Prescribing Medications for Patient Treatment Case Study

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SCENARIO : Sarah Johnson – Hypertension in PregnancyProblem: Sarah Johnson, a 32-year-old pregnant female at 24 weeks gestation, presents with a history of hypertension, previously treated with Lisinopril, which was discontinued due to pregnancy. Her current blood pressure of 150/95 mmHg indicates uncontrolled hypertension.Background: Hypertension in pregnancy is a significant risk factor for maternal and fetal complications, including preeclampsia, preterm birth, and fetal growth restriction (Agrawal & Wenger, 2020). ACE inhibitors like Lisinopril are contraindicated in pregnancy due to their teratogenic effects, requiring alternative treatment.Treatment Goals: The goal is to reduce Sarah’s BP to below 140/90 mmHg, minimizing the risk of complications while maintaining safety for both the mother and fetus (Garovic et al., 2022). Medications that are safe in pregnancy must be selected.Medication Options: First-line antihypertensive drugs during pregnancy include methyldopa, labetalol, and nifedipine (Conti-Ramsden et al., 2024).Methyldopa: It acts centrally by inhibiting sympathetic outflow, reducing BP. It is safe in pregnancy but may cause sedation, which can affect patient adherence.Labetalol: A combined alpha and beta-blocker that reduces BP without significantly affecting uteroplacental blood flow.Nifedipine (extended-release): A calcium channel blocker that can also be used, especially in cases of severe hypertension.

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Given Sarah’s elevated BP, labetalol is preferred for its efficacy and safety profile.Medication Order:· Drug: Labetalol 100 mg· Dose: 100 mg· Route: Oral· Frequency: Twice daily (BID)· Special instructions: Titrate dose upward every 1-2 weeks, as needed, to achieve target BP· # Dispensed: 30-day supply· Refills: 1Monitoring:· Weekly BP checks to ensure the treatment is effective.· Monthly blood work to assess kidney function (BUN, creatinine) and electrolytes, particularly potassium, as labetalol may affect renal function.· Fetal monitoring: Growth ultrasounds should be performed every 4 weeks to assess fetal development, especially if BP control remains challenging.Patient Education:· Sarah should be informed about the importance of adhering to the prescribed medication and attending regular prenatal visits.· Educate her on monitoring for any signs of preeclampsia, such as headaches, visual disturbances, or sudden swelling, which require immediate medical attention......

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