wk15

Juan Domingo: 13-year-old Hispanic male

• No known allergies or hypersensitivity reactions
• Blood pressure elevated at 150-159/90-95 on repeated measurements in the clinic and at home
• Obese
• Normal physical exam otherwise
• Laboratory data is pending

Please answer the following questions:

1. What secondary causes of hypertension should be considered prior to prescribing and why?
2. What factors should you consider when deciding if a diuretic is appropriate for this patient?
3. You have decided that a diuretic is appropriate for this patient.
   1. Which class of diuretic would you choose and why?
   2. Would you consider adding a second class of antihypertensives initially? Why or why not?
4. Choose a specific drug within this class of diuretics. Using provider-level language and scientific evidence, discuss the patient education you would provide about:
   1. How the drug works at the cellular level in the body to achieve its effects
   2. What the effects of these actions are
   3. Adverse effects, including any methods to mitigate and/or prevent these adverse effects
   4. Precautions and contraindications that could be relevant to this patient
   5. Three drug-to-drug interactions that might occur due to other drugs this patient could be prescribed, including possible consequences of these interactions
   6. The monitoring needed for the diuretic
   7. The monitoring needed for hypertension
   8. Non pharmacologic methods to lower blood pressure

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