PATIENT CARE

PLAN
BENIGN PROSTATE HYPERPLASIA
GROUP MEMBERS:

CALEB BOODJARRAT
VICTORIA FORTE
ALYSSA GEORGE
RAHUL MISTRY
SHENEECE RAJKUMAR
KAVITA RAMKISSOON

COURSE LECTURER: DR. DIANE IGNACIO

1
 TABLE OF CONTENTS

CASE INTRODUCTION.............................................................................................................................................3

MEDICAL COMPLICATIONS..................................................................................................................................4

BENIGN PROSTATE HYPERPLASIA...................................................................................................................4

DEFINITION........................................................................................................................................................4
SIGNS AND SYMPTOMS.....................................................................................................................................4
RISK FACTORS....................................................................................................................................................5
OTHER CAUSES..................................................................................................................................................5
DIAGNOSIS..........................................................................................................................................................5
HYPERTENSION.....................................................................................................................................................6
DEFINITION........................................................................................................................................................6
SIGNS AND SYMPTOMS.....................................................................................................................................6
RISK FACTORS....................................................................................................................................................7
DIAGNOSIS..........................................................................................................................................................7
HYPERLIPIDEMIA..................................................................................................................................................8
DEFINITION........................................................................................................................................................8
SIGNS AND SYMPTOMS.....................................................................................................................................8
RISK FACTORS....................................................................................................................................................9
DIAGNOSIS..........................................................................................................................................................9
TYPE 2 DIABETES MELLITUS..............................................................................................................................9
DEFINITION........................................................................................................................................................9
SIGNS AND SYMPTOMS...................................................................................................................................10
RISK FACTORS..................................................................................................................................................10
DIAGNOSIS........................................................................................................................................................11

PATIENT RECORD..................................................................................................................................................12

LABORATORY RESULTS.......................................................................................................................................13

K – POTASSIUM TEST...............................................................................................................................................14
BUN – BLOOD UREA NITROGEN TEST....................................................................................................................14
AST- SGOT (SERUM GLUTAMIC- OXALOACETIC TRANSAMINASE) TEST..............................................................14
ALT – ALANINE AMINOTRANSFERASE TEST...........................................................................................................14

MEDICATION RECORD.........................................................................................................................................15

DRUG HISTORY PTA (I.E. RX AND RECREATIONAL DRUGS)...................................................................................15

CURRENT MEDICATION RECORD..............................................................................................................................16

2
 MEDICATION HISTORY.............................................................................................................................................17

DRUG THERAPY PROBLEMS...............................................................................................................................19

TREATMENT INTERVENTIONS..........................................................................................................................21

TREATMENT GOALS:................................................................................................................................................21
Benign Prostate Hyperplasia:.............................................................................................................................21
Hypertension:......................................................................................................................................................21
Type 2 Diabetes:.................................................................................................................................................21
Hyperlipidaemia.................................................................................................................................................22
NON-PHARMACOLOGIC TREATMENT........................................................................................................................22
Hypertension.......................................................................................................................................................22
BPH.....................................................................................................................................................................22
Diabetes..............................................................................................................................................................23
Hyperlipidemia...................................................................................................................................................23

THERAPEUTIC OPTIONS........................................................................................................................................0

FOLLOW UP PLAN....................................................................................................................................................0

REEFERENCES...........................................................................................................................................................0

3
 CASE INTRODUCTION

CM is a 68-year-old man, with Benign Prostate Hyperplasia diagnosed 6 months ago. On his last
visit to the pharmacy, he reports that he has been experiencing persistent constipation and some
difficulty urinating.

CHIEF COMPLAINT: “I can’t pass water and I’m constipated.”

Mr.CM has a past medical history of:

- Type 2 diabetes mellitus
- Hypertension
- Hyperlipidemia
SOCIAL HISTORY:
- Smokes (½) pack per day
- Drinks (1) beer per day
FAMILY HISTORY:
- Mother died of chronic liver failure
- Father died of a stroke

4
 MEDICAL COMPLICATIONS

BENIGN PROSTATE HYPERPLASIA

DEFINITION

Benign prostate hyperplasia (BPH) also known as benign prostate hypertrophy characterized by
proliferation of the cellular elements of the prostate. There are (3) types of prostate gland tissue:
- Epithelial or glandular
- Stromal or smooth muscle
- Capsule
Cellular accumulation and gland enlargement may result from epithelial and stromal
proliferation impaired preprogrammed apoptosis or both.
Hyperplasia is likely to result in the enlargement of the prostate that may restrict the flow of
urine from the bladder. BPH can be considered a normal aging process in men and is hormonally
dependent on testosterone and dihydrotestosterone (DHT) production.
Prostate enlargement depends on the potent androgen dihydrotestosterone. DHT dings to
androgen receptors in the nuclei of cells, potentially resulting in BHP.
Bladder outlet obstruction (BOO) and prostate gland enlargement that causes the voiding
dysfunction, is termed Lower Urinary Tract (LUT) symptoms or prostatism. LUTs include
urinary frequency, urgency, nocturia, decreased force of stream or a sensation of incomplete
emptying. It should be noted that not all men with BPH have LUTs and not all men with LUTs
have BPH.
Example of medication that can exacerbate symptoms include:
- Testosterone
- Alpha-adrenergic agonists (decongestants)
- Those with significant anticholinergic effects such as antihistamines, phenothiazines,
tricyclic antidepressants, antispasmodics and antiparkinsonian agents.

5
SIGNS AND SYMPTOMS

- Urinary frequency
- Urinary urgency
- Hesitancy – difficulty in initiating urine stream such as interrupted, weak stream.
- Incomplete bladder emptying
- Straining- the need to “force” initiation of urination in order to fully evacuate the bladder.
- Decreased force of stream
- Dribbling- poor urinary stream causes small of loss of urine.
- Nocturia- frequent need to urinate at night.

RISK FACTORS

- Age – the most common risk factor especially in men over the age of 50.
- Ethnic background- according to a study found in the journal of urology, men of Black
and Hispanic are more likely to develop BHP as compared to White men.
- Family history

OTHER CAUSES

- Obesity- the waist circumference of a men will increase as his BMI increases which
makes him at greater risk to BPH.
- Diabetes – increases the risk of developing BPH as elevated insulin levels stimulate
growth and by extent obesity which is linked to the point above.
- In active lifestyle- sedentary lifestyle may lead BHP. An active lifestyle will aid in the
fight against obesity, reduce inflammation and type 2 diabetes, which are all risk factors
for BPH.

DIAGNOSIS

- Digital rectal examination; assess prostate size, evaluation for nodules and detect areas of
possible malignancy since the prostate is not always enlarged (>20g) soft, smooth and
symmetric.
- Ultrasonography
- Endoscopy of the LUT

6
Lab tests:
- Urinalysis
- Urine culture
- Prostate- specific antigen (PSA)
- Electrolytes, BUN, Creatinine
Other tests:
- Flow rate – useful in the initial assessment and to aid in determining the patient’s
response to treatment.
- PVR urine volume – used to gauge the severity of bladder decompensation using a
catheter or noninvasively with a transabdominal ultrasonic scanner.
- Pressure flow studies
- Urodynamic studies
- Cytologic studies – used in patients with predominantly irritative voiding symptoms.

HYPERTENSION

DEFINITION

Persistently elevated arterial blood pressure (BP). According to JNC 7 Guidelines:

Normal BP- <120 mmHg/ 80mmHg
Pre-hypertension- 120-139mmHg/ 80-89mmHg
Stage 1 hypertension- 140-159mmHg/ 90-99mmHg
Stage 2 hypertension- >160mmHg/100mmHg
Hypertensive crisis is defined as BP more than 180mmHg/120mmHg and may be characterized
as hypertensive emergency.
Hypertension which is from an unknown source or etiology can be defined as primary or
essential hypertension which hypertension from a specific cause (e.g. Chronic kidney disease,
renovascular disease, Cushing syndrome, obstructive sleep apnea) can be defined as secondary
hypertension.

SIGNS AND SYMPTOMS

7
 - Severe headache
- Fatigue or confusion
- Vision problems
- Chest pain
- Difficulty breathing/ shortness of breath
- Irregular heartburn
- Pounding in chest, neck, or ears
It should be noted that the listed signs and symptoms are not specific and usually don’t not occur
until high blood pressure has reached a severe or lift-threatening stage.
- JNC 7 guideline as listed above
- 2017 ACC/AHA guidelines eliminate the classification of prehypertension and divides it
into (2) levels:
1. Elevated BP with a systolic pressure of 120-129 mmHg and diastolic pressure less than
80mmHg
2. Stage 1 hypertension with a systolic pressure of 130-139mmHg or a diastolic pressure
of 80-89mmHg.

