Client 1 – Heart Condition


Clients Condition: Angina Pectoris

Medication 1: Metoprolol tartrate (Betaloc) 50mg

Schedule: S4

Pharmacodynamics: A relatively cardioselective beta-adrenoreceptor blocking agent. At lower doses, it acts on β1 receptors mainly in the heart. It reduces the frequency and severity of angina attacks, and increases exercise tolerance. It blocks action of chemicals in the body such as epinephrine on the heart and blood vessels, which results in reduced heart rate, BP, and strain on the heart.

Pharmacokinetics: More than 95% is rapidly absorbed from the GIT. It is rapidly distributed to the extravascular tissues at 5.6L/kg. Approx 12% is bound to serum proteins. Neither enhances or inhibits its own metabolism. More than 90% is excreted in the urine mainly as metabolites within 72hrs, and 3% unchanged. The elimination half life ranges from 3-5hrs.

Symptoms: Chest pain assoc with effort, left arm pain, high BP, intermittent claudication, stress, anxiety.


Clients Condition: Transient Ischaemic Attack (TIA)

Medication 2: Aspirin (Cartia) 100mg

Schedule: S2

Pharmacodynamics: Irreversibly acetylates cyclo-oxgenase and reduces production of TXA2 in platelets, and PGl2 in endothelial cells. It inhibits chemical processes in the body such as prostaglandins that cause pain and inflammation. It is an antiplatelet agent.

Pharmacokinetics: It is absorbed in the duodenum and small intestine when the pH is > 6. It is converted to salicylic acid mainly in the GI mucosa and liver. 80-90% Salicylate is bound to plasma protein, esp albumin. Mean recovery of aspirin as total urinary salicylate – 87 ± 9% of 100mg dose.

Symptoms: Weakness down left arm, pins and needles in fingers, fatigue.


Clients Condition: Hypertension

Medication 3: Candesartan Hydrochlorothiazid (Atacand Plus) 16mg / 12.5mg

Schedule: S4

Pharmacodynamics: An ACE inhibitor which blocks rennin-angiotensin system and reduces BP. Angiotensin receptor blocker and diuretic. It selectively blocks the binding of angiotensin II to the AT I receptor in smooth muscle & adrenal gland tissues, and reduces BP. The Thiazides affects the electrolyte reabsorption mechanism & directly increases excretion of sodium chloride. Relaxes blood vessels for easier blood flow, and increases urine production to remove extra water and salt from the body.

Pharmacokinetics: Candesartan - Rapidly and completely absorbed from the GIT. More than 99% highly bound to plasma proteins. Distribution – 0.1L/kg. It is mainly excreted unchanged in urine & feces (via bile), 26% in urine. Minor liver metabolism to an inactive metabolite. Elimination half life approx 9hrs. Absolute bioavailability approx 15%. Peak serum concentration after 3-4hrs.

Hydrochlorothiazid – Protein binding – approx 60%. Distribution – approx 0.81L/kg. The half life approx 8hrs, unchanged; not metabolised, eliminated rapidly by the kidney. Approx 70% of a dose is eliminated in urine within 48hrs.

Symptoms: Consistent high blood pressure.


Clients Condition: High Cholesterol, Atherosclerosis.

Medication 4: Rosuvastatin (Crestor) 10mg

Schedule: S4

Pharmacodynamics: HMG-CoA reductase inhibitor (statin). An enzyme that converts 3-hydroxy-3-methylglutaryl coenzyme A to mevalonate, a precursor of cholesterol. It increases the number of hepatic LDL receptors on the cell-surface to enhance uptake and catabolism of LDL. It also inhibits hepatic synthesis of VLDL, which reduces the total number of VLDL and LDL particles.

Pharmacokinetics: Peak plasma concentrations 3-5hrs; approx 20% absolute bioavailability; 88% bound to plasma proteins, mainly albumin; mean volume of distribution at steady rate, approx 134 L; not extensively metabolised, approx 10% found as a metabolite; greater than 90% of active plasma HMG-CoA reductase inhibitory activity is accounted for by the parent compound; approx 90% excreted in the feces; elimination half life approx 19hrs.

