[Expert Solution]: FP is a 77-year-old recovering alcoholic who…

FP is a 77-year-old recovering alcoholic who has lived and worked for the past few years with the indigent in a depressed area of Los Angeles. He helps run a soup kitchen and homeless shelter, and is involved in the management of a neighborhood “free clinic” to provide basic health care services to this population. Four months ago he was diagnosed with tuberculosis and given isoniazid. Unfortunately, he developed significant hepatoxicity from this antitubercular, most probably due to his advanced age and potentially complicated by both his drinking history and rapid acetylator phenotype. The drug was discontinued. He is currently taking rifampin for the TB. Relevant medical history includes treatment of rheumatoid arthritis first with various nonselective NSAIDs (severe GI distress resulted), then with penicillamine (discontinued due to development of a maculopapular rash and patient complaint of bad taste), and subsequently with celecoxib. The only way FP claims to remember to take his medications is to take them with his meals. His renal function is normal for his age. FP has a family history of cardiovascular disease and has been diagnosed with congestive heart failure (CHF). The doctor wants to begin therapy with an ACE inhibitor to prevent further progression of left ventricular dysfunction (LVD). As the pharmacist volunteer at the free clinic, your advice is sought on an appropriate therapeutic choice. Consider the structures of the four ACE inhibitors drawn below. 1. dentify and prioritize the patient specific factors that must be considered to achieve the desired therapeutic outcomes. [5 points] 2. Conduct a thorough and mechanistically oriented structure-activity analysis of all therapeutic alternatives provided in the case. [15 points] 3. Evaluate the SAR findings against the patient specific factors and desired therapeutic outcomes and make a therapeutic decision. [20 points]