RISK FACTORS

- Age – high blood pressure is more common in men than women. Women tend to develop
high BP after 65 years.
- Race – African heritage are more likely to develop high BP at an earlier age.
- Family history
- Weight - being overweight or obese puts pressure on artery walls since more blood is
needed to supply oxygen and nutrients to tissues.
- Inactive- lack of physical activity
- Tobacco- in addition to the tobacco raising BP temporarily, chemicals in tobacco can
damage the lining of artery walls. Secondhand smoke can also increase heart disease.
- High Sodium intake- too much salt can cause fluid retention, which increases BP.
- Low Potassium diet- potassium helps to balance sodium in the body.

8
 - Alcohol – drinking too much alcohol can damage your heart. More than one (1) drink
daily for women and more than two (2) drinks daily or men can affect BP.
- Stress
- Certain chronic diseases- kidney disease, diabetes and sleep apnea may increase risk of
hypertension.

DIAGNOSIS

Using a blood pressure machine, a Physician will take two to three blood pressure readings each
at (3) or more separate appointments before diagnosing a patient.
The Physician may also ask the patient to record their BP at home to provide additional
information.
Some Physicians may recommend a 24-hour BP monitoring test called ambulatory blood
pressure monitoring to confirm of the patient has high blood pressure. The devise used for this
test measures BP at regular intervals over a 24-hour period to confirm diagnosis.
Other tests a Physician may recommend are:
- Urinalysis
- Blood tests
- Cholesterol tests
- Electrocardiogram

HYPERLIPIDEMIA

DEFINITION

A medical term used for abnormally high levels of fats in the blood.
There are (2) major types of lipid found in the blood; triglycerides and cholesterol.
Hyperlipidemia refers to high levels of LDL cholesterol or triglycerides. This condition is
treatable; however, it is a life- long condition (chronic disease).
Cholesterol levels may be affected by certain medications such as:
- birth control pills
- diuretics
- some anti- depressants
9
SIGNS AND SYMPTOMS

Most patients having hyperlipidemia are asymptomatic. However, symptomatic patients may
complain of:
- Chest pain
- Palpitations
- Sweating
- Anxiety
- Shortness
- Difficulty in speech and movement

RISK FACTORS

- Poor diet – eating foods with saturated and trans-fat, animal protein like red meat and
dairy.
- Obesity
- Lack of exercise – results in high LDL cholesterol and low HDL cholesterol.
- Smoking
- Age- Men 45 years or older and women 55 years or older are at greater risk.
- Gender – post menopausal women are at a higher risk since their LDL cholesterol levels
goes up.
- Family history
- Diabetes
- Large waist circumference

DIAGNOSIS

A physician checks patient’s lipid levels regularly via blood test called a lipoprotein panel.
In this test it shows:
- LDL cholesterol- referred to as “bad” cholesterol that builds up inside the arteries
- HDL cholesterol – referred to as “good” cholesterol
- Triglycerides

10
 - Total cholesterol – a combination of all 3 listed above.
It is recommended that adults 20-years and older should have their cholesterol checked every 4-6
years according to the American Heart Association.

TYPE 2 DIABETES MELLITUS

DEFINITION

Diabetes Mellitus is classified as a chronic disease in which requires long term medical attention.
Type 2 Diabetes Mellitus is characterized by a numerous amount of dysfunction such as
hyperglycemia and resulting from the combination of resistance to insulin action, inadequate
insulin secretion and excessive or inappropriate glucagon secretion.
When type 2 Diabetes Mellitus is poorly controlled, it can result in complications such as:
- Microvascular (retinal, heart and possibly neuropathic disease)
- Macrovascular (coronary artery and peripheral vascular disease)
- Diabetic neuropathy (affecting autonomic and peripheral nerves)
Type 2 Diabetes Mellitus is not dependent on insulin; however, some patients may need insulin
as treatment since they retain the ability to secrete endogenous insulin.

SIGNS AND SYMPTOMS

- Polyuria
- Polydipsia
- Polyphagia
- Weight loss
- Blurred vision
- Lower- extremity paresthesia
- Yeast infections
- Slow healing of sores
- Chronically dry, itchy skin
- Constant hunger
- Patches of dark skin in the folds and areas of the body

11
RISK FACTORS

- Weight – patients who are overweight or obese, their cells become more resistant to
insulin
- Inactivity- being active allows you to lose weight if needed or control weight while using
up glucose as energy which makes the cells more sensitive to insulin.
- Family history
- Race- Hispanics, black people, American Indians, Asian- Americans are at greater risk.
- Gestational diabetes- developed while pregnant. Giving birth to a baby >9 pounds (4 kg)
puts the mother at a greater risk.
- Polycystic ovary syndrome
- High blood pressure
- Abnormal cholesterol and triglycerides.

DIAGNOSIS

Glycated hemoglobin (A1c) Test

According to American Diabetes Association (ADA) as patient is diagnosis based on:
- A fasting plasma glucose level of 120mh/dL (7.0mmol/L) or higher
- A 24-hour plasma glucose level of 200mg/ dL (11.1mmol/L) or higher during a 75g oral
glucose tolerance test or
- A random plasma glucose of 200mg/ dL (11.1mmol/L) or higher in patients with classic
symptoms of hyperglycemia or hyperglycemic crisis.
Indications for asymptomatic adults diabetic screening:
- Sustained blood pressure > 135/80 mmHg
- Overweight and one (1) or more other risk factors for diabetes
- ADA recommends screening at age 45-years and older in the absence of the above
criteria.

12
 PATIENT RECORD

PATIENT INFORMATION MEDICAL INFORMATION

NAME: CM MEDICAL HISTORY:
AGE: 68 - Benign prostate hyperplasia
SEX: M
- Type 2 Diabetes Mellitus
DOB: 01/02/1952 - Hypertension
- Hyperlipidemia
ALLERGIES: NKDA
TOBACCO: (½)pack per day
ALCOHOL: Drink (1) beer per day

13
 LABORATORY TEST RESULT VALUES NORMAL RESULT
VALUES
Na 142 mEq/L 135-145 mEq/L

K 3.3 mEq/L * 3.5-5.5 mEq/L

Cl 106 mEq/L 9-106 mEq/L

HCO3 23 mEq/L 22-28 mEq/L

BUN 22 mEq/L * 7-20 mEq/L

CrCl 1.2mg/dL Male: 0.6-1.2 mg/dL

Female: 0.5-1.1 mg/dL

FBG 140mg/dL >126mg/dL

AST 55 IU/L * 10-40 IU/L

ALT 62 IU/L * 7-56 IU/L

TC 194 mg/dL <200 mg/dL

TG 145mg/dL <149mg/dL

LABORATORY RESULTS

 Abnormality in laboratory results

14
K – Potassium Test

Mineral potassium helps in nerves and muscles to move nutrients into and waste out of your cells
and aids in heart function.
Potassium also helps to balance sodium in the body.
Normal potassium levels: 3.5- 5.0 mEq/L
Patient’s level is 3.3 mEq/L which is lower than the ideal value.
Low potassium level can be the cause from vomiting, diarrhea, adrenal gland disorders, or use of
diuretics.
Possible cause: Use of diuretic – Bendroflumethiazide

BUN – Blood Urea Nitrogen Test

This test measures how much of the waste product you have in your blood.
Patients level is 22mg/dL which is higher than the normal range value.
High BUN levels can also indicate various problems with your kidneys.

AST- SGOT (Serum Glutamic- Oxaloacetic Transaminase) Test

Patient’s level is 55 IU/L which is higher than the normal range values.
High levels of AST are a sign of liver damage; however, it can also mean you have damage to
other organs.

ALT – Alanine Aminotransferase Test

Alanine Aminotransferase is an enzyme made by cells in your liver.

Patient’s level is 62 IU/L which is higher than normal range values.
High levels of ALT can be an indicator of liver damage.

