logging in or signing up CLINICAL PHARMACY (CASE PRESENTATION) ackosisteph Download Post to : URL : Related Presentations : Let's Connect Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Copy embed code: Embed: Flash iPad Dynamic Copy Does not support media & animations Automatically changes to Flash or non-Flash embed WordPress Embed Customize Embed URL: Copy Thumbnail: Copy The presentation is successfully added In Your Favorites. Views: 736 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: March 05, 2013 This Presentation is Public Favorites: 1 Presentation Description A CASE PRESENTATION OF A PATIENT WITH A DIAGNOSIS OF HYPERTENSION :) Comments Posting comment... Premium member Presentation Transcript PowerPoint Presentation: CLINICAL PHARMACY CASE PRESENTATION BY: STEPHANIE OLIVEROS LAURETEPowerPoint Presentation: HYPERTENSION THE SYNOPSISPowerPoint Presentation: Hypertension i s a medical condition in which constricted arterial blood vessels increase the resistance to blood flow, causing an increase in blood pressure against vessel walls. is the tension or the pressure happening in the arteries. is one of the leading fatal cardiovascular diseases in the world usually occurring ages between 18-60 years old. has been prevalent typically to men in different ages with increasing and changing lifestyle. has been called the "silent killer”. is another name for high blood pressure.PowerPoint Presentation: Blood Pressure Readings Systolic: The blood pressure when the heart is contracting. Diastolic: The blood pressure when the heart is relaxed. Blood pressure is the force of the blood exerted on the walls of the arteries as it is circulated in the body.PowerPoint Presentation: Factors can affect blood pressure : How much water and salt you have in your body The condition of your kidneys, nervous system, or blood vessels The levels of different body hormonesPowerPoint Presentation: STAGES OF BLOOD PRESSURE READINGS: Normal : Less than 130/85 High normal : 130/85 to 139/89 Hypertension Stage 1 : 140/90 to 159/99 Hypertension Stage 2 : 160/100 to 179/109 Hypertension Stage 3 : 180/110 to 209/119 Hypertension Stage 4: 210+/120+PowerPoint Presentation: STAGES OF BLOOD PRESSURE READINGS: Normal : People with normal blood pressure should maintain the healthy lifestyle they have already adapted. High normal : People with pre-hypertension are at a risk for developing high blood pressure and should adopt a healthy lifestyle with changes in their diet, exercise, and salt intake.PowerPoint Presentation: Hypertension Stage 1 (mild) : For Stage 1 hypertension, your doctor will recommend lifestyle changes, which include: exercise, weight loss, diet modification, alcohol restrictions, and quitting smoking. Your doctor may let you try these modifications for a few months, and if they are not successful in bringing down your blood pressure, medication will be prescribed, usually through a combination of diuretics.PowerPoint Presentation: Hypertension Stage 2 (moderate) : Stage 2 hypertension is usually caused by some other health problem. Your doctor may prescribe at least two medications for you in addition to lifestyle modifications. If those don't work, additional medications may be added to the other medications.PowerPoint Presentation: Hypertension Stage 3 (severe) : Stage 3 hypertension is extremely serious and you need to seek medical attention immediately. You could damage your organs, experience small hemorrhages of the eyes, or suffer a stroke or heart attack. Your doctor will treat this with antihypertensive medications. Hypertension Stage 4 (very severe) : This is the most severe of the stages. If somebody fall into this category, should seek immediate help. Life- threatening condition may occur.PowerPoint Presentation: Hypertension Criteria Hypertension in Adults Goal Blood Pressures Hypertension without Co-morbidity: <140/90 Diabetes Mellitus: <130/80 Congestive Heart Failure: <130/80 Renal Insufficiency: <130/80 Hypertension in Adolescents Age 16-18 years Significant Hypertension: BP> 142/92 Severe Hypertension: BP> 150/98 Age: 13-15 years Significant Hypertension: BP> 136/86 Severe Hypertension: BP> 144/92 Hypertension in Children Age 10-12 years Significant Hypertension: BP> 126/82 Severe Hypertension: BP> 134/90 Age 6-9 years Significant Hypertension: BP> 122/78 Severe Hypertension: BP> 130/86 Age 3-5 years Significant Hypertension: BP> 116/76 Severe Hypertension: BP> 124/84 Age 1 month to 2 years Significant Hypertension: BP> 112/74 Severe Hypertension: BP> 118/82 Age 8-30 days Significant Hypertension: SBP> 104 Severe Hypertension: SBP> 110 Age <7 day old Significant Hypertension: SBP> 96 Severe Hypertension: SBP> 106PowerPoint Presentation: SIGNS & SYMPTOMS: Headache Weakness Nervousness Dizziness Ringing in the ears Loss of sleep Nose bleed Shortness of breath Chest pain Red face Changes in visionPowerPoint Presentation: Types of High Blood Pressure The two major types are: Primary (Essential) hypertension Secondary hypertension The other types include: Isolated diastolic hypertension Isolated systolic hypertension White Coat Hypertension Resistant HypertensionPowerPoint Presentation: The two major types are: Primary (Essential) hypertension The most common type of hypertension – accounts for around 90–95% of cases has no obvious or yet identifiable cause . Potential causes include genetic and environmental factors . Secondary hypertension This may be caused by: Kidney damage or impaired function (This accounts for most secondary forms of hypertension.) Tumours or overactivity of the adrenal gland Thyroid dysfunction Coarctation of the aorta Pregnancy-related conditions Sleep Apnea Syndrome Medication, recreational drugs, drinks & foodPowerPoint Presentation: The other types include: Isolated diastolic hypertension the diastolic pressure (bottom number) is raised but the systolic pressure is normal . Isolated systolic hypertension the systolic pressure (top number) is raised but the diastolic pressure is normal . White Coat Hypertension Also called anxiety-induced hypertension, it means blood pressure is only high when tested by a health professional. Resistant Hypertension If blood pressure cannot be reduced to below 140/90 mmHg, despite a triple-drug regime, resistant hypertension is considered.PowerPoint Presentation: Serious Problems: Hardening of the arteries Enlargement of the heart Kidney failure Eye damage that could result in blindness Stroke Heart attackPowerPoint Presentation: Who Is at Risk for Hypertension? Don't get much exercise Smoking Drinking a lot of alcohol Have a family history of high blood pressure Eating very salty and fatty foods Experiencing a lot of stress African-Americans Obese Over 60 years old Have diabetesPowerPoint Presentation: Diuretics - thiazide diuretics - loop diuretics - potassium-sparing diuretics Cardioinhibitory drugs - beta-blockers - calcium-channel blockers Centrally acting sympatholytics Vasodilators - alpha- adrenoceptor antagonists (alpha-blockers) - angiotensin converting enzyme inhibitors (ACE inhibitors) - angiotensin receptor blockers (ARBs) - calcium-channel blockers - direct acting arterial dilators - ganglionic blocker - nitrodilators - potassium-channel openers - renin inhibitors Drugs Used to Treat HypertensionPowerPoint Presentation: CASE PRESENTATION OF A PATIENT WITH A DIAGNOSIS OF HYPERTENSIONPowerPoint Presentation: PATIENT PROFILE AND MEDICAL RECORDS DATA DEMOGRAPHIC DATA: AGE: 61 yrs old SEX: Male RACE /ETHNICITY: Czech WEIGHT: 75 kg HEIGHT: 16.5 m BMI: 27.5 UNDERWEIGHT 0-18.5 Kg/m2 NORMAL 18.6 to 22.9 Kg/m2 OVERWEIGHT 23 to 24.9 Kg/m2 OBESE CLASS I 25 to 29.9 Kg/m2 OBESE CLASS II >30 Kg/m2PowerPoint Presentation: PATIENT PROFILE AND MEDICAL RECORDS DATA CHIEF COMPLAINT: Increase in shortness of breath with moderate exertion and bothersome nocturia . However, he states that he feels better today and just needs a check-up to follow-up his