Prescribing new medications?

[iLovePrecedex]

Let’s say you are trying to manage someone’s hypertension. How do you decide when to increase current medication dose vs adding a new medication?

[guest478081]

Read the guidelines for said medication and monitor for side effects and therapeutic effect........ they tell you starting dose when to titrate and max dose

and use clinical reasoning for each patient

[ToFNPandBeyond]

The JNC-8 guidelines explain this in detail.

In general, it's best to "start low and go slow" with meds. I usually start with monotherapy on one med when treating HTN, and start low (if not severely hypertensive) and titrate up to nearly the max or the max recommended before adding second agent.

[djmatte, ADN, MSN, RN, NP]

2 minutes ago, ToFNPandBeyond said:

The JNC-8 guidelines explain this in detail.

In general, it's best to "start low and go slow" with meds. I usually start with monotherapy on one med when treating HTN, and start low (if not severely hypertensive) and titrate up to nearly the max or the max recommended before adding second agent.

I’m not in a position to look for it right now, but this is how I used to do it. Either an article or CME I attended recommended rather than maxing out single drugs, to add a second or third agent. The thought was to reduce the potential side effects of Max doses and allow synergistic effects of some meds. I recall it noted people on multiple drugs at lower doses had more benefit than mono therapy. But it also noted people on more drugs were less likely to take meds as prescribed so there’s that.

[ToFNPandBeyond]

6 minutes ago, djmatte said:

I’m not in a position to look for it right now, but this is how I used to do it. Either an article or CME I attended recommended rather than maxing out single drugs, to add a second or third agent. The thought was to reduce the potential side effects of Max doses and allow synergistic effects of some meds. I recall it noted people on multiple drugs at lower doses had more benefit than mono therapy. But it also noted people on more drugs were less likely to take meds as prescribed so there’s that.

You're right. I believe it's either the JNC-8 or AHA/ACC that recommend target doses based on studies as opposed to max doses. I typically try not to go for absolute max, but rather aim for target before adding a second agent for those who aren't severely hypertensive.

[guest478081]

Not sure if OP meant just in general but yeah we have several aps available like meds are or epocrates or UTD for dosing. I’m in anesthesia and the drugs we use are less broad but if I forgot what a med does I just look it up. Usually these are new neuro or chemo drugs since those seem to be popping up all over. No one has memorized the dosing for much more than what they commonly use so OP find you a good app like UTD and see how you like it

[traumaRUs, MSN, APRN]

I work in nephrology and many of my pts are on max doses of 4-5 anti-HTN meds. I use UTD but I also use National Kidney Foundation guidelines as well as the ACC/AHA 2017 Guidelines.