15
 MEDICATION RECORD

Drug History PTA (i.e. Rx and Recreational Drugs)

Drug name, dosing Supportin

Indications Active Problem
regimen g Lab
1. Meformin 500mg 1. Diabetes mellitus; Type 2 diabetes
II tablets po bid prophylaxis mellitus
2. Polycystic ovary
syndrome
3. Type 2 diabetes
mellitus
4. Weight gain
2. Bendroflumethiazi 1. Edema Hypertension
de 5mg po od 2. Hypertension
3. Nifedipine SR 1. Hypertension Hypertension
20mg po bid 2. Stable angina,
chronic
3. Variant angina
4. Raynaud’s
phenomenon
4. Terazosin 2mg po 1. Benign prostatic Benign prostatic
nocté hyperplasia hyperplasia and
2. Hypertension Hypertension
5. Simvastatin 40mg 1. Familial Familial
½ tablet po nocté hypercholesterolem hypercholesterolemi
ia – heterozygous a- heterozygous
2. Familial
hypercholesterolem
ia – homozygous
3. Primary
hypercholesterolem

16
 ia
4. Mixed
hyperlipidaemia
6. Aspirin 81mg po 1. Atrial fibrillation Myocardial
od 2. Fever infraction, secondary
3. Unstable angina prophylaxis
4. Myocardial
infraction,
secondary
prophylaxis
5. Stable angina

Current Medication Record

Drug Name Strength Dosage Indication Start Date

Regimen
Metformin 500mg Two tablets Type 2 diabetes November,
orally two mellitus 2019
times a day
Bendroflumethiazide 5mg One tablet Hypertentsion November,
orally once a 2019
day
Nifedipine SR 20mg One tablet Hypertension November,
orally two 2019
times a day
Terazosin 2mg One tablet Benign prostatic November,
orally at hyperplasia 2019
night
Simvastatin 40mg Half tablet Familial November,
orally at hypercholesterolemia- 2019
night heterozygous
Asprin 81mg One tablet Myocardial November,
orally once a infraction, secondary 2019
day prophylaxis

17
Medication History

Star D/C Drug/Dose/Interv Desired Monitorin Therapeutic Achieve

t Dat al Outcome g Outcome d
Date e Parameter
s
Nov - Metformin 500mg: Lowering Daily Treating type 2 No
2019 take two tablets blood blood diabetes
two times a day glucose glucose
after a meal level testing
Nov - Bendroflumethiazi Lowering Testing Treating No
2019 de 5mg: take one blood blood hypertension
tablet once a day pressure pressure
after a meal twice daily
Nov - Nifedipine SR Lowering Testing Treating Yes
2019 20mg: take one blood blood hypertension
tablet two times a pressure pressure
day after a meal twice daily
(avoid grapefruit
juice)
Nov - Terazosin 2mg: Relaxatio At home Treating benign Yes
2019 take one tablet at n of urine prostatic hyperplasia
night after dinner smooth testing
muscles strips
in urinary
bladder
and
prostate
gland

18
 Nov - Simvastatin 40mg: Lowering Weekly Treating familial Yes
2019 take half tablet at lipid cholesterol hypercholesterolemi
night (avoid levels testing a- heterozygous
grapefruit juice)

Nov - Aspirin 81mg: take Lowering Testing Treating myocardial Yes

2019 one tablet once a myocardi blood infraction,
day after a meal al pressure secondary
infraction twice daily prophylaxis

19
 DRUG THERAPY PROBLEMS

SUB-THERAPEUTIC DOSING

The patient is taking Nifedipine SR 20 mg orally twice daily but

Nifedipine SR because this preparation is a slow release, his dose should be between
30-90 mg orally once daily.

Metformin The patient is taking Metformin 1000 mg orally twice daily but his
fasting blood glucose test shows his blood glucose levels are still
high, therefore this dose/drug is ineffective in treating his type 2
diabetes.
Terazosin This patient is taking Terazosin 2 mg orally at night but because of
his chief complaints, his benign prostate hyperplasia is not under
control, thus this dose can be said to be subtherapeutic.
ADVERSE DRUG REACTION
Bendroflumethiazide A side effect of this drug is constipation which is one of the patient’s
chief complaints.
Simvastatin Side effect is constipation which is one of the patient’s complaints.
This drug can also cause alteration to liver enzymes which is seen in
his AST and ALT lab results which are elevated.
Nifedipine Side effect is hypokalemia which can be seen from patient’s lab
results. This class of medication is also associated with lower urinary
tract symptoms.
DRUG-DRUG INTERACTIONS
Aspirin – Major NSAIDS when used in combination with Thiazide
Bendroflumethiazide Diuretics can lower the effectiveness of the diuretic and
can result in nephrotoxicity.
Aspirin – Metformin Major Aspirin when used in combination with oral
Hydrochloride hypoglycemic drugs increases the risk of hypoglycemia.
DRUG-FOOD INTERACTIONS
Simvastatin Major Simvastatin and cranberry juice when used together

20
 increases the risk of hepatitis and myopathy/
rhabdomyolysis.
Simvastatin Major Simvastatin and grapefruit juice when taken together can
increase the bioavailability of simvastatin which
increases the risk of myopathy or rhabdomyolysis.
Aspirin Moderate Aspirin, an anti-platelet drug, when used in combination
with celery, increases the risk of bleeding.
Nifedipine Moderate Nifedipine and grapefruit juice used together can result
in severe hypotension, myocardial ischemia and
increased vasodilator side effects.
DRUG-ETHANOL INTERACTIONS
Aspirin Moderate Aspirin when used in combination with ethanol increases
the risk of gastrointestinal bleeding.
Metformin Hydrochloride Moderate Metformin HCl when used in combination with ethanol
increases the risk of lactic acidosis.
DRUG-LAB INTERACTIONS
Aspirin Minor NSAIDs can cause a falsely positive fecal hemoccult test
because of NSAID-induced gastrointestinal bleeding.
Aspirin Minor Aspirin can cause a falsely increased glucose
measurement due to assay interference.
Aspirin Minor Aspirin can cause false increases in acetaminophen
levels because of acetaminophen assay interference.

TREATMENT INTERVENTIONS

Treatment Goals:

21
Benign Prostate Hyperplasia:

1. To improve the symptoms associated with benign prostate hyperplasia that CM is

experiencing like their inability to urinate.
2. To halt disease progression and prevent any complications of benign prostatic
hyperplasia like urinary tract infections, bladder damage and kidney damage.
3. Increasing CM’s quality of life.
4. To reduce morbidity.

Hypertension:

1. To lower blood pressure to the acceptable range of <130/90 and maintain it.
2. To prevent/retard cardiovascular damage.
3. To improve CM’s quality of life and prolong their life.
4. To reduce risks associated with hypertension.

Type 2 Diabetes:

1. To control CM’s blood sugar level to the appropriate glycemic level.

2. To reduce microvascular and macrovascular complications associated with type 2
diabetes by controlling glycemic levels, blood pressure, lipid levels and smoking
cessation.

Hyperlipidaemia

1. To lower cholesterol levels in CM who has type 2 diabetes to below 100 mg per dL.
2. To provide secondary prevention in patients at risk for cardiovascular disease like CM.

Non-Pharmacologic Treatment

Hypertension

22
 1. Patients who are overweight should make an effort to lose weight.
2. Patients can partake in a heart healthy diet which includes reducing sodium, saturated fats
and total fats intake and increasing potassium, vegetables, fruits and grains.
3. Patients can increase physical activity which can help with weight loss. Cardiovascular or
aerobic exercise has shown to help reduce blood pressure.
4. Reducing alcohol intake to two beers per day for men and one beer per day for women.

BPH

1. Patients should be advised to double evacuate where after initially urinating, patients
should wait 30-60 seconds and urinate again.
2. Patients should empty their bladder every two to three hours.
3. Pelvic floor exercises should be done where they’re contracted in order to strengthen
them.
4. Restrict nightly fluid intake.
5. Avoid food like caffeine, alcohol and highly seasoned or irritative foods to reduce risk of
constipation.
6. Urethral milking helps to reduce micturition dribbling, however, may be uncomfortable
to do in public.

Diabetes

1. Patients should introduce a low-calorie diet that is low in saturated fats and trans fats,
refined carbohydrates.
2. Adding whole grain foods into the diet with fruits and vegetables is encouraged.
3. Weight loss is encouraged in patients with diabetes.
4. Increasing physical activity is also recommended for diabetic patients as it aids in weight
loss.
5. Reducing stress levels by including stress management techniques like mindfulness has
shown to reduce high blood sugar associated with stress.

