, G. (2011). Diuretic treatment of hypertension. Diabetes care, 34 Suppl 2(Suppl 2), S313–S319. https://doi.org/10.2337/dc11-s246

Thiazide Diuretics


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