Pharmacy Practice III

pressure exerted on the walls of the blood vessels by the circulating blood due to the pumping of the heart

• Normal < 120/80
• Prehypertensive 120-139/80-89
• stage 1 HTN 140-159/90-99
• stage 2 HTN > 160/100

• Thiazide diuretics for most
• ACEI
• ARB
• BB
• CCB
• or Combination

• two drug comination for most
• -usually thiazide-type diuretics and ACEI or ARB or BB or CCB

combo therapy should be used cautiously in those at risk for orthostatic hypertension

< 130/80

• Antihypertensive therapy has been associated with reductions in 
• -stroke 35-40%
• -MI 20-25%
• -heart failure 50%

• clinical or conventional 
• ambulatory 
• home or self-measurement

auscultatory method - mercury or aneroid device

• auscultatory- mercury or aneroid monitor
• oscillometric method- digital monitor

• Provides a more complete and accurate view
• Better prognostic indicator of stroke and CV mortality
• Helps better assess response to antihypertensive
• Helps identify "white coat hypertensive"
• Tighter correlation with regression of left ventricle hypertrophy in response to treatment
• Possible decrease cost for patient due to 
• -decreased clinic visits
• -reduced treatment due to "white coat HTN"

• medical instrument used to measure arterial blood pressure
• measures in mmHg
• manual devices
• -mercury
• -aneroid
• digital devices

• Auscultatory method
• -korotkoff's sounds
• -SBP- identified when at least 2 consec. beats
• -DBP- disappearance of sound
• Comprised of cuff, mercury or aneroid monometer, stethosc.
• More difficult to use
• -knowledge of stethoscope
• -trained ear to identify sounds

• gold standard
• most accurate
• rarely used
• banned due to concern of mercury spillage

• -inexpensive
• -easy to maintain
• -aneroid monitors are very accurate if calibrated every 6 to 12 months against a mercury sphygmomanometer
• -requires training
• -not best for individuals with:
• hearing and visual impairments
• lack of fine motor skills

• arm (most accurate)
• wrist (not as accurate; for patients with large arm)
• finger (not recommended)

• Cuff size (most important factor)
• display
• stethoscope
• cost 
• accuracy

• sit for 5 minutes resting
• no talking
• feet flat on the ground
• arm at heart level

• caffeine 
• tobacco
• alcohol
• avoid food 30 min prior

twice daily

• normal <= 99
• impaired fasting glucose 100-125
• diabetes >= 126

• normal <= 139
• impaired glucose140-199
• diabetes >= 200

no caloric intake for at least 8 hrs

• Preprandial capilary plasma glucose 70-130 mg/dL
• peak postprandial capillary plasma glucose < 180 mg/dL

• track whether goals are being met
• prevent or detect hypoglycemia
• evaluate glycemic response
• -diet
• -physical activity
• -medication changes

• type 1 diabetic
• pregnant woman on insulin
• insulin pump
• multiple insulin injections

• prone to hypoglycemia
• during illness
• dose adjustments

• lancing device
• Lancets
• test strips

• FDA allows a specific variance for monitors
• accuracy can vary by up to 20%
• meters that report capillary/whole blood glucose levels are more accurate (closer to lab results)

• original container
• room temp
• avoid exposure to significant weather changes or humidity
• check expiration dates

• wash hands (use soap and warm water)
• -allow alcohol to dry if used
• lance side of fingertip (less pain)
• -never reuse lancet
• -alt. test sites may be used
• ensure adequate size of blood drop

• glucose concentrations are rapidly changing
• -postprandial
• -hypoglycemic episodes
• -increased physical activity

• fasting 
• preprandial

sensor inserted into SQ tissue and records glucose concentrations every 5 min for 72 hours

• better detect glucose fluctuations
• better detect trends throughout the whole day

• patient convenience
• insurance coverage/cost