Hyperlipidemia

23
 1. Patients should decrease saturated and trans fats in their diet and replace them for
polyunsaturated and monounsaturated fats.
2. Persons should increase their fiber intake through their diet by eating green vegetables,
fruits and beans.
3. Patients should limit alcoholic drink consumption to 1 per day for women and 2 per day
for men.
4. To improve lipid profiles, physical activity should be increased as it reduces body weight
such as introducing aerobic exercise 20 minutes a day.

24
 THERAPEUTIC OPTIONS

Significant
Onset of
Drug-drug, Convenience
Previous Therapeutic Therapeutic Effect/ Adverse Precautions/ Relative
drug-food or (dosing, route,
Drug Options Efficacy Time to Effects Contraindications Cost
drug-disease administration)
Peak
interaction

Metformin 1.Second 1. This 1.Onset 1. Diarrhea, 1.Metabolic 1.Drug-drug: 1. Oral: 1.Tablet

500mg Line: combination of effect: headache, acidosis, severe, Iopentol- Tablet
Sitagliptin/ has shown a 1 week3 upper renal impairment, metformin: can (sitagliptin/metfo Box:
Metformin great effect respiratory lactic acidosis, heart cause lactic rmin) $344.00
50/500mg on lowering Time to infection, failure, hypoxemia acidosis and 50mg/500mg,
HbA1c and peak: 3 to renal acute renal 50mg/1000mg
fasting 6 hours failure, failure
glucose. It is pancreatic Convenient due
well tolerated. cancer, Ciprofloxacin- to combination
arthralgia sitagliptin: can formula.
cause changes
in blood Dose:
glucose, either 50mg/500mg
causing hyper- Tablet po bid
or
hypoglycemia.

Drug-food:
Metformin-
Alcohol: may
result in lactic
 acidosis

2. First Line: 2. As the dose 2.Onset 2. Diarrhea, 2. Metabolic 2. Acetrizoic 2. Oral: 2.Table:
Metformin increases, of effect: cobalamin acidosis, severe Acid- Modified-release XR
1000mg maximal 4 to 5 deficiency, renal impairment. Metformin: can tablet: 500mg, 1000mg:
benefits have days6 flatulence, Precautions: acute result in lactic 1g
been seen in Time to lactic congestive heart acidosis and Box:
treating type peak: 1 to acidosis. failure, concomitant renal failure. Tablet: $181.95
2 diabetes. 3 hours use with insulin, Metformin for 30
hepatic disease. Metrozic- 500mg, 850mg tablets
Metformin: can
result in lactic Oral solution:
acidosis and 100mg per 1 mL,
renal failure. 170mg per 1 mL,
200mg per 1 mL.
Drug-food:
Metformin-
Alcohol: may
result in lactic
acidosis

3. Drug- drug:
Dulaglutide-
3. Second 3. It lowers 3. Onset 3. 3. Hypoglycemia Glipizide: risk 3. Subcutaneous 3.Box of
Line: A1C levels by of effect: Abdominal may occur, of Injection: 4
Metformin 0.78% to 2 to 4 pain, pancreatitis has hypoglycemia. Prefilled syringes:
500mg 1.64%.7 It weeks9 Decrease in been reported along Syringe: $2093.80
also shows appetite, with acute renal Dulaglutide- 0.75mg/0.5mL,
+ great retinopathy, failure. Alcohol 1.5mg/0.5mL
Dulaglutide reduction in Time to thyroid increases risk
Dose: 0.75mg
0.75mg cardiovascula peak: 13 cancer. of
per week.
r events.8 weeks10 hypoglycemia.

1
 4.5mg/1
4.Second 4. This 4. Onset 4.UTI, 4. Contraindicated 4.Besifloxacin- 4. Oral: 000mg
Line:Dapagl combination of effect: pyelonephri in persons with Dapaglifloxin: Tablet: (30
iflozin/Metf is used 1 week12 tis, genital acute or chronic may result in 2.5mg/100mg, tablets):
ormin together to infection, metabolic acidosis, changes in 5mg/500mg, $427.50
5mg/500mg improve diarrhea. dialysis and end blood glucose 5mg/1000mg.
blood sugar Time to stage renal diseases. resulting in
levels.11 peak: Hypoxemia, hypoglycemia
12 hypotension and or
hours13 decreased levels of hyperglycemia.
vitamin b12 may
occur

5. Third 5. This 5. 5. Metabolic 5. Drug- drug: 5.

Line: combination 5.Onset Hypertensio acidosis, severe Aspirin- 5. Oral: Tablet:
Metformin/ improves of effect: n, diarrhea, renal impairment, Glipizide: Tablet: Box of
Glipizide impaired 4 to 5 headache, excessive intake of increased risk 2.5mg/250mg,2. 100:
250mg/2.5m fasting days lactic alcohol of 5mg/500mg, $400
g glucose and acidosis. hypoglycemia. 5mg/500mg
has proven to
work better Time to Metrizamide-
than other peak: 1 to Metformin:
monotherapy 3 hours15 may result in
14
lactic acidosis
and renal
failure.

2
 Drug-food:
Metformin-
Alcohol: may
result in lactic
acidosis

Bendroflum 1. First Line: 1. Reduces 1. Onset 1. 1. Addison’s 1. Drug-drug: 1. Oral: 1.

ethiazide Bendroflum blood of effect: Constipatio disease, Aspirin- Tablet 2.5mg, Tablet:
5mg ethiazide pressure for a Time to n, gout, hypercalcemia, Bendroflumethi 5mg Box of
5mg moderate peak: 3 to hypercalce diabetes, azide: reduced Dose: 5mg po od 28:
time. It is 6 hours17 mia, severe hyperuricemia, diuretic AM $14.30
+ completely joint pain, acute cholecystitis. effectiveness
Polyethylene absorbed in loss of and possible For 1:
Glycol 17g the appetite18 nephrotoxicity $0.50
gastrointestin
al tract.16 Bendroflumethi
azide-
naproxen:
reduced
diuretic
effectiveness
and possible
nephrotoxicity

2. First Line: 2. Reduces 2. Onset 2.Hyperkale 2.Afro-Caribbean 2. Drug-drug: 2. Oral: 2.

3
 Lisinopril blood of effect: mia, patients, caution in Aliskiren- Tablet 2.5mg, Tablet:
5mg pressure and 2 to 4 hypotension patients with severe Lisinopril: 5mg or 10mg. Box of
has shown weeks20 , syncope, aortic stenosis, risk increased risk Dose: 5 mg po 28:
results for dizziness, of agranulocytosis of od $47.50
elderly Time to myocardial increased in hyperkalemia,
patients peak: 7 infarction. vascular disease hypotension Oral solution
without hours and renal 1mg per 1mL
affecting impairment
glycemic
control or Sacubitril-
lipid lisinopril:
profiles.19 increased risk
of angioedema

3.First Line: 3. Well 3. Onset 3. 3.Concomitant use 3.Drug-drug: 3. Oral: 3.

Losartan tolerated of effect: Backache, with aliskiren, Aliskiren- Oral suspension: Tablet:
50mg medication 3 to 6 cough, avoid use in Losartan: risk 2.5mg per 1 mL Box of
that reduces weeks21 upper patients with of 30:
blood respiratory impaired renal hyperkalemia, Tablet:12.5mg, $439.00
pressure.20 Time to tract function. renal 25mg, 50mg
peak: 6 infections, impairment and
hours22 syncope, hypotension.
renal
failure. Drug-food:
Losartan-
Grapefruit:
may lower
efficacy of
losartan.

4
 4. First Line: 4.It is well 4. Onset 4. edema, 4. Hypotension may 4.Simvastain- 4. Oral: Tablet: 4. 5mg
Amlodipine tolerated and of effect: abdominal occur, can worsen Amlodipine: 2.5mg, 5mg, For 1
5 mg effective has 1 week24 pain, angina and acute may cause for 10mg tablet:
shown to fatigue. myocardial increased $3.10
reach the Time to infarction may simvastatin
therapeutic peak: 8 occur, precaution in exposure and
goal in a high hours25 patients with severe increased risk
amount of hepatic impairment. of myopathy.
persons.23

5. Third 5. It lowers 5. Onset 5. 5.Contraindiacted in 5. Triamterene- 5.Oral: Tablet: 5.5mg

Line: blood of effect: Gynecomas persons with Spironolactone: 25mg, 50mg, Box of
Spironolacto pressure in tia, hyperkalemia, may result in 100mg 28:
ne 25mg in uncontrolled Time to somnolence eplerenone use and hyperkalemia $737.10
combination hypertension . peak:1 , breast Addison disease. Oral Suspension:
26
with first hour27 cancer, Avoid use in older 25mg/5mL
line metabolic persons.
acidosis.

