Pharmaceutical Care: Hypertension Flashcards
What are the symptoms?
Only appear if severe
Headaches
Retinal haemorrhage
What is the primary cause?
NO real explanation
Age?
Which medications can cause it?
Pill
nSAIDs
Steroids = corticosteroids
What can be the secondary cause?
Specific reason
eg. tumour in adrenal gland#
= more adrenaline secreted
= increased BP
When is the BP suggestive?
140/90 or higher
What are the challenges of measuring BP?
White coat syndrome
= seem to have high BP but don’t actually
Due to more stress + anxiety
What can you do to overcome white coat syndrome?
Ambulatory BP monitoring
= at home 24hr monitoring
How many stages of hypertension is there?
3
What is stage 1?
Greater than 140/90 or 135/85 at home
Treat on risk
What is stage 2?
160/100 or 150/95 at home
Treat everyone
What is stage 3?
180/110 or higher
Treat there + then
NO take home
What lifestyle advice can you give people?
Exercise
Lose weight
Improve diet
Drink less
Decrease salt intake
What is step 1 of treatment?
Patient under 55 = ACE
Over or black people of African or Caribbean = CCB
CCB NOT suitable = thiazide-like diuretic
What are examples of ACE?
Lisinopril
Enalapril
Ramipril
What problems with ACE?
Posterior hypotension = drop in BP when stand up
= make dizzy
Chronic dry cough
Because of posterior hypotension side effect of ACE, what do you do?
Start low + go slow with dose
Advise to take at night
What can ACE interact with?
Electrolytes + renal failure
Increase K+ levels = hypercalcemia
What are examples of A2RBs?
Losartan
Candesartan
Irbesartan
What is good about A2RBs?
Don’t cause chronic dry cough
What are the problems with CCBs?
Headaches
Ankle oedema
Interact with grapefruit juice
What are examples of thiazide-like diuretics?
Indapamide
Chlortalidone
Would you use higher dose of thiazide-like diuretics?
NO
= higher dose cause more side effects with little effect on BP
What is the problem with thiazide-like diuretics?
Can disturb electrolytes
= increase uric acid + glucose
= diabetes problem
What are the other types of diuretics?
Loop = NOT used to treat hypertension
K+ sparring
What is step 2 of treatment?
BP NOT controlled by step 1
CCB in combo with ACE/ARB
If CCB not suitable = thiazide
For black people = CCB with ARB
What is step 3?
First ensure step 2 doses are optimal + they are taking them
Combo of ACE (or ARB), CCB + thiazide
What is step 4?
Above 140/90
= resistant hypertension
Additional diuretics, higher dose of thiazide or alpha/beta blocker
Dependent on patient
What is the problem with K= sparring diuretic?
Hypercalcemia
= increases risk of high K+
Which can stop the heart
What do alpha blockers do?
Vasodilate
What are examples of alpha blockers?
Doxazosin
Prazosin
Terazosin
What are the side effects of alpha blockers?
Postural hypotension
Urinary incontinence
What are beta blockers mostly used for?
Angina
What are examples of beta blockers?
Atenolol
Bisoprolol
Propranolol
Why is there a caution when stopping beta blockers?
Reduce CO when used
= increase sympathetic NS
= if abruptly stopped still get sympathetic
= tachycardia
What are the problems with beta blockers?
Selectivity of beta 1 + 2
Bronchospasm = asthma
