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Pharmacy Practice III
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blood pressure
pressure exerted on the walls of the blood vessels by the circulating blood due to the pumping of the heart
Blood Pressure classifications
Normal < 120/80
Prehypertensive 120-139/80-89
stage 1 HTN 140-159/90-99
stage 2 HTN > 160/100
stage 1 hypertension initial drug therapy
Thiazide diuretics for most
ACEI
ARB
BB
CCB
or Combination
stage 2 hypertension
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
BP goal for patients with chronic kidney disease or diabetes
< 130/80
Benefits of BP lowering
Antihypertensive therapy has been associated with reductions in
-stroke 35-40%
-MI 20-25%
-heart failure 50%
3 methods to measure BP
clinical or conventional
ambulatory
home or self-measurement
clinic/conventional method
auscultatory method - mercury or aneroid device
home/self-measurment
auscultatory- mercury or aneroid monitor
oscillometric method- digital monitor
home BP monitoring benefits
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"
sphygmomanometer
medical instrument used to measure arterial blood pressure
measures in mmHg
manual devices
-mercury
-aneroid
digital devices
Manual Sphygmomanometer
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
mercury sphygmomanometer
gold standard
most accurate
rarely used
banned due to concern of mercury spillage
Aneroid BP monitors
-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
Various types of digital BP monitors
arm (most accurate)
wrist (not as accurate; for patients with large arm)
finger (not recommended)
BP monitors features to consider
Cuff size (most important factor)
display
stethoscope
cost
accuracy
BP self-monitoring technique
sit for 5 minutes resting
no talking
feet flat on the ground
arm at heart level
Bp self-monitoring avoid prior to checkup
caffeine
tobacco
alcohol
avoid food 30 min prior
how often do you check BP
twice daily
Fasting plasma glucose results
normal <= 99
impaired fasting glucose 100-125
diabetes >= 126
Gluconse test 2 hrs after ingesting 75mg glucose load
normal <= 139
impaired glucose140-199
diabetes >= 200
definition of fasting
no caloric intake for at least 8 hrs
Blood glucose therapeutic goals
Preprandial capilary plasma glucose 70-130 mg/dL
peak postprandial capillary plasma glucose < 180 mg/dL
self monitoring of Blood Glucose
track whether goals are being met
prevent or detect hypoglycemia
evaluate glycemic response
-diet
-physical activity
-medication changes
Recommended SMBG 3 or more times per day
type 1 diabetic
pregnant woman on insulin
insulin pump
multiple insulin injections
more frequent monitoring with oral diabetes meds if
prone to hypoglycemia
during illness
dose adjustments
SMBG monitors
lancing device
Lancets
test strips
glucometer accuracy
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)
test strips storage
original container
room temp
avoid exposure to significant weather changes or humidity
check expiration dates
SMBG technique
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
Alternate BG testing sites not recommended
glucose concentrations are rapidly changing
-postprandial
-hypoglycemic episodes
-increased physical activity
Alternative sites recommended
fasting
preprandial
CGM
sensor inserted into SQ tissue and records glucose concentrations every 5 min for 72 hours
Advantages of CGM
better detect glucose fluctuations
better detect trends throughout the whole day
Disadvantages of CGM
patient convenience
insurance coverage/cost
Author
alvo2234
ID
186068
Card Set
Pharmacy Practice III
Description
Pharmacy Practice III (home diagnostic care)
Updated
2012-11-29T18:27:37Z
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