Nifedipine 1. First Line: 1. Reduces 1. Onset 1.Hypokale 1. Afro-Caribbean 1. Drug-drug: 1. Oral: 1.

SR 20mg Lisinopril blood of effect: mia, patients, caution in Aliskiren- Tablet 2.5mg, Tablet:
5mg pressure and 2 to 4 hypotension patients with severe Lisinopril: 5mg or 10mg. Box of
has shown weeks29 , syncope, aortic stenosis, risk increased risk Dose: 5 mg po 28:
results for Time to dizziness, of agranulocytosis of od $47.50
elderly peak: 7 myocardial increased in hyperkalemia,

5
 patients hours30 infarction, vascular disease hypotension Oral solution
without diarrhea, and renal 1mg per 1mL
affecting chest pain, impairment
glycemic cough
control or Sacubitril-
lipid lisinopril:
profiles.28 increased risk
of angioedema

2. Losartan 2. Well 2. Onset 2. 2. Backache, cough, 2.Drug-drug: 2. Oral: 2.

50mg tolerated of effect: Backache, upper respiratory Aliskiren- Oral suspension: Tablet:
medication 3 to 6 cough, tract infections, Losartan: risk 2.5mg per 1 mL Box of
that reduces weeks.31 upper syncope, renal of 30:
blood respiratory failure. hyperkalemia, Tablet:12.5mg, $439.00
pressure Time to tract renal 25mg, 50mg
peak: 6 infections, impairment and
hours syncope, hypotension.
renal
failure. Drug-food:
Losartan-
Grapefruit:
may lower
efficacy of
losartan

3.Hydrochlo 3. The 3. Onset 3. 3.Contraindiacted in 3. Sitagliptin- 3.Oral: Tablet: 3.25mg

rothiazide antihypertensi of Hypotensio persons hydrochlorothi 25mg, 50mg, Box of
25mg ve effect of effect:2 n, vertigo, hypersensitive to azide: may 100mg 30: $40
this drug is to 3 cardiac hydrochlorothiazide result in

6
 proven to be weeks dysrhythmi or sulfonamides. increased Capsule 12.5mg,
inferior when a, Stevens May cause hyperglycemia 50mg
compared to Time to Johnson hypokalemia, risk
other peak:4 syndrome, precipitation of
classes.32 hours33 renal hyperuricemia, and
failure. diabetes.

4. Third 4. Onset 4. 4. Contraindicated 4. Triamterene- 4. Oral: Tablet:

Line: 4. It lowers of effect: Gynecomas in persons with Spironolactone: 25mg, 50mg,
Spironolacto blood tia, hyperkalemia, may result in 100mg 4.5mg
ne 25mg in pressure in Time to somnolence eplerenone use and hyperkalemia Box of
combination uncontrolled peak:1 , breast Addison disease. Oral Suspension: 28:
with first hypertension hour35 cancer, Avoid use in older 25mg/5mL $737.10
34
line metabolic persons.
acidosis.

Terazosin 1. First Line: 1. It is 1. Onset 1. 1. History of 1. Drug-drug: 1. Oral: 1.

2mg Terazosin effective of effect: Orthostatic micturition Asenapine- Tablet 2mg, Tablet:
4mg therapy for 2 to 4 hypotension syncope, history of terazosin: 5mg, 10mg. 2mg:
patients with week37 , peripheral postural additive Dose: 2mg 2 $2.70 for
benign edema, hypotension, hypotensive Tablets po q.h.s 1 tablet
prostatic Time to nausea , intraoperative effect
hyperplasia peak: 1 to headache, floppy eye
and has 2 hour38 nasal syndrome Tadalafil-
shown to be congestion. terazosin:
just as potentiation of
effective hypotensive
alone effects
compared to
it combined
with

7
 finasteride.36
It is
completely
absorbed into
the
bloodstream.

2. First Line: 2. A high 2. Onset 2.Infectious 2. Caution in 2.Drug-drug: 2. Oral: 2.

Tamsulosin tolerability of effect: disease, patients with sulfa Boceprevir- Modified Tablet:
0.4mg and safety in 5 days40 rhinitis, allergies, avoid use Tamsulosin: Release Tablet: Box of
patients with headache, with strong increased 400mcg. 30:
efficacious Time to priapism, CYP3A4 tamsulosin $293.80
results up to 6 peak: 4 to retinal exposure. Modified
years.39 5 hours detachment Release Capsule:
without Drug-food: 400mcg
food41 Food-
tamsulosin:
when taken
with food it
may affect
intestinal
absorption of
the drug.

8
 3. Second 3.As 3.Onset 3.Abnormal 3.Contraindicated in 3.Finasteride- 3.Oral: Tablet: 3.5mg
Line: monotherapy, of effect: ejaculation, persons with known St. John’s 1mg, 5mg. box of
Finasteride it has reduced unknown reduced or suspected Wort: may 30: $600
43
5mg prostate libido, pregnancy. May decrease
volume by prostate cause hepatic plasma
over 20%42 Time to cancer, impairment and exposure and
peak: 1 to neoplasm of increase high grade increase the
2 hours44 breast. prostate cancer metabolism and
reports. clearance of
finasteride.

4. Third 4.Used in 4.Constipat 4.Contrainidcated in 4.Tolteridon- 4.Oral: Tablet: 4.4mg @

Line: combination 4.Onset on, persons with gastric Potassium: may 1mg, 2mg $24.80
Tolterodine with alpha of effect: abdominal retention, result in risk of each
2mg antagonists 3 to 6 pain, hypersensitivity to gastrointestinal Capsule: 2mg,
and has months46 headache, this drug, lesions. 4mg.
reduced angioedema uncontrolled narrow
LUTS that . angle glaucoma and
were Time to urinary retention. It
irritative.45 peak:1 to should be avoided
2 hours47 in older patients.

Simvastatin 1. First 1. Lowers 1. Onset 1. 1. Persons with 1. Drug-drug: 1. Oral: 1.

20mg Line: LDL levels of effect: Rhabdomyo active liver disease Verapamil- Oral Suspension: Tablet:
Simvastatin by 30-49%48. 6 weeks50 lysis, and nursing mothers simvastatin 4mg per 1mL, Box of
20mg It is well Time to abdominal or persons at increases 8mg. 90:
absorbed in peak: 1 to pain, childbearing age myopathy and $92.00
the 3 hours51 constipation should be cautioned rhabdomyolysi Tablet: 10mg,
gastrointestin , liver when using this s 20mg, 40mg,

9
 al tract but failure, drug. 80mg.
hepatic jaundice. Drug-food:
extraction Grapefruit- Dose: 20mg
limits simvastatin Tablet po nocte.
bioavailabilit increases drug
y by 5%.49 levels and Switching to a
increases side 20mg improves
effects convenience as
the patient no
longer has to cut
the tablet in half.
2. Second 2. It lowers 2. Onset 2. 2. Contraindicated 2. Drug-drug: 2. Oral: Powder: 2.
Line: LDL of effect: Abdominal in persons with Digoxin- 4g Powder
Cholestyram cholesterol by 1 month53 discomfort, complete biliary cholestyramine 378g:
ine 4g 12-18%.52 Time to constipation obstruction and : may result in $603.05
peak: , flatulence precautioned decreased
against persons with digoxin levels
renal impairment.
Do not take
with
multivitamins
as it may
decrease the
effect of the
multivitamin.

3. Onset
3. Second 3. Most of effect: 3. Flushing, 3. Contraindicated 3.Drug-drug: 3. Oral: Tablet: 3.
Line: Niacin effective Unknown nausea, in persons with increased 50mg,100mg,25 Tablet:
250mg agent that vomiting, active liver disease, exposure of 0mg, 500mg 250mg/1
increases the Time to rhabdomyol active peptic ulcer both drugs and 00
levels of peak: 45 ysis. and precautioned increased risk Extended tablets:
HDL.54 mins55 against persons with of myopathy Release Tablet: $91.00

10
 and 250mg, 500mg,
rhabdomyolysi 750mg, 1000mg
s.

