For Margaret, the primary treatment goals today would include:
- Blood Pressure Management: Given her current BP reading of 156/85, the primary goal is to manage her hypertension effectively. Since Clonidine is being discontinued due to adverse effects (headaches, dizziness, dry mouth, and difficulty urinating), it’s essential to transition her to an alternative antihypertensive medication that she can tolerate better while still effectively controlling her blood pressure. Options could include ACE inhibitors, ARBs, calcium channel blockers, or thiazide diuretics, depending on her individual response and any contraindications.
- Management of Essential Tremor: Margaret reports that her essential tremor has worsened and is now affecting her daily activities, such as pouring a drink, using utensils, and writing. The goal here would be to initiate treatment to help manage her tremor and improve her quality of life. Beta-blockers like propranolol or anticonvulsants such as primidone are commonly used to manage essential tremor and could be considered.
- Addressing Side Effects from Clonidine: Since Margaret is experiencing adverse effects from Clonidine, including headaches, dizziness, dry mouth, and difficulty urinating, it’s crucial to alleviate these symptoms by discontinuing the medication and providing supportive care or alternative treatments as needed.
- Continued Monitoring and Follow-up: It’s important to schedule a follow-up appointment to assess Margaret’s response to the new antihypertensive regimen and the management of her tremor. Monitoring her blood pressure, symptom improvement, and any potential side effects from the new medications will be critical in ensuring that her treatment plan is effective and well-tolerated.
