Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected.

Colleague 1

Your case shows that the patient is suffering from hypertension as well as type 2 diabetes. For the hypertension, I would recommend considering an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) as first-line treatment options. They work by blocking the production of angiotensin 2, a hormone which causes blood vessels and blood pressure to contract. Examples of ACE inhibitors are lisinopril or ramipril. ARBs, on the other hand, include losartan (or valsartan), and lisinopril (or ramipril). Lifestyle modifications such as exercise and diet can be helpful in controlling hypertension.

The combination therapy of metformin/sulfonylurea would be recommended to type 2 diabetics. Metformin works by decreasing the liver’s production of glucose and increasing the sensitivity of muscle cells to insulin. The pancreas is stimulated to make more insulin by sulfonylureas. This combination therapy can help to effectively control the patient’s blood sugar levels. To manage diabetes, it is important that the patient be encouraged to change their lifestyle, including eating a healthier diet, and to exercise regularly.

Colleague 2

Your case shows that the patient is suffering from asthma and GERD. As for the asthma I recommend a mixture of long-acting beta-agonists (LABAs), and inhaled corticosteroids. Inhaled corticosteroids can be used to treat asthma by reducing inflammation and improving symptoms. To improve your breathing, LABAs relax the muscles of the airways. Combination therapy is a good option for managing symptoms of asthma.

A proton pump inhibitor (PPI) is recommended for GERD. The stomach acid production is decreased by PPIs, which may help reduce acid reflux symptoms such as acid heartburn or acid reflux. PPIs include omeprazole, lansoprazole, and others. In order to control GERD it’s important to motivate patients to adopt lifestyle changes such as avoiding trigger food and not eating too close to bedtime.

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