4. Onset
4. Second 4. Reduces of effect: 4. 4. Contraindicated 4. Drug-drug: 4.Oral: Tablet: 4.Tablet:
Line: total 3 months Abdominal in concomitant Simvastatin- 600mg 0.6mg/6
57
Gemfibrozil cholesterol pain, repaglinide, gemfibrozil: 0
1.2g and is safe indigestion, simvastatin, increased risk Capsule: 300mg Tablets:
and well Time to myopathy, dasabuvir use and of myopathy $1701.70
tolerated peak:1 to rhabdomyol precautioned and
while 2 hours58 ysis. against persons with rhabdomyolysi
lowering renal insufficiency. s.
cardiovascula
r events.56 Drug-food:
gemfibrozil-
grapefruit
juice: increases
concentration
of gemfibrozil
and increasing
side effects.

Aspirin Aspirin Aspirin is Onset of Confusion Active peptic Drug-drug: Oral: Tablet:
81mg 81mg used as a effect: ulceration Aspirin- Tablet: 75mg, 81mg/12
secondary Gastrointest bendroflumethi 81mg, 300mg. 0
prevention for inal Haemophilia azide: reduced Tablets:
patients with Time to Haemorrha diuretic Dose: 81mg po $34.90
hyperlipidemi peak: 3 to ge Severe cardiac effectiveness od.
60
a and 4 hours failure and possible
hypertension Gastrointest nephrotoxicity
to reduce the inal ulcer

11
 risk of Aspirin-
cardiovascula Angioedem naproxen:
r diseases.59 a increases the
risk of stomach
bleeding

12
 FOLLOW UP PLAN
Alternatives and Implementation
Drug Related Problem Clinical Outcomes Monitoring Plan
Assessments Plan
(9) Multiple Metformin 500mg Metformin: Works Sitagliptin/ Discontinue  Achieving
drug therapy by decreasing Metformin Metformin 500mg glycemic control,
is used when glucose 50/500mg: and initiate including meeting
single production in the Management of Sitagliptin/Metfor HbA1c goal is
therapy is liver and type 2 diabetes, min 50/500mg indicative of
ineffective decreasing Sitagliptin/Metfor tablet po bid. efficacy.
absorption of min is used with a  HbA1c:
glucose by the proper diet and There is no need Twice yearly in
intestines. exercise program for tapering patients who are
to control high because drugs are meeting treatment
Parameter: blood sugar of the same drug goals; every 3
The lowering of class. months in patients
blood sugar levels. whose therapy has
Improvement of Metformin/Glipizid changed and/or
blood sugar levels e: Metformin who are not
should be seen works by meeting glycemic
within 1 week of decreasing glucose goals; more
use. production in the frequently as
liver and clinically warranted 
decreasing  Blood
absorption of glucose (self-
glucose by the monitoring): As
intestines. Glipizide needed to assist in
is a sulfonylurea meeting goals of
and works by therapy 
stimulating the  Blood
 release of your glucose (self-
body’s natural monitoring,
insulin and by pediatric patients):
decreasing the Upon initiating or
amount of sugar changing treatment
that your liver regimens, when
makes. This combo glycemic goals are
of drug is used to not being met,
control high blood during intercurrent
sugar in patients illnesses, and
with type 2 periodically as
diabetes. needed 
 Estimated
GFR: Prior to
initiation of
treatment and
annually thereafter
with more frequent
monitoring in
patients with
increased risk of
renal impairment
(eg, elderly) 
 Reassess
eGFR 48 hours after
an iodinated
contrast imaging
procedure if therapy
was discontinued 
 Hematologic
parameters:

1
 Baseline and then
annually 
 Vitamin B12
levels: Every 2 to 3
years
 Renal
function: at baseline
and periodically.

6. Adverse Bendroflumethiazi Bendroflumethiazi Bendroflumethiazi Continue  Blood

Drug de de belongs to the de 5mg: Adverse Bendroflumethiazi pressure, urine
Reactions/S 5mg diuretic class of reaction is de 5mg po od AM. output, reduction in
drug. It is used in constipation and edema 
E the treatment of therefore a laxative Start polyethylene  Serum and
high blood like polyethylene glycol 17mg (about urine electrolyte
pressure and the glycol 17g is taken 1 heaping (eg; potassium,
build-up of fluid in to treat this side tablespoon) orally sodium, calcium) 
the body effect. per day dissolved  Renal
in 4-8 ounces of function, hepatic
Parameter: Lisinopril: Is used water, juice, function, CBC
Management of to treat high blood coffee, soda or tea.  Serum uric
high blood pressure and has acid, blood glucose
pressure been shown to  Decreased
(hypertension). have positive abdominal
Improvement in results in elderly discomfort and pain
high blood patients without  Bowel
pressure should affecting glycemic movement in 2 to 4
be seen within 2-4 control or lipid days 
hours. profiles.  Electrolyte
imbalance
Losartan: Well (prolonged,
tolerated

2
 medication that frequent, excessive
reduces blood use) 
pressure. Works by
keeping blood
vessels from
narrowing, which
lowers blood
pressure and
improve blood
flow.
6. Adverse Nifedipine SR Nifidipine SR Lisinopril 5mg: Is Discontinue  Angina:
Drug 20mg 20mg: Reduces used to treat high Nifedipine SR chest pain
blood pressure blood pressure and 20mg.  Hypertensio
Reactions/S
and has shown has been shown to n: blood pressure
E results for elderly have positive Initiate Lisinopril  Heart rate,
patients without results in elderly initially at 5 mg orally signs and symptoms
affecting glycemic patients without once daily; of peripheral edema
control or lipid affecting glycemic maintenance 10 mg  Liver
orally daily or higher as
profiles. However control or lipid function;
tolerated 
the adverse side profiles. periodically
effect is  Signs and
hypokalemia Losartan: Well symptoms of cardiac
which can be seen tolerated failure
in the patient’s lab medication that
report. This reduces blood
medication is pressure. Works by
associated with keeping blood
lower urinary tract vessels from
symptoms. narrowing, which
lowers blood
Parameter: pressure and

3
 Management of improve blood
high blood flow.
pressure
(hypertension).
(3) Sub- Terazosin 2mg Relaxes the Terazocin 4mg: Increase Terazosin  Benign
Therapeutic muscles in the Due to the patient dose to 2mg 2 prostatic
Dosage prostate and still exhibiting tablets po q.h.s. hyperplasia:
bladder neck, lower urinary tract improvement in the
making it easier to symptoms the dose signs and symptoms
urinate. was increased to within 2 to 4 weeks
aid in reducing indicates efficacy 
Parameters: these symptoms.  Hypertensio
Improve urination n: reduction in
in men with Tamsulosin 0.4mg: blood pressure
benign prostatic Relaxes the indicates efficacy
hyperplasia. muscles in the  Benign
Improvement is prostate and prostatic
seen within 2 to 4 bladder neck hyperplasia: rule out
weeks. making it easier to prostate cancer;
urinate, used to prior to initiating
improve urination therapy and
in men with benign annually thereafter 
prostatic  Benign
hyperplasia. prostatic
hyperplasia: severe
hypotension; during
initial
administration 
 Hypertensio
n: blood pressure;
within 2 to 3 hours

4
 after dosing and at
the end of each
dosing interval
during dose titration

7. Drug Simvastatin 20mg Management of Simvastatin 20mg:  Lipid panel:

interaction cholesterol, in Drug-food After 4 weeks of
lowering the blood interaction therapy and
levels of grapefruit, periodically
cholesterol. simvastatin throughout
increases drug treatment
Parameters: levels and  Liver
Lowering blood increases side function: Before
levels of low effects. initiating therapy
density lipoprotein and repeat as
(LDL) and Cholestyramine 4g: clinically indicated;
increasing the it lowers LDL note a rising ALT
levels of high- cholesterol by 12- with creatine kinase
density lipoprotein 18%. may indicate
(HDL) and to lower myopathy
triglycerides. The Niacin 250mg:  Creatine
onset of week is 6 Works by kinase: May
weeks increasing the consider periodically
levels of HDL. at initiation of
Gemfibrozil 1.2g: therapy and with
Reduces total dose increases;
cholesterol and it is closer monitoring
safe and well warranted in patient
tolerated while with complicated
lowering medical history
cardiovascular including renal

5
 events. insufficiency due to
long-standing
diabetes
 Myopathy:
Chinese patients
may be at higher
risk.
 Myopathy/rh
abdomyolysis:
Patients with
complicated medical
histories including
renal insufficiency
associated with
long-standing
diabetes mellitus.
7. Drug Aspirin 81mg Aspirin 81mg: is Aspirin 81mg:  Chronic
interaction used as a Drug-drug: Aspirin- coronary artery
secondary bendroflumethiazi disease: Reduced
prevention for de: reduced incidence of
patients with diuretic nonfatal reinfarction
hyperlipidemia effectiveness and and other vascular
and hypertension possible events (eg, first
to reduce the risk nephrotoxicity occurrence of
of cardiovascular myocardial
diseases Aspirin-naproxen: infarction or stroke)
increases the risk indicates efficacy.
Parameter: used of stomach  Ischemic
in the treatment bleeding stroke and transient
of hyperlipidemia ischemic attack:
and hypertension. Reduced incidence

6
 The time for to of stroke and
see improvement transient ischemic
is attack indicates
efficacy.

MEDICATION RELATED PROBLEMS

1.Untreated Indication 2. Improper drug selection
3. Sub therapeutic dosage 4. Failure to receive drug
5. Over dosage 6. Adverse Drug Reactions/SE
7. Drug interaction 8. Drug use without indication
9. Other (describe) 10. None Identified – continue monitoring.

