Here are 3 responses to the posts with at least 200 words each, including a scholarly reference within the last 5 years per response in APA style: RESPONSE 1: I agree that patient attitudes and beliefs greatly impact treatment adherence for hypertension (Ashoorkhani et al., 2018). Providing thorough education is crucial, but healthcare providers must also be sensitive to cultural beliefs that may influence a patient's perspective on medication. While homeopathic approaches alone may not sufficiently control blood pressure, incorporating some cultural practices could help patients feel more engaged in their care. For the Iranian patient mentioned, suggesting reduced salt substitutes like fresh herbs and spices in cooking may be a good compromise that respects cultural traditions while still lowering sodium intake. Taking time to

1. Q-1
The disease process I chose for this article is the treatment of
chronic hypertension and the medication I chose was
Amlodipine (Norvasc).
Hypertension is on the rise in the world and becoming one of
the highest occurring disease processes according to the World
Health Organization (Lee et al., 2019). The age group with the
largest rate of occurrence is patients ages 65 and older at a
prevalence rate of 67% (Lee et al., 2019). Amlodipine (Norvasc)
is a calcium channel blocker and has a longer half life with a
slower onset when compared to other generations of calcium
channel blockers (Lee et al., 2019).
The mechanism of action for Norvasc is that it inhibits the
movement of calcium ions into the vascular smooth muscle cells
and cardiac muscle cells to prevent the constriction of the
cardiac muscle and vascular smooth muscle (Lee et al., 2019).
This prevention of contraction keeps the vessels “wide” in order
to allow easy flow of blood and to decrease blood pressure by
decreasing peripheral vascular resistance (Lee et al., 2019).
Oral administration
Some common adverse effects of Norvasc are due to the
vasodilatation of the blood vessels (Hong et al., 2019). They
include peripheral edema, dizziness, palpiations, fatigue,
nausea, abdominal pain, somnolence, and flushing (Hong et al.,
2019). Rare side effects include blood disorders, impotence,
depression, peripheral neuropathy, insomnia, tachycardia,
gingival enlargement, hepatitis, and jaundice (Hong et al.,
2019).
There are several drugs that have an interaction with Norvasc
(Hong et al., 2019). Mainly any drug that influences the level or
efficiency of CYP3A inhibitors will also cause an increase of
bioavailability of Norvasc in the body (Hong et al., 2019). Some
other interactions occur when the patient is also taking
cardizem, clarithromycin, and some antifungal (Hong et al.,

2. 2019). These interactions with drugs also increase the
bioavailability of Norvasc in the body (Hong et al., 2019).
There was a time where a patient came into the ER with a
hypertensive emergency and this patient was taking beta-
blockers and an ARB. When this patient came to the ICU we
started him on cardine for a B/P of 195/103. As we started to
bring his pressure out of stroke range, they physician then
started Norvasc at 5mg p.o. daily. We did give him his first
dose, and noticed a further drop in blood pressure down to a
normal range. We then titrated the patient off cardine and were
able to keep him off with the new combination of anti-
hypertensives and the fact that we were addressing three of the
four ways to control hypertension.
References:
Hong, S. J., Jeong, H. S., Cho, J.-M., Chang, K., Pyun, W. B.,
Ahn, Y., … Kim, H.-S. (2019). Efficacy and Safety of Triple
Therapy With Telmisartan, Amlodipine, and Rosuvastatin in
Patients With Dyslipidemia and Hypertension: The Jeil
Telmisartan, Amlodipine, and Rosuvastatin Randomized
Clinical Trial. Clinical Therapeutics, 41(2), 233–248.
https://doi-
org.lopes.idm.oclc.org/10.1016/j.clinthera.2018.12.008
Lee, D. W., Jung, M., Wang, H. W., Khan, Z., & Pinton, P.
(2019). Systematic Review with Network Meta-Analysis:
Comparative Efficacy and Safety of Combination Therapy with
Angiotensin II Receptor Blockers and Amlodipine in Asian
Hypertensive Patients. International Journal of Hypertension, 1–
8. https://doi-org.lopes.idm.oclc.org/10.1155/2019/9516279
Q-2
Hypertension is condition when there is a sustained elevation of
systemic arterial blood pressure of systolic greater than 140
mmHg or higher, or a diastolic pressure of 90 mmHg or higher.
It is a result of an increase in cardiac output, total peripheral
resistance, or both conditions (Brashers, 2019, p. 1061). One
way of how the body maintains its blood pressure is through the

