Pharmaceutical Care of CV hospital 1 - hypertension, IHD, MI Flashcards
briefly list how to manage a cardiovascular patients in a hospital
1) improve symptoms
2) prevent deterioration
3) review medicines/lifestyle
4) communicate changes
outline the role of a hospital pharmacist with regards to managing patients with hypertension
1) Monitor BP to aim for a blood pressure of ≤140/90 mmHg
2) Monitor side effects – especially in elderly
3) Watch for drug-drug and drug-disease interactions
4) Health promotion
5) Compliance
6) monitoring medicines used in hypertension
Diuretics are used in hypertension. what parameters need to be monitored on this drug?
1) Serum creatinine
2) eGFR
3) Serum electrolytes (sodium, potassium, magnesium)
4) Uric acid (if gout is suspected)
5) Check within 2–4 weeks of starting therapy or increasing dose, then at least annually throughout therapy
6) When starting a thiazide-type diuretic: check serum urea, electrolytes and the estimated glomerular filtration rate (eGFR) at baseline and again 4–6 weeks after starting treatment
the following classes of drugs are used to treat hypertension:
- ACE inhibitors
- Aldosterone antagonists
- ARBs
- Direct renin inhibitors
what parameters need to be monitored when on these drugs?
1) Serum creatinine
2) eGFR
3) Serum electrolytes (sodium, potassium)
4) Check within 2–4 weeks of starting therapy or increasing dose, then at least annually throughout therapy. (More frequent renal monitoring is required with aldosterone antagonists.)
Calcium-channel blockers (non-dihydropyridine agents only) are used to treat hypertension. what parameter needs to be checked when on this medication?
1) Heart rate (maintain above 55 beats per minute)
- For people who are starting antihypertensive drug treatment, follow up:To recheck blood pressure after at least 4 weeks for treatment effects to stabilize
discuss the self limiting and long term side effects of Calcium channel blockers
Self limiting : 1) headache 2) facial flushing 3) dizziness 4) tiredness 5) palpitations Long term: 1) Ankle oedema 10% 2) Reduce dose 3) Add in ACEi or ARB 4) Ankle elevation
list the Side effects of ACE inhibitors and outline how you could reduce them.
1) First dose hypotension:
- Reduce diuretic
- Use longer acting drugs e.g ramipril
2) Hyper-kalaemia
- Monitor
- Watch for other drugs that raise potassium
3) Impaired renal function: 20% reduction in eGFR
4) Cough: Try angiotensin receptor blockers (ARB) instead
state the most common side effect of long-term treatment with ACE inhibitors and outline why it occurs.
1) a dry, irritating cough
2) This can occur several months after starting therapy and is thought to be due to an excess of bradykinin.
3) Coughs caused by ACE inhibitors do not respond to cough medicines and may become troublesome for patients. If this is the case, an ARB can be used as an alternative.
list the side effects of thiazide diuretics and outline what should be monitored in patients taking them
1) Hypokalaemia
- Monitor 4 weeks after starting therapy and then periodically
2) Fluid loss
- Watch for dehydration
3) Ineffective if eGFR
How do diuretics reduce blood pressure?
1) Diuretics reduce sodium and water retention by inhibiting sodium reabsorption in the nephron of the kidney
2) the resulting diuresis causes an initial decrease in circulating volume and hence a reduction in cardiac output.
3) This decreases the patient’s blood pressure and peripheral flow, which leads to a decrease in peripheral resistance as a result of autoregulation. Overall, the cardiac output is maintained with a net reduction in blood pressure.
4) Thiazides and related diuretics also have a direct relaxant effect on vascular smooth muscle.
discuss the Drug-drug/Drug-disease Interactions which might occur in Hypertension.
- give examples
1) New drugs may interact with antihypertensives to increase/reduce effects of drugs e.g. increased levels of metoprolol with citalopram
2) New drugs may increase/reduce blood pressure in their own right e.g corticosteroids
3) Condition of patient may increase/reduce blood pressure e.g. stress, infection
describe how a drug interaction would be managed in hypertension
1) is the reaction significant?- if it is not then no change is required and you just need to monitor the patient
2) if there is a significant reaction look for an alternative
3) if there is no alternative available monitor BP and review antihypertensive as necessary
4) if there is an alternative- swap
discuss the Compliance/Adherence of patients taking anti-hypertensive medication and outline how it could be improved.
1) Hypertension is asymptomatic in most patients
2) Willingness to start and persist with therapy can be poor
3) Need to make sure patient fully aware of consequences of persistent high blood pressure
4) Actively involve patients in decisions about their care
5) Identify any beliefs/concerns
6) Use interventions to overcome practical problems
7) Consider alternative drugs/regimes
outline the role of a hospital pharmacist with regards to managing patients with Ischaemic Heart Disease (IHD)
1) Control of symptoms and prevention of further events
2) Monitoring for side effects/effect
3) Watch for drug-drug and drug-disease interactions
4) Health promotion
5) Counselling
how would you control the symptoms of IHD?
1) Glyceryl trinitrate (GTN) – sublingual or can be given by infusion for persistent pain
2) Morphine/Diamorphine: Analgesic, anxiolytic and vasodilating effects