7
 REEFERENCES
Mahmood, S., Shah, K. U., Khan, T. M., Nawaz, S., Rashid, H., Baqar, S., & Kamran, S. (2019).
Non-pharmacological management of hypertension: in the light of current research. Irish journal
of medical science, 188(2), 437–452. https://doi.org/10.1007/s11845-018-1889-8

Kelly R. B. (2010). Diet and exercise in the management of hyperlipidemia. American family

physician, 81(9), 1097–1102. https://www.aafp.org/afp/2010/0501/p1097.html

(n.d.). Retrieved May 04, 2020, from https://www.bhj.org.in/journal/2002_4401_jan/cost_93.htm

Standards of Medical Care in Diabetes—2020 Abridged for Primary Care Providers. Clinical
Diabetes. 2019;38(1):10-38.

Ballav C, Gough S. Safety and Efficacy of Sitagliptin-Metformin in Fixed Combination for the
Treatment of Type 2 Diabetes Mellitus. Clinical Medicine Insights: Endocrinology and Diabetes
[Internet]. 2013 [cited 5 May 2020];6:CMED.S7314. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767579/

Association A. Wait Times: How Long Until Your Med Begins Working [Internet]. Diabetes
Forecast. 2020 [cited 5 May 2020]. Available from: http://www.diabetesforecast.org/2016/jan-
feb/wait-times-how-long-until.html

Optimal Second- and Third-Line Therapy in Type 2 Diabetes [Internet]. Ncbi.nlm.nih.gov. 2020
[cited 7 May 2020]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK361996/

Garber A, Duncan T, Goodman A, Mills D, Rohlf J. Efficacy of Metformin in Type II Diabetes.

The American Journal of Medicine. 1997;103(6):491-497.
Association A. Wait Times: How Long Until Your Med Begins Working [Internet]. Diabetes
Forecast. 2020 [cited 7 May 2020]. Available from: http://www.diabetesforecast.org/2016/jan-
feb/wait-times-how-long-until.html

Kugler A, Thiman M. Efficacy and safety profile of once-weekly dulaglutide in type 2 diabetes:
a report on the emerging new data. Diabetes, Metabolic Syndrome and Obesity: Targets and
Therapy. 2018;Volume 11:187-197.

Dulaglutide Reduces Cardiovascular Disease in People with Type 2 Diabetes | ADA [Internet].
Diabetes.org. 2020 [cited 11 May 2020]. Available from:
https://www.diabetes.org/newsroom/press-releases/2019/dulaglutide-reduces

Dulaglutide (Trulicity) | Davis’s Drug Guide [Internet]. Drugguide.com. 2020 [cited 11 May
2020]. Available from: https://www.drugguide.com/ddo/view/Davis-Drug-
Guide/110166/all/dulaglutide

Dapagliflozin-Metformin - Side Effects, Dosage, Interactions - Drugs - Everyday Health

[Internet]. EverydayHealth.com. 2020 [cited 11 May 2020]. Available from:
https://www.everydayhealth.com/drugs/dapagliflozin-metformin

Dapagliflozin: medicine used to treat type 2 diabetes [Internet]. nhs.uk. 2020 [cited 11 May
2020]. Available from: https://www.nhs.uk/medicines/dapagliflozin/

Glipizide/Metformin: Diabetes Drug Side Effects & Dosage [Internet]. MedicineNet. 2020 [cited
7 May 2020]. Available from: https://www.medicinenet.com/glipizidemetformin-oral/article.htm

Glipizide: 7 things you should know - Drugs.com [Internet]. Drugs.com. 2020 [cited 7 May
2020]. Available from: https://www.drugs.com/tips/glipizide-patient-tips

1
Aprinox / Bendroflumethiazide 2.5mg Tablets - Summary of Product Characteristics (SmPC) -
(emc) [Internet]. Medicines.org.uk. 2020 [cited 5 May 2020]. Available from:
https://www.medicines.org.uk/emc/product/2240/smpc

Aprinox / Bendroflumethiazide 2.5mg Tablets - Summary of Product Characteristics (SmPC) -

(emc) [Internet]. Medicines.org.uk. 2020 [cited 5 May 2020]. Available from:
https://www.medicines.org.uk/emc/product/2240/smpc

Aprinox / Bendroflumethiazide 2.5mg Tablets - Summary of Product Characteristics (SmPC) -

(emc) [Internet]. Medicines.org.uk. 2020 [cited 5 May 2020]. Available from:
https://www.medicines.org.uk/emc/product/2240/smpc

Toto R, Shultz P, Raij L, Mitchell H, Shaw W, Ramjit D et al. Efficacy and Tolerability of
Losartan in Hypertensive Patients With Renal Impairment. Hypertension. 1998;31(2):684-691.

Losartan: medicine to treat high blood pressure [Internet]. nhs.uk. 2020 [cited 7 May 2020].
Available from: https://www.nhs.uk/medicines/losartan/

Losartan Potassium Drug Information, Professional [Internet]. Drugs.com. 2020 [cited 7 May
2020]. Available from: https://www.drugs.com/mmx/losartan-potassium.html

Valcarcel Y, Jiminez R, Hernandez V, Arisetgui R, Gil A. Efficacy and Safety of Amlodipine

[Internet]. Medscape. 2020 [cited 11 May 2020]. Available from:
https://www.medscape.com/viewarticle/528305

Kane S. Using Amlodipine Responsibly in Hospitalized Patients - ClinCalc.com [Internet].

Clincalc.com. 2020 [cited 11 May 2020]. Available from:
https://clincalc.com/blog/2013/03/using-amlodipine-responsibly-in-hospitalized-patients/

Chapman N, Dobson J, Wilson S, Dahlöf B, Sever P, Wedel H et al. Effect of Spironolactone on

Blood Pressure in Subjects With Resistant Hypertension. Hypertension. 2007;49(4):839-845.

2
Spironolactone Tablets 100mg - Summary of Product Characteristics (SmPC) - (emc) [Internet].
Medicines.org.uk. 2020 [cited 11 May 2020]. Available from:
https://www.medicines.org.uk/emc/product/5919/smpc

Goa K, Haria M, Wilde M. Lisinopril. A Review of Its Pharmacology and Use in the
Management of the Complications of Diabetes Mellitus. Drugs [Internet]. 1997 [cited 5 May
2020];53(6):1081-1105. Available from: https://pubmed.ncbi.nlm.nih.gov/9179532/

Drugs & Medications [Internet]. Webmd.com. 2020 [cited 5 May 2020]. Available from:
https://www.webmd.com/drugs/2/drug-6873-9371/lisinopril-oral/lisinopril-oral/details

Zestril (Lisinopril): Uses, Dosage, Side Effects, Interactions, Warning [Internet]. RxList. 2020
[cited 5 May 2020]. Available from: https://www.rxlist.com/zestril-drug.htm

Messerli F, Makani H, Benjo A, Romero J, Alviar C, Bangalore S. Antihypertensive Efficacy of

Hydrochlorothiazide as Evaluated by Ambulatory Blood Pressure Monitoring. Journal of the
American College of Cardiology. 2011;57(5):590-600.

Microzide Capsules [Internet]. Accessdata.fda.gov. 2020 [cited 11 May 2020]. Available from:
https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020504s018lbl.pdf

Lepor H, Williford W, Barry M, Brawer M, Dixon C, Gormley G et al. The Efficacy of

Terazosin, Finasteride, or Both in Benign Prostatic Hyperplasia. New England Journal of
Medicine. 1996;335(8):533-540.