medical problems.PowerPoint Presentation: PATIENT PROFILE AND MEDICAL RECORDS DATA PATIENT’S HISTORY He had been smoking a pipe since his 20-ies and quit smoking about 6 years ago. He has recently retired and devotes time to gardening or climbing regularly every day. He pays attention to sodium, fat, or carbohydrate content of food ("I try to avoid it"). He usually uses ("a little") table salt for his foods. He denies "high consumption" of alcohol", and noncompliance with his medication. He experienced no chest pain, subjective or objective complaints at rest, or hemoptysis, only mild shortness of breath when climbing stairs.PowerPoint Presentation: PATIENT PROFILE AND MEDICAL RECORDS DATA FAMILY HISTORY Father died of acute myocardial infarction at age 73 mother deceased due to lung cancer at age 69 and "had high blood pressure“ Brother (age 68) undergoes treatment for hypertension and "high cholesterol“ younger sister (age 52) has no medical problems.PowerPoint Presentation: PATIENT PROFILE AND MEDICAL RECORDS DATA MEDICATION AMICLOTON (hydrochlorothiazide + chlorthalidon 2 . 5/25 mg ) 1 tabl/each two days orally for 8 years.PowerPoint Presentation: PATIENT PROFILE AND MEDICAL RECORDS DATA PATIENT EXAMINATION: BP: 150/98 mmHg (sitting), 155/110 mmHg (upright), H eart rate: 56/min (regular), Body temperature = 36.8º C. Neck: without bruits above vessels, supple without masses of bruits, no thyroid enlargement or lymphadenopathy. Lungs: A few basilar crackles, no wheezing. Heart and abdomen : normal. Prostate : slightly enlarged without nodules, induration, or asymmetry. Ex tremities: no clubbing, cyanosis or edema.PowerPoint Presentation: PATIENT PROFILE AND MEDICAL RECORDS DATA LABORATORY TESTS: BLOOD PATIENT VALUE NORMAL VALUE SODIUM 138 mmol /L 135-140 mmol /L POTASSIUM 4.1 mmol /L 3.5-5.0 mmol /L CHLORIDE 103 mmol /L 98-108 mmol /L SERUM CREATININE 105 µmol/L 60-110 μ mol/l GLUCOSE 4.8 mmol /L 3.9–5.8 mmol /L AST (ASPARTAME AMINOTRANSFERASE) 0.4 µ kat /L 0.25 - 0.75 µ kat /L ALT (ALANINE AMINOTRANSFERASE) 0.5 µ kat /L 0.15-1.1 µ kat /L ALP (ALKALINE PHOSPHATE) 2.0 µ kat /L 0.33- 2.08 µ kat /L TOTAL BILIRUBIN 18 µmol/L 5.1-20.5 μ mol/L TOTAL PROT. 6.7 g/ dL 6-8.5 g/ dL CALCIUM 2.4 mmol /L 2.25–2.75 mmol /L MAGNESIUM 0.9 mmol /L 0.7—1.0 mmol /L PHOSPHOROUS 1.1 mmol /L 0.97-1.45 mmol /L URIC ACID 400 µmol/L 238 - 506 µmol/LPowerPoint Presentation: PATIENT PROFILE AND MEDICAL RECORDS DATA LABORATORY TESTS: LIPID PROFILE URINALYSIS PATIENT VALUE NORMAL VALUE TOTAL CHOLESTEROL 7.7 mmol /L 3.88-5.15 mmol /L HDL 0.70 mmol /L < 3.36 mmol /L LDL 4.8 mmol /L <1.04 mmol /L TRIGLYCERIDES 4.7 mmol /L <2.82 mmol /L PATIENT VALUE NORMAL VALUE COLOR CLEAR CLEAR/ YELLOW pH 5 4.6-8.0 PROTEIN NEGATIVE NEGATIVE ERYTHROCYTES 0 </= 3 high-power field WHITE BLOOD CELLS 0 </= 5 high-power field BACTERIA 0 0PowerPoint Presentation: PATIENT PROFILE AND MEDICAL RECORDS DATA LABORATORY TESTS: Electrocardiogram (ECG) Bradycardia , Regular rhythm Echocardiogram Sinusoidal Rhythm, the axis shifted to the left, with normal conditions. Ophthalmoscopic examination Ocular fundus : mild changes of vessels, no papilledema , congestion of hemorrhage of the retina.PowerPoint Presentation: CLINICAL FINDINGS The pathophysiological mechanisms that can explain the elevated blood pressure in this patient is Genetic Predisposition. The pharmacotherapy of hypertension is not appropriate or not effective enough, in spite of the fact that the treatment has been based on a low-dose thiazide for 8 years, BP is greater that the desired range (140/90 mmHg). An appropriate regimen of specific life-style modifications for this patient , he must have an a ccent on aerobic execises for everyday (walking, jogging, or swimming, gardening), diet with salt restriction (5-6 g/day) . Decrease in consumption of fat, sugar and alcohol (30 g/day, e. i . 