Cardiovascular Medication Adherence, Case Study Example

In the following scenario, Ms. Flores, an 87 year old retired school teacher, has been prescribed two specific drugs for heart failure: Hydrochlorothiazide, a drug that inhibits the kidneys’ ability to retain water and metoprolol, a selective beta receptor blocker that is used in the treatment for cardiovascular disease. Although both of these drugs have been prescribed, Ms. Flores has not adhered to the drug regimen, stating specific concerns regarding fears of falling down in the bathroom at night and nightmares as a result of taking metoprolol. There could be more done to address the concerns and pharmacological needs of this patient.

1) Part of the problem with the patient seems to be that she has fear regarding the potential side effects of medication that could probably be either substituted or given at lower dosages to help her out. The first step would be to go over the medications with Ms. Flores and address her fears regarding falling in the bathroom (perhaps taking precautions to address this fear) and also trying to substitute with different medications.

2) For example, rather than prescribing the higher dosed version of metoprolol, a lower dose could be administered via propanol, a lower dose alternative that might deal with her problems of hypertension without leading to excessive nightmares. This prescription regime, should of course follow the rule of never prescribing a diuretic alone. Thus, if the doctor were to prescribe a new medication, it should address problems related to hypertension, while at the same time trying to address the fears of the patient.

Sources:

Ho, M., Bryson, C., & Rumsfeld, J. (2009). Medication Adherence: Its Importance in Cardiovascular Outcomes. Circulation, 119(1), 3028-3035.

NEHI (2009). Thinking Outside the Pillbox.