Drugs & Medications [Internet]. Webmd.com. 2020 [cited 5 May 2020]. Available from:
https://www.webmd.com/drugs/2/drug-6834/terazosin-oral/details

Somberg J, Achari R, Laddu A. Terazosin: Pharmacokinetics and the effect of age and dose on
the incidence of adverse events. American Heart Journal. 1991;122(3):901-905.

3
A. Narayan, P., & Tunuguntla, H. S. (2005). Long-term efficacy and safety of tamsulosin for
benign prostatic hyperplasia. Reviews in urology, 7 Suppl 4(Suppl 4), S42–S48.

Flomax: 7 things you should know - Drugs.com [Internet]. Drugs.com. 2020 [cited 7 May 2020].
Available from: https://www.drugs.com/tips/flomax-patient-tips

Tamsulosin Hydrochloride Drug Information, Professional [Internet]. Drugs.com. 2020 [cited 7

May 2020]. Available from: https://www.drugs.com/mmx/tamsulosin-hydrochloride.html

Carson C, Smith A. Finasteride in the treatment of patients with benign prostatic hyperplasia: a
review. Therapeutics and Clinical Risk Management. 2009;:535.

finasteride [Internet]. Glowm.com. 2020 [cited 11 May 2020]. Available from:

https://www.glowm.com/resources/glowm/cd/pages/drugs/f014.html

Knezevich E, Knezevich J, Spangler M. Benign Prostatic Hyperplasia and the Medication

Management of Associated Lower Urinary Tract Symptoms [Internet]. Uspharmacist.com. 2020
[cited 11 May 2020]. Available from: https://www.uspharmacist.com/article/benign-prostatic-
hyperplasia-and-the-medication-management-of-associated-lower-urinary-tract-symptoms

New drugs for the prostate - Harvard Health [Internet]. Harvard Health. 2020 [cited 11 May
2020]. Available from:
https://www.health.harvard.edu/newsletter_article/New_drugs_for_the_prostate

tolterodine tartrate [Internet]. Glowm.com. 2020 [cited 11 May 2020]. Available from:
https://www.glowm.com/resources/glowm/cd/pages/drugs/t043.html

Guidelines Made Simple | 2018 Blood Cholesterol Guideline - American College of Cardiology
[Internet]. American College of Cardiology. 2020 [cited 5 May 2020]. Available from:

4
https://www.acc.org/education-and-meetings/image-and-slide-gallery/media-detail?
id=1764DA8859F1484995627D666CD5F6B7

simvastatin [Internet]. Glowm.com. 2020 [cited 5 May 2020]. Available from:

https://www.glowm.com/resources/glowm/cd/pages/drugs/s012.html

Simvastatin Uses, Dosage & Side Effects - Drugs.com [Internet]. Drugs.com. 2020 [cited 5 May
2020]. Available from: https://www.drugs.com/simvastatin.html

Riaz S, John S. Cholestyramine Resin [Internet]. Ncbi.nlm.nih.gov. 2020 [cited 7 May 2020].
Available from: https://www.ncbi.nlm.nih.gov/books/NBK534089/

AboutKidsHealth [Internet]. Aboutkidshealth.ca. 2020 [cited 7 May 2020]. Available from:

https://www.aboutkidshealth.ca/Article?contentid=98&language=English

Garg A, Sharma A, Krishnamoorthy P, Garg J, Virmani D, Sharma T et al. Role of Niacin in

Current Clinical Practice: A Systematic Review. The American Journal of Medicine.
2017;130(2):173-187.

niacin (vitamin B3, nicotinic acid) [Internet]. Glowm.com. 2020 [cited 7 May 2020]. Available
from: https://www.glowm.com/resources/glowm/cd/pages/drugs/n018.html

Nyman J. Cost-effectiveness of Gemfibrozil for Coronary Heart Disease Patients With Low
Levels of High-Density Lipoprotein Cholesterol<subtitle>The Department of Veterans Affairs
High-Density Lipoprotein Cholesterol Intervention Trial</subtitle>. Archives of Internal
Medicine. 2002;162(2):177.

Drugs & Medications [Internet]. Webmd.com. 2020 [cited 7 May 2020]. Available from:
https://www.webmd.com/drugs/2/drug-11423/gemfibrozil-oral/details

5
Lopid (Gemfibrozil): Uses, Dosage, Side Effects, Interactions, Warning [Internet]. RxList. 2020
[cited 7 May 2020]. Available from: https://www.rxlist.com/lopid-drug.htm

Jeemon P, Gupta R, Onen C, Adler A, Gaziano T, Prabhakaran D et al. Management of

Hypertension and Dyslipidemia for Primary Prevention of Cardiovascular Disease. Disease
Control Priorities, Third Edition (Volume 5): Cardiovascular, Respiratory, and Related
Disorders. 2017;:389-404.

Patrono C, Rocca B. Drug Insight: Aspirin Resistance -- Fact or Fashion? [Internet]. Medscape.
2020 [cited 5 May 2020]. Available from: https://www.medscape.com/viewarticle/550558_7

Sherman J. BPH: Focus on Medication Management [Internet]. Pharmacy Times. 2020 [cited 5
May 2020]. Available from: https://www.pharmacytimes.com/publications/issue/2007/2007-
01/2007-01-6170

Deters L. BPH: Focus on Medication Management [Internet]. Pharmacy Times. 2020 [cited 5
May 2020]. Available from: https://www.pharmacytimes.com/publications/issue/2007/2007-
01/2007-01-6170

Safeer R, Ugalat P. Cholesterol Treatment Guidelines Update [Internet]. Aafp.org. 2020 [cited 5
May 2020]. Available from: https://www.aafp.org/afp/2002/0301/p871.html

Last A, Ference J, Falleroni J. Pharmacologic Treatment of Hyperlipidemia [Internet]. Aafp.org.

2020 [cited 5 May 2020]. Available from: https://www.aafp.org/afp/2011/0901/p551.html

Exercise Tips for High Blood Pressure [Internet]. WebMD. 2020 [cited 5 May 2020]. Available
from: https://www.webmd.com/hypertension-high-blood-pressure/safe-exercise-tips#1

6
Kapoor O. Non Pharmacological Treatment of BPH (Benign Prostatic Hypertrophy) [Internet].
Bhj.org.in. 2020 [cited 5 May 2020]. Available from:
https://www.bhj.org.in/journal/2002_4401_jan/cost_93.htm

Florence J, Yeager B. Treatment of Type 2 Diabetes Mellitus [Internet]. Aafp.org. 2020 [cited 5
May 2020]. Available from: https://www.aafp.org/afp/1999/0515/p2835.html

Multum C. Metformin and sitagliptin Uses, Side Effects & Warnings [Internet]. Drugs.com.
2020 [cited 2020May7]. Available from: https://www.drugs.com/mtm/metformin-and-
sitagliptin.html

Glipizide-Metformin Oral : Uses, Side Effects, Interactions, Pictures, Warnings & Dosing
[Internet]. WebMD. WebMD; 2018 [cited 2020May7]. Available from:
https://www.webmd.com/drugs/2/drug-64318/glipizide-metformin-oral/details

NHS Choices. NHS; 2018 [cited 2020May7]. Available from:

https://www.nhs.uk/medicines/bendroflumethiazide/

Polyethylene glycol 3350 Uses, Side Effects & Warnings [Internet]. Drugs.com. 2016 [cited
2020May7]. Available from: https://www.drugs.com/mtm/polyethylene-glycol-3350.html

Lisinopril: Uses, Dosage, Side Effects & Warnings [Internet]. Drugs.com. 2017 [cited
2020May7]. Available from: https://www.drugs.com/lisinopril.html

Sinha S. Losartan: Uses, Dosage, Side Effects & Interactions [Internet]. Drugs.com. 2018 [cited
2020May7]. Available from: https://www.drugs.com/losartan.html

7
Sinha S. Terazosin (Hytrin) Uses, Dosage, Side Effects [Internet]. Drugs.com. 2019 [cited
2020May7]. Available from: https://www.drugs.com/terazosin.html

Estringer S. Tamsulosin Uses, Dosage & Side Effects [Internet]. Drugs.com. 2019 [cited
2020May7]. Available from: https://www.drugs.com/tamsulosin.html

Sinha S. Simvastatin Uses, Dosage & Side Effects [Internet]. Drugs.com. 2019 [cited
2020May7]. Available from: https://www.drugs.com/simvastatin.html