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Need help to reply three post.



Each reply should be at least 200 words.

2- One scholarly reference ( NO MAYO CLINIC/ AHA)

3- APA style needs to be followed.

4- Each response should have reference at the end

5- Reference should be within last 5 years



disease process I chose for this article is the treatment of chronic hypertension and the medication I chose was Amlodipine (Norvasc).

Hypertension is on the rise in the world and becoming one of the highest occurring disease processes according to the World Health Organization (Lee et al., 2019). The age group with the largest rate of occurrence is patients ages 65 and older at a prevalence rate of 67% (Lee et al., 2019). Amlodipine (Norvasc) is a calcium channel blocker and has a longer half life with a slower onset when compared to other generations of calcium channel blockers (Lee et al., 2019).

The mechanism of action for Norvasc is that it inhibits the movement of calcium ions into the vascular smooth muscle cells and cardiac muscle cells to prevent the constriction of the cardiac muscle and vascular smooth muscle (Lee et al., 2019). This prevention of contraction keeps the vessels “wide” in order to allow easy flow of blood and to decrease blood pressure by decreasing peripheral vascular resistance (Lee et al., 2019). Oral administration

Some common adverse effects of Norvasc are due to the vasodilatation of the blood vessels (Hong et al., 2019). They include peripheral edema, dizziness, palpiations, fatigue, nausea, abdominal pain, somnolence, and flushing (Hong et al., 2019). Rare side effects include blood disorders, impotence, depression, peripheral neuropathy, insomnia, tachycardia, gingival enlargement, hepatitis, and jaundice (Hong et al., 2019).

There are several drugs that have an interaction with Norvasc (Hong et al., 2019). Mainly any drug that influences the level or efficiency of CYP3A inhibitors will also cause an increase of bioavailability of Norvasc in the body (Hong et al., 2019). Some other interactions occur when the patient is also taking cardizem, clarithromycin, and some antifungal (Hong et al., 2019). These interactions with drugs also increase the bioavailability of Norvasc in the body (Hong et al., 2019).

There was a time where a patient came into the ER with a hypertensive emergency and this patient was taking beta-blockers and an ARB. When this patient came to the ICU we started him on cardine for a B/P of 195/103. As we started to bring his pressure out of stroke range, they physician then started Norvasc at 5mg p.o. daily. We did give him his first dose, and noticed a further drop in blood pressure down to a normal range. We then titrated the patient off cardine and were able to keep him off with the new combination of anti-hypertensives and the fact that we were addressing three of the four ways to control hypertension.



Hong, S. J., Jeong, H. S., Cho, J.-M., Chang, K., Pyun, W. B., Ahn, Y., … Kim, H.-S. (2019). Efficacy and Safety of Triple Therapy With Telmisartan, Amlodipine, and Rosuvastatin in Patients With Dyslipidemia and Hypertension: The Jeil Telmisartan, Amlodipine, and Rosuvastatin Randomized Clinical Trial. Clinical Therapeutics, 41(2), 233–248.

Lee, D. W., Jung, M., Wang, H. W., Khan, Z., & Pinton, P. (2019). Systematic Review with Network Meta-Analysis: Comparative Efficacy and Safety of Combination Therapy with Angiotensin II Receptor Blockers and Amlodipine in Asian Hypertensive Patients. International Journal of Hypertension, 1–8.


Hypertension is condition when there is a sustained elevation of systemic arterial blood pressure of systolic greater than 140 mmHg or higher, or a diastolic pressure of 90 mmHg or higher. It is a result of an increase in cardiac output, total peripheral resistance, or both conditions (Brashers, 2019, p. 1061). One way of how the body maintains its blood pressure is through the renin-angiotensin-aldosterone system (RAAS). The kidneys’ release of renin is triggered by decreased blood pressure in the renal circulation. The renin cleaves the angiotensinogen to form an inactive angiotensin I. In the presence of an angiotensin-converting enzyme (ACE) from the pulmonary and renal endothelium, angiotensin I is converted to angiotensin II, a potent vasoconstrictor (Huether, 2019, p. 1236). ACE inhibitors (ACEI) are widely used as drug therapy in the treatment of condition such as high blood pressure, heart failure, diabetic nephropathy and type 2 diabetes mellitus (Seema, Sabina, Vipin, Tulshi, Shailendra, & Yousuf, 2019). Captopril (Capoten) is an ACEI drug which has a high affinity for ACE and competes with angiotensin I, the natural substrate, to block its conversion to angiotensin II.

