Case Study #77 Gout
Why should the use of pseudoephedrine by this patient be carefully monitored by the
primary care provider?
This patient has a history of hypertension. Patients with high blood pressure should be
careful when using decongestants like pseudoephedrine because pseudoephedrine
works by constricting blood vessels in the nose to reduce swelling and congestion and
can constrict blood vessels elsewhere in the body, leading to a systemic increase in
blood pressure. It is important that this patient communicate their use of OTC nasal
decongestion products, such as pseudoephedrine, to their primary care provider for
ongoing evaluation of their hypertension and hypertension treatment efficacy.
Additionally, the patient is already on Flunisolide, a corticosteroid, for nasal rhinitis.
Excessive need for PRN use of pseudoephedrine for nasal rhinitis may indicate that the
steroid isn’t working well for the treatment of the patient’s chronic sinus drainage and
rhinitis.
Has an optimal target for blood pressure management been reached in this patient?
This patient is not displaying an in-office blood pressure reading reflective of optimal
blood pressure control. The patient’s blood pressure is currently 145/85, which is
classified as stage 1 hypertension as his systolic blood pressure is elevated and falls
within the range of 140-159 mm Hg. This patient has a 9-year history of hypertension for
which he is taking 25 mg HCTZ. There are multiple reasons why his blood pressure may
be elevated this office visit, ie. he’s in acute pain, he may be anxious, he may not be
taking his blood pressure medications correctly, his medication dose may no longer be
adequately controlling his hypertension, he may be dehydrated, or he may have taken
medications such as PRN nasal spray earlier in the day. I would be curious to know if the
patient takes their blood pressure regularly at home and if so, what have his most recent
readings been like.
Given that this patient had a TIA 3 months ago, close monitoring and control of
hypertension are warranted to decrease the risk of recurrent TIA or stroke.
Antihypertensive therapy to prevent recurrent stroke or transient ischemic attack for
patients with a history of hypertension has the goal of lowering systolic BP to less than
130 mm Hg with angiotensin inhibitors, calcium channel blockers, or diuretics
("Antihypertensive therapy to prevent recurrent stroke or transient ischemic attack",
2018). However, given this patient’s presentation that is consistent with gout, I would
suggest this patient be switched from a diuretic to an ace-inhibitor or calcium channel
blocker to prevent the risk of dehydration and goat attacks while improving control over
hypertension and stroke risk factors.
Is this patient underweight, overweight, obese, or normal?
This patient’s BMI is 29.7, which is classified as overweight.
Are any of the patient’s vital signs consistent with a diagnosis of gout?
The pathophysiology of gout includes a local inflammatory response within the
peripheral joint space as well as systemic inflammation which can manifest as fever,
chills, leukocytosis, and malaise. This patient’s elevated temperature is an indicator of
the systemic inflammatory response that accompanies the local inflammatory response
of a gout attack.
The patient’s weight from his vital signs, coupled with his height, designate him as
overweight and nearly in the obese range. Obesity is a risk factor for gout as the excess
This study source was downloaded by 100000848649392 from CourseHero.com on 07-17-2022 03:40:51 GMT -05:00
https://www.coursehero.com/file/35714455/Gout-Case-Study-77docx/
Why should the use of pseudoephedrine by this patient be carefully monitored by the
primary care provider?
This patient has a history of hypertension. Patients with high blood pressure should be
careful when using decongestants like pseudoephedrine because pseudoephedrine
works by constricting blood vessels in the nose to reduce swelling and congestion and
can constrict blood vessels elsewhere in the body, leading to a systemic increase in
blood pressure. It is important that this patient communicate their use of OTC nasal
decongestion products, such as pseudoephedrine, to their primary care provider for
ongoing evaluation of their hypertension and hypertension treatment efficacy.
Additionally, the patient is already on Flunisolide, a corticosteroid, for nasal rhinitis.
Excessive need for PRN use of pseudoephedrine for nasal rhinitis may indicate that the
steroid isn’t working well for the treatment of the patient’s chronic sinus drainage and
rhinitis.
Has an optimal target for blood pressure management been reached in this patient?
This patient is not displaying an in-office blood pressure reading reflective of optimal
blood pressure control. The patient’s blood pressure is currently 145/85, which is
classified as stage 1 hypertension as his systolic blood pressure is elevated and falls
within the range of 140-159 mm Hg. This patient has a 9-year history of hypertension for
which he is taking 25 mg HCTZ. There are multiple reasons why his blood pressure may
be elevated this office visit, ie. he’s in acute pain, he may be anxious, he may not be
taking his blood pressure medications correctly, his medication dose may no longer be
adequately controlling his hypertension, he may be dehydrated, or he may have taken
medications such as PRN nasal spray earlier in the day. I would be curious to know if the
patient takes their blood pressure regularly at home and if so, what have his most recent
readings been like.
Given that this patient had a TIA 3 months ago, close monitoring and control of
hypertension are warranted to decrease the risk of recurrent TIA or stroke.
Antihypertensive therapy to prevent recurrent stroke or transient ischemic attack for
patients with a history of hypertension has the goal of lowering systolic BP to less than
130 mm Hg with angiotensin inhibitors, calcium channel blockers, or diuretics
("Antihypertensive therapy to prevent recurrent stroke or transient ischemic attack",
2018). However, given this patient’s presentation that is consistent with gout, I would
suggest this patient be switched from a diuretic to an ace-inhibitor or calcium channel
blocker to prevent the risk of dehydration and goat attacks while improving control over
hypertension and stroke risk factors.
Is this patient underweight, overweight, obese, or normal?
This patient’s BMI is 29.7, which is classified as overweight.
Are any of the patient’s vital signs consistent with a diagnosis of gout?
The pathophysiology of gout includes a local inflammatory response within the
peripheral joint space as well as systemic inflammation which can manifest as fever,
chills, leukocytosis, and malaise. This patient’s elevated temperature is an indicator of
the systemic inflammatory response that accompanies the local inflammatory response
of a gout attack.
The patient’s weight from his vital signs, coupled with his height, designate him as
overweight and nearly in the obese range. Obesity is a risk factor for gout as the excess
This study source was downloaded by 100000848649392 from CourseHero.com on 07-17-2022 03:40:51 GMT -05:00
https://www.coursehero.com/file/35714455/Gout-Case-Study-77docx/