3. renin-angiotensin-aldosterone system (RAAS). The kidneys'
release of renin is triggered by decreased blood pressure in the
renal circulation. The renin cleaves the angiotensinogen to form
an inactive angiotensin I. In the presence of an angiotensin-
converting enzyme (ACE) from the pulmonary and renal
endothelium, angiotensin I is converted to angiotensin II, a
potent vasoconstrictor (Huether, 2019, p. 1236). ACE inhibitors
(ACEI) are widely used as drug therapy in the treatment of
condition such as high blood pressure, heart failure, diabetic
nephropathy and type 2 diabetes mellitus (Seema, Sabina,
Vipin, Tulshi, Shailendra, & Yousuf, 2019). Captopril
(Capoten) is an ACEI drug which has a high affinity for ACE
and competes with angiotensin I, the natural substrate, to block
its conversion to angiotensin II.
Additionally, Kininase II, identical to ACE, is an enzyme that
degrades bradykinin, a potent vasodilator, to inactive peptides.
Whether increased bradykinin levels play a part in the
therapeutic effects of ACE inhibitors is presently unclear.
Bradykinin-induced vasodilation is thought to be of secondary
importance in the blood-pressure-lowering effect of ACE
inhibitors. The "local" activity of ACE inhibitors may be more
responsible for their clinical outcomes than systemic activity.
ACE-inhibiting drugs may act locally (i.e., within a specific
tissue) to reduce vascular tone by decreasing local angiotensin
II-induced sympathetic activity and/or by decreasing local
angiotensin II-induced vasoconstrictive activity. Decreases in
plasma angiotensin II levels reduce aldosterone secretion, with
a subsequent reduction in sodium and water retention. Captopril
should not be given to a patient with renal artery stenosis,
pregnant women, and hyperkalemia (Prescriber's Digital
Reference [PDR], 2020). According to Robinson (2016, p. 295-
305), careful use should be observed among populations with
impaired renal function, especially older adults, and liver
disease. Checking for serum potassium level should be done
before initiation of ACEI and a week after to note trends.
Severe ADR for patients taking ACEI includes angioedema due

4. to an increased level of bradykinin when ACE is inhibited; thus,
the medication should be stopped immediately. Mild and
transient ADR includes hypotension, dizziness, fatigue, and
orthostatic hypotension. Hacking cough that usually occurs
during the first week of therapy is noted, but switching to later
generation ACEI diminishes this symptom. Captopril and all
ACEI should not be given together with lithium as the
combination will result to increase lithium levels and symptoms
of toxicity. Captopril should not be given along with diuretics,
as it may lead to severe hypotension and renal dysfunction
(p.303). Aliskiren-containing products are contraindicated in
combination with ACEI in patients with diabetes mellitus. In
general, avoid combined use of two renin-angiotensin-
aldosterone systems (RAAS) inhibitors, particularly in patients
with a creatinine clearance of less than 60 mL/minute.
Combination therapy increases the risk of hyperkalemia, renal
impairment, and other side effects (PDR, 2020).
A story I would like to share about Captopril is when I admitted
a patient with new-onset of irregular heart rhythm after taking
this medication. Her potassium level was way above the
reasonable value when she came to the emergency department.
Unfortunately, her doctor failed to educate her about the
necessity of diet modification when taking this medication. Her
diet consisted mainly of fruits and vegetables as she was trying
to avoid fatty meat to control her blood pressure better.
Unbeknownst to her, a high-potassium dietary intake should be
avoided as this may result in an abnormal rise in serum
potassium, which may lead to irregular heartbeat and lethal
rhythm.
References
Brashers, V.L. (2019). Alterations of vascular function. In N.S.
Rote (Eds). Pathophysiology: The biologic basis for disease in
adults and children (8th ed., pp. 1059- 1142). St. Louis, MO:
Elsevier, Inc.

