Comment 1Smokers such as Mrs. J should benefit from evidence-based guidelines nicotine replacement therapy, bupropion SR, and/or varenicline as an effective alternative for smoking cessation therapy, especially when combined with behavioral interventions. Combination pharmacotherapy is indicated for highly nicotine-dependent smokers like this patient, since Mrs. J has failed with monotherapy for several years. An additional form of nicotine replacement therapy or an addition of a non-nicotine replacement therapy oral medication (bupropion or varenicline) may also be helpful. Thus, rate of successful smoking cessation at 1 year will be about 3% to 5% when the patient simply tries to stop, 7% to 16% if the patient/smoker undergoes behavioral intervention, and up to 24% when receiving pharmacological treatment and behavioral support.Comment 2It is true that hypertension is a silent killer and can have deadly effects on the cardiovascular system. This week we are focsuing on heart conditions, but it is important to remember that uncontrolled hypertension can cause strokes as well (AHA, 2018) . When I worked on a neuro icu floor, there were many patients who suffered strokes and had no idea they were caused by high blood pressure. Many would have burst aneurysms as well and that would be there first sign of disease. They would have moerate to severe brain hemorraghing, sometimes irreversible and unfortunately did not recover or died. The families overwhelmingly thought that only the heart could be affected by hypertension, and not the brain. It is amazing how the vascualr system is all interconnected. We must stress the importance of brain health as well as heart health when teaching patients, the public, and family members about prevention.Comment 3Many older adults end up with several pills to take at several different times per day. At a minimum this is often a hassle; at worst it becomes a serious drain on quality of life. Some older adults are unable to take all their medications properly. Depending on which medications are missed, this can cause serious effects on an older person’s health.
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