Uploaded by Syafiqah Abdul

Comprehensive review

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Comprehensive review
Mary has medical compliance as she is not taking her medicine on time. Mary is skipping her fluid tablet
i.e Furosemide makes her urinate more frequent. Mary takes Perindopril(5mg) for her hypertension As it
is suggested to take only 2.5 mg for people having renal impairment1. As Perindopril is not able to
maintain her BP, so her GP should review if Perindopril is the best medication for her to use. As
therapeutics guidelines suggest that Mary should combine 2 or more drugs for the management of her BP
to reach the normal target2. Anyway, Mary should engage in physical activity. As, she used to go
regularly for gym but she has completely stop going there. Her BMI is 28.9 on her weight 74 kg and
height 165cm. For patients having diabetes, the healthy range of BMI is (18.5-24.9) and engage in more
physical exercise3. Mary falls in overweight category. The non-pharmacological management should be
adopted which includes weight reduction, sodium restriction, avoidance of alcohol intake, regular
physical exercise, healthy eating and cessation of smoking. Mary should disregard eating take-away and
start on a healthy diet and do more exercises4. As in Mary’s case Metformin and Perindopril is already in
high dose which is dangerous for renal function. So her medication should be monitored.
Problem List
Actual Problem: Mary’s lab test shows that she has renal function is CrCl 40ml/minute. Due to frequent
urge to go bathroom Mary’s stops taking her fluid tablet i.e. Furosemide in weekdays and takes only at
weekends which increases her weight as a result of fluid retention in the body. Mary is currently
overweight with a BMI 28.9 and has gained 5 kg in last 2 months. Mary is also diagnosed with Type 2
diabetes and is also hypertensive with a BP of 150/90. The factors that are contributing to his actual
problem are negligence towards medication, alcohol consumption, her diet, decreased physical activity,
interactions and side-effects of medicines. Potential Problems: Renal impairment increases risk of
hyperkalaemia and may affect the excretion of some ACE inhibitors5. A potential risk of developing
hyperkalaemia is cardiac arrhythmia and in severe case cardiac arrest. Mary has been taking too many
take-away which contains high amount of salt which may lead to increase in blood pressure and high
cholesterol increases risk of diabetes and heart diseases. Mary is at increased risk of having obesity.
Excess body weight is common worldwide and is public health problem and an important cardiovascular
risk for individuals and associated with many risk factors for CVD including type 2 diabetes, elevated
blood pressure and dyslipidaemia, including osteoarthritis, poor mental health, some cancers, and
conditions affecting reproductive and gastrointestinal systems6.
1.Mims Online https://www-mimsonline-comau.ezp01.library.qut.edu.au/Search/AbbrPI.aspx?ModuleName=Product%20Info&se
archKeyword=Perindopril&PreviousPage=~/Search/QuickSearch.aspx&SearchType
=&ID=76250001_2
2. eTG complete. [Internet]. Melbourne (VIC): Therapeutic Guidelines Ltd.; 2015. Elevated Blood
Pressure: [cited 2017 Sep 28]; [6 screens]. Available from: https://tgldcdp-tg-orgau.ezp01.library.qut.edu.au/viewTopic?topicfile=elevated-blood-pressure#MPS_d1e1264
3. EveryDay Health
https://www.everydayhealth.com/hs/type-2-diabetes-live-better-guide/does-bmi-matter/
4. Malays Fam Physician 2011
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267017/
5. AMH
https://amhonline-amh-net-au.ezp01.library.qut.edu.au/chapters/cardiovasculardrugs/antihypertensives/ace-inhibitors/perindopril?menu=hints
6. ETG Complete
https://tgldcdp-tg-org-au.ezp01.library.qut.edu.au/viewTopic?topicfile=cardiovascular-disease-riskmodification#toc_d1e91
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