Symptoms: High cholesterol confirmed by blood tests. An increase in cholesterol may be associated with BP medication.


Beneficial Nutrients:

  • Omega 3 EFA’s

  • CoQ10

Drug / Nutrient interactions:

Omega 3 EFA’s (fish oil) may further increase blood thinning effects, especially if taken with aspirin. Fish oil is also an activator of Phase II Glucuronidation, so may reduce effects of other drugs. Caution in high doses, monitor patient.

Statin drugs & beta blockers may reduce levels of CoQ10 in the body, so a CoQ10 supp may be beneficial. Caution – CoQ10 with aspirin may further increase blood thinning effects.


Interpretation of the Case: Heart disease risk including hypertension, cholesterol, TIA, stroke, angina, MI may be prevented through diet and lifestyle, without the need for medications. Once cholesterol and hypertension medication has been started, it cannot be discontinued, especially abruptly.


The above nutrients have blood thinning effects, so it may be a safer alternative, as aspirin has many side effects including GI problems. 


The Betaloc medication, the BP & cholesterol lowering medication should be continued, under the supervision of a GP; in conjunction with a health practitioner incorporating dietary & lifestyle changes, including the above nutrients. This may lead to the possible reduction or gradual discontinuation of some of the medications. 


Client 2 – Asthma


Clients Condition: Asthma

Medication 1: Fluticasone Propionate (Flixotide Accuhaler) 250mcg

Schedule: S4

Pharmacodynamics: Potent glucocorticoid activity in the airway, which has anti-inflammatory action which improves the symptomatic control of asthma.

Pharmacokinetics: Inhaled systemic bioavailability approx 10-30%. The systemic absorption reflects the amount reaching the lungs. Virtually zero amount reaches GIT. 87-100% is excreted in the faeces; upto 75% unchanged, depending on dose. Between 1-5% is excreted as metabolites in urine. A single dose produced 0.5nanogram/mL plasma levels.

Symptoms: Cough; wheeze; SOB; dyspnea; lung congestion; increased mucous production; allergies; several episodes.


Clients Condition: Asthma

Medication 2: Salbutamol sulphate (Ventolin CFC-Free Inhaler)

Schedule: S3

Pharmacodynamics: Relatively selective β2-adrenoreceptor stimulant (Agonist). Relief of bronchospasm in asthmatics or COPD.

Pharmacokinetics: Low concentrations are seen in the blood after 2-3 hrs. Elimination half life between 2.7 – 5 hrs. It is not metabolised in the lung, but approx 90% of a dose is converted in the liver to a sulfate ester (inactive form); approx 60-70% is excreted in the urine as free drug and as the metabolite.

Symptoms: Cough; wheeze; SOB; dyspnea; lung congestion; increased mucous production.


Beneficial Nutrients:

  • Omega 3 EFA’s

  • Antioxidants – eg. Vit C.


    Drug / Nutrient interactions: There are no known interactions with the above nutrients. In patients with impaired liver or renal function, the antioxidants may help improve these functions and thus reduce possible accumulation, and prolonged effects when taking ventolin.


    Interpretation of the Case: Asthma involves inflammation, and may be triggered by allergies. The above nutrients may help improve immune function, and regulate prostaglandin formation, and reduce inflammation, and thus the need for ventolin.


    The medications should be continued until asthma is under control. The preventer medication (Flixotide) may eventually be weaned off gradually, under GP’s advice. The above nutrients may help strengthen the immune system; optimal antioxidant status may help protect tissue from oxidation, and possibly reduce the need for asthma medication.


    The use and discontinuation of asthma medication should be done under the supervision of a GP, and in conjunction with a health practitioner.

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Hills Nutrition 4 Health
Northmead NSW  2152
ATMS Accredited Practitioner

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