1-2 dl of wine), body weight reduction should be implemented as well (obesity confers an increased risk of blood pressure elevation). Pharmacotherapy should be changed because of unwanted effects of thiazides in patients with hyperlipoproteinemia. The patient should be prescribed calcium blockers, ACEI, alpha blocking drugs or betalytics with ISA.PowerPoint Presentation: CLINICAL RECOMMENDATION Beta- adalat Capsules; Oral Atenolol 50 mg+ Nifedipine 20 mg beta-blocker+ calcium channel blocker for e lderly , dosage should not exceed one capsule daily in hypertension. 20.35 php (BAYER) MOA of Beta- adalat Atenolol works by blocking beta receptors that are found in the heart. This reduces the action of adrenaline and noradrenaline on the heart, causing it to beat more slowly and with less force. In turn, this reduces the pressure at which the blood is pumped out of the heart and around the body, which helps to reduce blood pressure. Nifedipine works by slowing the movement of calcium through the muscle cells that are found in the walls of blood vessels. It does this by blocking 'calcium channels' in these muscle cells. Calcium is needed by muscle cells in order for them to contract, so by depriving them of calcium, nifedipine causes the muscle cells to relax in order to decrease blood pressure in patients with hypertension.PowerPoint Presentation: CLINICAL RECOMMENDATION Beta- adalat Not to be used in People with a serious defect in the heart's electrical message pathways, resulting in decreased function of the heart (2nd or 3rd degree heart block). Unstable angina. Failure of the heart to maintain adequate circulation of blood around the body ( cardiogenic shock). People who have recently had a heart attack (in the last month). Low blood pressure (hypotension). People with an increase in the acidity of the blood (metabolic acidosis). Severely decreased kidney function.PowerPoint Presentation: CLINICAL RECOMMENDATION Beta- adalat Adverse effects of Beta- adalat Dizziness. Headache Fatigue Sexual problems such as impotence. Bleeding in the skin ( purpura ) Cold hands and feet Disturbed sleep Nightmares Confusion Dry mouth Dry or irritated eyes Visual disturbances Skin reactions such as rash, swelling, burning sensation of hands and feet.PowerPoint Presentation: Check-up of the patient in two months : MEDICAL RECORDS DATA Previous Patient Value Current Patient Value Normal value BP (SITTING) 150/98 mmHg 150/95 mmHg 130/85 mmHg BP (UPRIGHT) 155/110 mmHg 155/100 mmHg 130/85 mmHg BODY WEIGHT 75 kg 75 kg -- BMI 27.5 27.5 18.6 to 22.9 Kg/m2 GLUCOSE 4.8 mmol /L 6.0 mmol /L 3.9–5.8 mmol /L TOTAL CHOLESTEROL 7.7 mmol /L 6.48 mmol /L 3.88-5.15 mmol /L HDL 0.70 mmol /L 0.91 mmol /L < 3.36 mmol /L LDL 4.8 mmol /L 3.49 mmol /L <1.04 mmol /L TRIGLYCERIDES 4.7 mmol /L 4.29 mmol /L <2.82 mmol /LPowerPoint Presentation: CLINICAL FINDINGS No remarkable unwanted effects were obtained with Beta- adalat . Values above the recommended range: BP Body weight (BMI) Total Cholesterol HDL LDL Triglycerides Evaluation to the influence of dietary and exercise regimens: No body weight reduction, slightly improving lipid profile. Conclusion: Hypertension without an expected response to therapy so far.PowerPoint Presentation: CLINICAL RECOMMENDATION Triapin Tablet; Oral Ramipril 2.5 mg + felodipine 2.5 mg Ace-inhibitor + calcium channel blocker One tablet Triapin once daily. The maximum dose is two tablets Triapin once daily. 22.05 php (SANOFI) MOA of Triapin Ramipril work by blocking the action of a compound in the body called angiotensin converting enzyme (ACE). Normally ACE produces another compound called angiotensin II, as part of the body's natural control of blood pressure. Felodipine acts specifically on the muscle cells in the walls of arteries, causing them to relax. This allows the arteries in the body to widen, which decreases the resistance that the heart has to push against in order to pump the blood around the body. This in turn reduces the pressure within the blood vessels.PowerPoint Presentation: CLINICAL RECOMMENDATION Triapin Not to be used