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Hypertension Case Presentation

Hypertension Case Presentation. Kori Lawie , Pharm. d candidate SaRAH DAOUD, PHARM. D CANDIDATE Preceptor: dr. Thomas Robertson. Objectives. Case Overview Define hypertension Discuss diagnostic criteria Identify the pathophysiology of hypertension Identify the pathophysiology of NIDDM

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Hypertension Case Presentation

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  1. Hypertension CasePresentation KoriLawie, Pharm. d candidate SaRAH DAOUD, PHARM. D CANDIDATE Preceptor: dr. Thomas Robertson

  2. Objectives • Case Overview • Define hypertension • Discuss diagnostic criteria • Identify the pathophysiology of hypertension • Identify the pathophysiology of NIDDM • Discuss treatment strategies for hypertension • Evaluate and assess the patient’s current drug therapy • Discuss pharmacist’s care plan • Discuss counseling points

  3. Chief Complaint • “ I’m just here for my regular check-up”

  4. Past Medical History • NIDDM for past six years

  5. History of Present Illness • JB is a 46 year old AA man who presents to his local physician for routine check-ups. His only complaint is mild SOB when walking long distances or up a flight of stairs.

  6. Social History Family History • Smokes 8 cigarettes a day • No known drug or alcohol problems • Both parents had hypertension • NIDDM in one older sister, younger brother, two aunts (deceased), and mother • Mother has a CRI and had a CVA several yrs ago • Father died of MI at 54yrs old

  7. Medications • He was initially managed with • Glipizide 10mg po BID • Advil 2-3 tabs po PRN

  8. Current Presentation General Patient is a WDWN AA man in no acute distress. ROS Non-contributory HEENT PERRLA: EOMI; mild arteriolar narrowing, with AV ration 1:3; no hemorrhages, exudates, or papilledema; TMs intact; oral mucosa clear Pulm Clear to A&P CV RRR, no murmurs, S3 gallop noted

  9. Abd +BS, NT/ND, no masses, no bruits Ext No CCE; pulses 2+ throughout Neuro Cranial nerves grossly intact; DTRs 2+; sensory and motor levels intact; toes downgoing UA Negative; no microalbuminuria present Echocardiogram Increased size of the left ventricle; ejection fraction 0.40

  10. Definition: Hypertension • A medical condition in which the pressure in the arteries are elevated. • Hypertension is considered after the BP reaches 140/90 mm Hg or higher or when pt is on antihypertensive drug therapy. • Blood pressure is measured in two ways: • Systolic • Diastolic

  11. Diagnosis Periodic screening for all individuals older than 21 years Patient seated quietly in chair for at least 5 minutes Use appropriate cuff size (bladder length at least 80% the circumference of the arm). Take BP at least 2 times, separated by at least 2 minutes. The average BP on two separate visits is required to diagnose hypertension accurately.

  12. Pathophysiology: Hypertension

  13. Pathophysiology: NIDDM

  14. Algorithm for Treatment

  15. Classes of Anti-Hypertensives

  16. Classes of Anti-Hypertensives

  17. Classes of Anti-Hypertensives

  18. Classes of Anti-Hypertensives

  19. Classes of Anti-Hypertensives

  20. DRUG THERAPY ASSESSMENT

  21. Drug Therapy Assessment

  22. PHARMACIST CARE PLAN

  23. Pharmacist Care plan

  24. Pharmacist Care plan

  25. Pharmacist Care plan

  26. Pharmacist Care plan

  27. Counseling Tips

  28. Counseling Tips Cont. Monitor hyper- and hypoglycemia Clean injection site (abdomen preferred) Weight Gain Insulin at Bedtime Take ACE inhibitor, Statin, and diuretic in the morning with full glass of H20. Reduce sodium intake to less than 1.5gms per day. Incorporate fruit and vegetables into diet Photosensitivity S/E of Pravachol Smoking is a major risk factor

  29. References DiPiro, Joseph T., Robert L. Talbert, et al. “Pharmacotherapy, A Pathophysiologic Approach (Chapter : Hypertension)”. 7th. 7. New York: McGraw-Hill, 2008. 185-217. Print. Feher, Michael D., et al. Hypertension in non-insulin dependent diabetes mellitus and its management. Postgrad Med J (1990) 67, 938-946 Galloway, John A., et al. Treatment of NIDDM with insulin agonists or substitutes. Diabetes Care, Vol. 13. No. 12, December 1990. Disertori M, Latini R, Barlera S, et al. Valsartan for prevention of recurrent atrial fibrillation. N Engl J Med. 2009;360(16):1606-17. Sacks FM, Campos H. Dietary therapy in hypertension. N Engl J Med. 2010;362(22):2102-12. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report.2003 May 21; 289(19) :2560-71 

  30. QUESTIONS?

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