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 knowncoronary artery disease (CAD), who presents to your clinic withsubsternal chest pain for the past 3 months. It is not positional; itreliably occurs with exertion, approximately one to two times daily, andis relieved with rest, or one or two sublingual nitroglycerin (NTG)tabs. It is similar in quality, but is much less severe, than the chestpain 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 noshortness of breath (SOB) or palpitations. He does not vomit. He deniesorthopnea, paroxysmal nocturnal dyspnea (PND), syncope, presyncope,dizziness, lightheadedness, and symptoms of stroke or transient ischemicattack (TIA). An echocardiogram done after his MI demonstrated apreserved left ventricular ejection fraction (LVEF). Other medicalproblems include well-controlled type 2 diabetes mellitus (DM),well-controlled hypertension (HTN), and hyperlipidemia, with low-densitylipoprotein (LDL) at goal. He also has stage 3 chronic kidney disease(CKD) and diabetic neuropathy. He no longer smokes and does not usealcohol or recreational drugs. His daily medications include: Atenolol25 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 andoriented, and in no apparent distress (NAD). His neck is withoutjugular venous distention (JVD) or carotid bruits. Lungs are clear toauscultation bilaterally. Cardiovascular:normal S1 & S2, RRR,without rubs, murmurs or gallops. Abdomen has active bowel tones and issoft, nontender, and nondistended (NTND). Extremities are withoutclubbing, cyanosis, or edema. Distal pedal pulses are 2+ bilaterally

1. What would you add to the current treatment plan? Why?
2. Would you discontinue any of the currently prescribed medication? Why or why not?
3. How does the diagnosis stage 3 chronic kidney disease affect your choices?
4. Why is the patient prescribed more than one antihypertensive?
5. What is the benefit of the aspirin therapy in this patient?

Discussion Question 2

List three classes of drugs affecting the Hematopoietic System. Listthe mechanism of action for each class of drug. Choose one medicationfrom the three classes and discuss what disorder the drug is used totreat? How often the medication is given? What labs should get monitoredwhile the patient is taking this medication? Your response should be atleast 350 words.