What medication recommendations will you make?

What medication recommendations will you make? Include the drug class, generic and trade name and starting dose range. Provide rationale for your choices.According to the American Heart Association, at least two antihypertensive medications are recommended for African American patients, including a thiazide type-diuretic or calcium channel blocker (Sulaica et al., 2020). However, we do not have enough information to determine if his edema and high blood pressure may be due to heart failure or kidney issues in this particular case. Also, we need to explore his reported sulfa allergy and the symptoms and reactions he experiences. With this information, we would determine the risk-benefit of prescribing a thiazide diuretic and a calcium channel blocker. Verapamil could be an option, but only if his fluid retention is not related to heart failure as calcium channel blockers are contraindicated on patients suffering from congestive heart failure (Rosenthal & Rosenjack Burchum, 2021). Hydrochlorothiazide would be the diuretic of choice, but once again, only after we explore his sulfa allergy in depth.Drug class: Non-dihydropyridine calcium channel blockerGeneric name: VerapamilTrade name: Calan SRStarting dose: 180 mg dailyRationale: Verapamil is used to lower hypertension and treat and prevent angina (Rosenthal & Rosenjack Burchum, 2021). It functions by inhibiting extracellular calcium ions from entering the myocardial and peripheral vascular cells, preventing contraction. Verapamil slows AV conduction and prolongs the effective refractory period within the AV node (Exela Pharma Sciences, 2016).Drug class: Thiazide diureticGeneric name: HydrochlorothiazideTrade name: EsidrixStarting dose: 12.5-25mg dailyRationale: Hydrochlorothiazide affects the distal convoluted tubules and inhibits the sodium chloride system. This results in a diuretic action and loss of potassium, sodium, and bicarbonate (Herman & Bashir, 2021). Hydrochlorothiazide lowers blood pressure by promoting diuresis and decreasing plasma volume when administered acutely. In chronic use, it appears to reduce blood pressure by reducing peripheral resistance (Herman & Bashir, 2021).Drug class: HMG-CoA reductase inhibitors or statinsGeneric name: AtorvastatinTrade name: LipitorStarting dose: 10-20mg at nighttimeRationale: Atorvastatin targets cholesterol production by acting on the rate-limiting step and serving as an HMG-CoA reductase inhibitor, leading to decreased cholesterol concentrations (Talreja, 2021). Statins also inhibit platelet aggregation, reduce inflammation at the site of atherosclerotic plaque, and improve endothelial function (Talreja, 2021).Discuss any potential side effects and drug interactions for this patient.Verapamil can cause dizziness, nausea, abdominal pain, vertigo, muscle fatigue, and sleepiness (Exela Pharma Sciences, 2016). The patient is allergic to sulfa, but if eventually is determined hydrochlorothiazide may be appropriate, he should be advised to monitor any allergic reactions, such as difficulty breathing. Other hydrochlorothiazide side effects include back, leg, or stomach pains, black, tarry stools, blurred vision, chest pain, dry mouth, and increased sweating, among other side effects (Rosenthal & Rosenjack Burchum, 2021). Atorvastatin may cause diarrhea, gas, joint pain, heartburn, forgetfulness, and confusion (MedlinePlus, 2021). Mr. Smith should also be advised to monitor his blood pressure daily because taking verapamil and hydrochlorothiazide could cause hypotension.What non-pharmacological interventions would you suggest?Regarding non-pharmacological interventions targeted to lower blood pressure and cholesterol levels, I would suggest Mr. Smith adapts a Dietary Approach to Stop Hypertension (DASH), exercises regularly, and considers weight control. A diet rich in fruits, vegetables, whole grains, low salt, and low-fat dairy has proven to be the most effective intervention in lowering blood pressure (Jinming et al., 2020). Aerobic exercise, isometric, and resistance training at least three times a week for 30-50 minutes could also benefit Mr. Smith and stress reduction activities. A comprehensive lifestyle modification involving the mentioned activities and diet could also help Mr. Smith lose weight and adopt a healthier lifestyle (Jinming et al., 2020).What patient education would you provide?Mr. Smith should be educated on the importance of medication compliance, indications, and side effects. Stressing the importance of adherence is also essential due to his history of non-compliance. Suggestions such as telephone alarms and reminders can be given as alternatives for remembering to take the medications at specific times. Addressing the importance of a healthy diet and exercise is also needed to encourage the patient to lose weight and adopt a healthier lifestyle. Mr. Smith should also be educated on the significance of monitoring blood pressure daily, especially before taking the medications, and keeping a log with the values to bring to the next appointment to help determine medication efficacy.ReferencesExela Pharma Sciences. (2016). Verapamil. Retrieved September 14, 2021, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/018925s010lbl.pdfHerman, L. L., & Bashir, K. (2021). Hydrochlorothiazide. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430766/Jinming, F., Yupeng, L., Lei, Z., Lu, Z., Dapeng, L, Hude, Q., Lin, Z., , Fulan, H., Xia, L., Shuhan, M., Ran, Y., Suhua, Z., Ucheojor Onwuka, Baofeng, Y., Dianjun, S., Yashuang Z. (2020). Nonpharmacologic interventions for reducing blood pressure in adults with prehypertension to established hypertension. Journal of the American Heart Association, 9(19). https://doi.org/10.1161/JAHA.120.016804Khan, S., Khan, I., Novak, M., Regmi, A., & Difilippo, W. (2018). The Concomitant Use of Atorvastatin and Amlodipine Leading to Rhabdomyolysis. Cureus, 10(1), e2020. https://doi.org/10.7759/cureus.2020MedlinePlus. (2021). Atorvastatin. Retrieved September 1, 2021, from https://medlineplus.gov/druginfo/meds/a600045.html#side-effectsRosenthal, L. D., & Rosenjack Burchum, J. (2021). Lehne’s pharmacotherapeutics for Advanced Practice Nurses and physician assistants (2nd ed.). St. Louis, MO: Elsevier.Sulaica, E. M., Wollen, J. T., Kotter, J., & Macaulay, T. E. (2020). A review of hypertension management in Black male patients. Mayo Clinic Proceedings, 95(9), 1955-1963. https://doi.org/10.1016/j.mayocp.2020.01.014Talreja, O., Kerndt, C. C., Cassagnol, M. (2021). Atorvastatin. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532919/