What is the best course of action for a 43-year-old female with a history of anxiety, asthma, migraines, IBS, and chronic pain, presenting for a refill of her antihypertensive medication and reporting a post-concussive headache?

From the Guidelines

I would provide a short-term refill of the patient's blood pressure medication while ensuring proper follow-up care. Based on her presentation, I would authorize a 30-day supply of her current antihypertensive medication at the same dose she has been taking, which should be verified through pharmacy records or her previous prescription 1. I would also schedule a follow-up appointment within 2-4 weeks at our clinic to properly assess her blood pressure control and medication needs. During this visit, I would check her blood pressure, review her medication efficacy and side effects, and perform a more comprehensive evaluation of her multiple chronic conditions including anxiety, asthma, migraines, IBS, and chronic pain.

The patient's history of postconcussion syndrome is also a concern, and I would consider the potential for postconcussive symptoms such as headache, sleep disturbances, dizziness/vertigo, nausea, fatigue, oversensitivity to noise/light, attention/concentration problems, memory problems, irritability, anxiety, depression, and emotional lability 1. I would advise the patient to monitor her blood pressure at home if possible and keep a log to bring to the follow-up appointment.

For her migraines, I would consider the recommendations for acute medication use, including the use of NSAIDs, triptans, and other medications as needed 1. I would also consider non-pharmacological treatments such as cognitive-behavioral therapy, biofeedback, and relaxation training to help manage her migraines and other chronic conditions 1.

This approach balances the immediate need for blood pressure control with the importance of proper ongoing management, and takes into account the patient's complex medical history and potential for postconcussive symptoms. Untreated hypertension increases the risk of stroke, heart attack, and other cardiovascular complications, making continuity of medication essential. However, her complex medical history requires comprehensive evaluation rather than indefinite medication refills without proper assessment.

From the FDA Drug Label

What should I tell my doctor before taking amlodipine besylate Tell your doctor about any prescription and non-prescription medicines you are taking, including natural or herbal remedies. Tell your doctor if you: ever had heart disease ever had liver problems are pregnant, or plan to become pregnant. Your doctor will decide if amlodipine besylate is the best treatment for you. are breast-feeding. Amlodipine passes into your milk

The patient should inform her doctor about her significant past medical history, including anxiety, asthma, migraines, IBS, and chronic pain, as well as her current medications, before taking amlodipine besylate. However, the FDA drug label does not provide information on how to manage a refill for a patient who is unable to get in with her family doctor.

• The patient's headache due to postconcussion is not directly addressed in the label.
• The label advises to consult a doctor before taking any new prescription or non-prescription medicines or supplements 2.

From the Research

Patient Profile

• The patient is a 43-year-old female with a significant past medical history of anxiety, asthma, migraines, IBS, and chronic pain.
• She presents to urgent care for a refill on her blood pressure medication due to being unable to get an appointment with her family doctor.
• She reports a headache, which she attributes to a postconcussion syndrome.

Complex Health Needs

• Studies have shown that patients with complex health needs, like the one presented, require a comprehensive and coordinated approach to care 3, 4.
• Care plans are an evidence-based strategy that can help manage the care of patients with complex health needs, leading to lower hospital costs and improved patient outcomes 3.
• Aligning care with the personal values of patients with complex care needs is crucial, and this can be achieved by exploring and acknowledging a patient's values, providing access to nonphysician providers, and offering values-aligned mental health care 4.

Anxiety and Medical Illness

• Anxiety disorders, such as generalized anxiety disorder (GAD), are common among patients with medical comorbidities, including chronic pain conditions, gastrointestinal disorders, and cardiovascular disease 5, 6.
• Anxiety can exacerbate medical illnesses, and comorbid medical illnesses may influence treatment choice for anxiety disorders 6.
• The patient's history of anxiety, IBS, and chronic pain suggests that her anxiety may be contributing to her medical illnesses, and vice versa.

Person-Centered Care

• Providing person-centered care for patients with complex healthcare needs is essential, and this can be achieved by focusing on functional outcomes and overall wellbeing 7.
• A person-centered modular service architecture can help address the complex needs and requirements of patients with chronic conditions, enabling increased responsiveness of healthcare services to people with complex healthcare needs 7.