Additionally, Kininase II, identical to ACE, is an enzyme that degrades bradykinin, a potent vasodilator, to inactive peptides. Whether increased bradykinin levels play a part in the therapeutic effects of ACE inhibitors is presently unclear. Bradykinin-induced vasodilation is thought to be of secondary importance in the blood-pressure-lowering effect of ACE inhibitors. The “local” activity of ACE inhibitors may be more responsible for their clinical outcomes than systemic activity. ACE-inhibiting drugs may act locally (i.e., within a specific tissue) to reduce vascular tone by decreasing local angiotensin II-induced sympathetic activity and/or by decreasing local angiotensin II-induced vasoconstrictive activity. Decreases in plasma angiotensin II levels reduce aldosterone secretion, with a subsequent reduction in sodium and water retention. Captopril should not be given to a patient with renal artery stenosis, pregnant women, and hyperkalemia (Prescriber’s Digital Reference [PDR], 2020). According to Robinson (2016, p. 295-305), careful use should be observed among populations with impaired renal function, especially older adults, and liver disease. Checking for serum potassium level should be done before initiation of ACEI and a week after to note trends. Severe ADR for patients taking ACEI includes angioedema due to an increased level of bradykinin when ACE is inhibited; thus, the medication should be stopped immediately. Mild and transient ADR includes hypotension, dizziness, fatigue, and orthostatic hypotension. Hacking cough that usually occurs during the first week of therapy is noted, but switching to later generation ACEI diminishes this symptom. Captopril and all ACEI should not be given together with lithium as the combination will result to increase lithium levels and symptoms of toxicity. Captopril should not be given along with diuretics, as it may lead to severe hypotension and renal dysfunction (p.303). Aliskiren-containing products are contraindicated in combination with ACEI in patients with diabetes mellitus. In general, avoid combined use of two renin-angiotensin-aldosterone systems (RAAS) inhibitors, particularly in patients with a creatinine clearance of less than 60 mL/minute. Combination therapy increases the risk of hyperkalemia, renal impairment, and other side effects (PDR, 2020).

A story I would like to share about Captopril is when I admitted a patient with new-onset of irregular heart rhythm after taking this medication. Her potassium level was way above the reasonable value when she came to the emergency department. Unfortunately, her doctor failed to educate her about the necessity of diet modification when taking this medication. Her diet consisted mainly of fruits and vegetables as she was trying to avoid fatty meat to control her blood pressure better. Unbeknownst to her, a high-potassium dietary intake should be avoided as this may result in an abnormal rise in serum potassium, which may lead to irregular heartbeat and lethal rhythm.


Brashers, V.L. (2019). Alterations of vascular function. In N.S. Rote (Eds). Pathophysiology: The biologic basis for disease in adults and children (8th ed., pp. 1059- 1142). St. Louis, MO: Elsevier, Inc.

Huether, S.E. (2019). Structure and function of the renal and urologic systems. In V.L. Brashers & N.S. Rote (Eds). Pathophysiology: The biologic basis for disease in adults and children (8th ed., pp. 1228- 1292). St. Louis, MO: Elsevier, Inc.

PDR (2020). Captopril: Drug summary. Retrieved from

Robinson, M.V. (2016). Drugs affecting the cardiovascular and renal systems. In T.M. Woo (Eds). Pharmacotherapeutics for advanced nurse prescribers (4th Edition, pp. 295-359). Philadelphia, PA: F.A. Davis Company

Seema B., Sabina, Y., Vipin, S., Tulshi, C., Shailendra, S.C., & Yousuf, A. (2019). Treatment and Management of Hypertension by Targeting ACE Inhibitors: in silico Approach. International Journal Bioautomation, (1), 13.


For patients who are undergoing treatment for hypertension there are many factors that affect treatment adherence. The most common influencer is attitudes and beliefs of the individuals who are undergoing treatment (Ashoorkhani et al., 2018). The attitudes and beliefs of individuals changes based on the culture they come from (Ashoorkhani et al., 2018). For example, some cultures do not believe in medicine and would rather be treated homeopathically, but the patient themselves want treatment (Ashoorkhani et al., 2018). This patient would require a thorough explanation of medications, nutrition, lifestyle changes, and much more (Ashoorkhani et al., 2018). As healthcare providers it is our responsibility to ensure that the patients understand what they are taking and why as this would improve patient adherence (Ashoorkhani et al., 2018). This could even become a class that could extend to the rest of the practice that patients can be provided to in order for them to learn more about the medications they are taking (Ashoorkhani et al., 2018).

Another example is an ethnic and cultural difference but of food culture in Iranians (Ashoorkhani et al., 2018). Iranians enjoy a lot of salt in their foods and end up consuming 10 to 15 grams a day and is about two to three times higher than the global standard (Ashoorkhani et al., 2018). Ingesting a large about of salt is a common contributing factor to hypertension (Ashoorkhani et al., 2018). So an further example, an Iranian patient who is being treated for hypertension would have to have instruction on how to keep track of their salt intake and ways to reduce salt intake overall (Ashoorkhani et al., 2018).

In my approach I would have to find a way to reach this patient in a positive way that they would understand the information and want to make that change. Instructing a patient on a major lifestyle change positively and also suggesting a substitute actually increases the success rate of the patient converting to the new regimen (Garzon & Heredia, 2019). I would imagine information and explanation would be the best way to reach someone in order to make a change. So for the lifestyle change we would want to modify we would have to also suggest a adequate substitution. However, regardless of the amount of instruction we could give them in any setting, it is ultimately up to the patient if they want to make changes in their lifestyle. I would imagine that it would be difficult the longer the patient has been doing that routine.


Ashoorkhani, M., Majdzadeh, R., Gholami, J., Eftekhar, J., & Bozorgi, J. (2018). Understanding Non-Adherence to Treatment in Hypertension: A Qualitative Study. International Journal of Community Based Nursing and Midwifery, (4), 314. Retrieved from

Garzón, N. E., & Heredia, L. P. D. (2019). Validity and Reliability of the Treatment Adherence Questionnaire for Patients with Hypertension. Investigacion & Educacion En Enfermeria, 37(3), 99–111.


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