A 55-year-old black man with a history of type 2 diabetes and chronic kidney disease (CKD) comes into the clinic for a 1-month follow-up visit. He does not smoke and his BMI is 32. His blood pressures at the last 2 visits have been 144/90, 144/85, 140/90, and 144/90 mm Hg. Today his blood pressure is 144/90. His HbA1c is 7.5%, Microalbumin to Creatinine ratio is 45mg/dL. His lipids are as follows: HDL 30mg/dL, LDL 190mg/dL, triglycerides 100mg/dL. Current medications are Metformin 500mg-1 TID and Vitamin D3 1000 iu daily. You explain to the patient that he has hypertension and appropriate management is important to prevent complications.
Answer all of the following questions:
1. Calculate the patient’s total cholesterol based on HDL, LDL, and triglycerides.
2. Calculate the patient’s ASCVD risk score.
3. According to the latest ACC/AHA Hyperlipidemia guidelines, would you prescribe the patient a statin medication? If yes, which statins would be most appropriate? Include at least 2 statins with prescribing information.
4. What labs would you order prior to starting a statin?
5. What labs should be ordered based on his current medications (Metformin and Vit. D)?
6. Would you modify the patient’s diabetic medications? If yes, include rationale and the change in prescription.
7. How would you treat this patient’s HTN based on ACC/AHA HTN guidelines? Include all medication classes and the starting doses.
8. How would you treat this patient’s HTN based on JNC-8 guidelines? Include all medication classes and starting doses.
9. List a comprehensive treatment plan for each diagnosis (use ICD-10 codes). The plan should include lifestyle modifications, screening exams/consultations if appropriate, pharmacological management, diagnostic testing and follow-up for each ICD 10 code? There are 4-5 diagnosis codes based on the case information provided. Please provide a treatment plan for a minimum of 4 diagnoses.
Example for Diagnosis #1
HTN (list ICD-10)
a. Start (list medication name, dose, route, and frequency)
b…
c…