in Allergy to other ACE inhibitors, eg captopril . Allergy to other related calcium channel blockers ( dihydropyridines , eg amlodipine , nifedipine ). Failure of the heart to maintain adequate circulation of blood ( cardiogenic shock). Untreated heart failure. People who have had a heart attack (myocardial infarction) in the last month. Angina not well controlled by medical treatment (unstable angina). Stroke. Severely decreased liver function. Severely decreased kidney function or people having dialysis for kidney failure.PowerPoint Presentation: CLINICAL RECOMMENDATION Triapin Adverse effects of Triapin Headache Dizziness. Pins and needles sensations Alteration in taste or smell Pain in the muscles or joints Anxiety and restlessness. Fatigue Sexual problems such as impotence. Confusion Dry mouth Visual disturbances Flushing Dry cough Enlargement of the gums (gingival hyperplasia). To keep non-pharmacological therapy, and to increase the dose of the antihypertensive agent. Check-up in 2 months.PowerPoint Presentation: Check-up of the patient in two months : MEDICAL RECORDS DATA (1)Previous Patient Value (2)Previous Patient Value Current Patient Value Normal value BP (SITTING) 150/98 mmHg 150/95 mmHg 130/85 mmHg 130/85 mmHg BP (UPRIGHT) 155/110 mmHg 155/100 mmHg 135/90 mmHg 130/85 mmHg BODY WEIGHT 75 kg 75 kg -- BMI 27.5 27.5 27.5 18.6 to 22.9 Kg/m2 TOTAL CHOLESTEROL 7.7 mmol /L 6.48 mmol /L 6.0 mmol /L 3.88-5.15 mmol /L HDL 0.70 mmol /L 0.91 mmol /L 1.0 mmol /L < 3.36 mmol /L LDL 4.8 mmol /L 3.49 mmol /L 3.5 mmol /L <1.04 mmol /L TRIGLYCERIDES 4.7 mmol /L 4.29 mmol /L 3.5 mmol /L <2.82 mmol /LPowerPoint Presentation: CLINICAL FINDINGS No remarkable unwanted effects were obtained with Triapin Values above the recommended range: Lipid profile Body weight (BMI) Conclusion: Hypertension with a good response to the therapy, disorders of the lipid profile are still obtained.PowerPoint Presentation: Additional Clinical Recommendation: HYPOLIPIDEMIC PHARMACOTHERAPY Pravastatin ( Pravachol ) 40 mg tablet once daily (1 hour after taking the antihypertensive drug to avoid interactions) It reduces levels of "bad" cholesterol (low-density lipoprotein, or LDL) and triglycerides in the blood, while increasing levels of "good" cholesterol (high-density lipoprotein, or HDL). side effects may include: headache; mild muscle pain; diarrhea ; mild skin rash; or dizziness.PowerPoint Presentation: Additional Clinical Recommendation: HYPOLIPIDEMIC PHARMACOTHERAPY Pravastatin ( Pravachol ) What should a patient avoid while taking pravastatin ? Avoid eating foods that are high in fat or cholesterol. Pravastatin will not be as effective in lowering your cholesterol if you do not follow a cholesterol-lowering diet plan. Avoid drinking alcohol. It can raise triglyceride levels and may increase your risk of liver damage. Grapefruit and grapefruit juice may interact with pravastatin .PowerPoint Presentation: Additional Clinical Recommendation: SELF-CARE Eat for health. Achieve a healthy weight Exercise Don’t smoke Limit alcohol and caffeine Manage stress Get plenty of sleepPowerPoint Presentation: Principles of Treatment: Hypertension treatment must focus un controlling the blood pressure and avoiding complications. Frequent monitoring and progress checks are an integral part of this treatment modality. It is better to use drugs with long duration of action (prophylaxis of considerable fluctuation of blood pressure during the day). Rapid decreasing of blood pressure to low figures is dangerous, especially for elderly patients. To improve life prognosis is the aim that has a more significant meaning than character of drugs used to reach this aim. It is better to prescribe cheap and 'non-modern' drugs than don't treat the patient at all.PowerPoint Presentation: “To keep the body in good health is a duty... otherwise we shall not be able to keep our mind strong and clear.” -Buddha You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.