5. Huether, S.E. (2019). Structure and function of the renal and
urologic systems. In V.L. Brashers & N.S. Rote (Eds).
Pathophysiology: The biologic basis for disease in adults and
children (8th ed., pp. 1228- 1292). St. Louis, MO: Elsevier, Inc.
PDR (2020). Captopril: Drug summary. Retrieved from
https://www.pdr.net/drug-summary/Captopril-captopril-
2348.4130#15
Robinson, M.V. (2016). Drugs affecting the cardiovascular and
renal systems. In T.M. Woo (Eds). Pharmacotherapeutics for
advanced nurse prescribers (4th Edition, pp. 295-359).
Philadelphia, PA: F.A. Davis Company
Seema B., Sabina, Y., Vipin, S., Tulshi, C., Shailendra, S.C., &
Yousuf, A. (2019). Treatment and Management of Hypertension
by Targeting ACE Inhibitors: in silico Approach. International
Journal Bioautomation, (1), 13. https://doi-
org.lopes.idm.oclc.org/10.7546/ijba.2019.23.1.13-28
Q3-
For patients who are undergoing treatment for hypertension
there are many factors that affect treatment adherence. The most
common influencer is attitudes and beliefs of the individuals
who are undergoing treatment (Ashoorkhani et al., 2018). The
attitudes and beliefs of individuals changes based on the culture
they come from (Ashoorkhani et al., 2018). For example, some
cultures do not believe in medicine and would rather be treated
homeopathically, but the patient themselves want treatment
(Ashoorkhani et al., 2018). This patient would require a
thorough explanation of medications, nutrition, lifestyle
changes, and much more (Ashoorkhani et al., 2018). As
healthcare providers it is our responsibility to ensure that the
patients understand what they are taking and why as this would
improve patient adherence (Ashoorkhani et al., 2018). This

6. could even become a class that could extend to the rest of the
practice that patients can be provided to in order for them to
learn more about the medications they are taking (Ashoorkhani
et al., 2018).
Another example is an ethnic and cultural difference but of food
culture in Iranians (Ashoorkhani et al., 2018). Iranians enjoy a
lot of salt in their foods and end up consuming 10 to 15 grams a
day and is about two to three times higher than the global
standard (Ashoorkhani et al., 2018). Ingesting a large about of
salt is a common contributing factor to hypertension
(Ashoorkhani et al., 2018). So an further example, an Iranian
patient who is being treated for hypertension would have to
have instruction on how to keep track of their salt intake and
ways to reduce salt intake overall (Ashoorkhani et al., 2018).
In my approach I would have to find a way to reach this patient
in a positive way that they would understand the information
and want to make that change. Instructing a patient on a major
lifestyle change positively and also suggesting a substitute
actually increases the success rate of the patient converting to
the new regimen (Garzon & Heredia, 2019). I would imagine
information and explanation would be the best way to reach
someone in order to make a change. So for the lifestyle change
we would want to modify we would have to also suggest a
adequate substitution. However, regardless of the amount of
instruction we could give them in any setting, it is ultimately up
to the patient if they want to make changes in their lifestyle. I
would imagine that it would be difficult the longer the patient
has been doing that routine.
References:
Ashoorkhani, M., Majdzadeh, R., Gholami, J., Eftekhar, J., &
Bozorgi, J. (2018). Understanding Non-Adherence to Treatment
in Hypertension: A Qualitative Study. International Journal of
Community Based Nursing and Midwifery, (4), 314. Retrieved
from https://search-ebscohost-
com.lopes.idm.oclc.org/login.aspx?direct=true&db=edsdoj&AN

7. =edsdoj.87f989c469464f199cb0ba6d1f7cc8d0&site=eds-
live&scope=site
Garzón, N. E., & Heredia, L. P. D. (2019). Validity and
Reliability of the Treatment Adherence Questionnaire for
Patients with Hypertension. Investigacion & Educacion En
Enfermeria, 37(3), 99–111. https://doi-
org.lopes.idm.oclc.org/10.17533/udea.iee.v37n3e09
Need help to reply three post.
DO NOT JUST REPEAT SAME INFORMATION, DO NOT
JUST SAY I AGREE OR THINGS LIKE THAT. YOU NEED
TO ADD NEW INFORMATION TO DISCUSSION.
1- Each reply should be at least 200 words.
2- One scholarly reference ( NO MAYO CLINIC/ AHA)
3- APA style needs to be followed.
4- Each response should have reference at the end
5- Reference should be within last 5 years