Thursday, March 11, 2010

Hypertension

Hypertension - Chronic
Rahul Soman, M. Pharm


 

Definition  

An untreated systolic blood pressure (BP) of 140 mmHg or higher or a diastolic BP of 90 mmHg or higher, taking antihypertensive medications, or being told at least twice by a physician or other health professional that you have high blood pressure


 

Medical History  

* Family history of Hypertension

* Family history of Diabetes mellitus

* Diabetes mellitus [Diabetes mellitus - Chronic]

* Obesity [Obesity - Chronic]

* Dietary sodium - high

* Lack of exercise

* Smoking

* Alcohol Abuse


 

Findings  

* Increased blood pressure


 

Tests  


 

Initial testing prior to initiating hypertensive therapy to obtain baseline values and screen for secondary causes  

* 12 lead ECG

* Urinalysis

* Plasma fasting glucose measurement

* Hematocrit determination

* Serum potassium measurement

* Creatinine measurement, serum

* Serum calcium measurement

* Fasting lipid profile


 

Differential Diagnosis  

* Essential hypertension

* Labile hypertension

* Secondary hypertension

* Chronic renal failure - Chronic

* Renovascular hypertension

* Cushing's syndrome

* Hypertension secondary to drug

* Pheochromocytoma - Acute

* Primary aldosteronism

* Sleep apnea

* Hyperparathyroidism

* Hyperthyroidism - Chronic

* Hypothyroidism - Chronic

* Coarctation of aorta


 

Treatment  


 

Drug Therapy  


 

Thiazide diuretics  


 

CHLOROTHIAZIDE  

Adults: 125 to 500 mg orally once or in 2 divided doses daily


 

CHLORTHALIDONE  

Adults: 12.5 to 25 mg (generic) orally once daily


 

HYDROCHLOROTHIAZIDE  

Adults: 12.5 to 50 mg orally once daily


 

POLYTHIAZIDE  

Adults: 2 to 4 mg orally once daily


 

INDAPAMIDE  

Adults: initial dose 1.25 mg orally daily; titrate every 4 weeks to desired effect; maintenance dose 2.5 to 5 mg daily


 

METOLAZONE  

Adults: 0.5 to 1 mg (Mykrox) orally once daily


 

Loop diuretics  


 

BUMETANIDE  

Adults: 0.5 to 2 mg orally in 2 divided doses daily


 

FUROSEMIDE  

Adults: 20 to 80 mg orally in 2 divided doses daily


 

TORSEMIDE  

Adults: 2.5 to 10 mg orally once daily


 

Potassium-sparing diuretics  


 

AMILORIDE HYDROCHLORIDE  

Adults: 5 to 10 mg orally in 1 or 2 divided doses daily


 

TRIAMTERENE  

Adults: 50 to 100 mg orally in 1 or 2 divided doses daily


 

ACE inhibitor  


 

BENAZEPRIL HYDROCHLORIDE  

Adults: 10 to 40 mg orally once daily


 

CAPTOPRIL  

Adults: 25 to 100 mg orally in divided doses twice daily


 

ENALAPRIL MALEATE  

Adults: 5 to 40 mg orally once daily or in divided doses twice daily


 

FOSINOPRIL SODIUM  

Adults: 10 to 40 mg orally once daily


 

LISINOPRIL  

Adults: 10 to 40 mg orally once daily


 

MOEXIPRIL HYDROCHLORIDE  

Adults: 7.5 to 30 mg orally once daily


 

PERINDOPRIL ERBUMINE  

Adults: 4 to 8 mg orally once daily


 

QUINAPRIL HYDROCHLORIDE  

Adults: 10 to 80 mg orally once daily


 

RAMIPRIL  

Adults: 2.5 to 20 mg orally in 1 or 2 divided doses daily


 

TRANDOLAPRIL  

Adults: 1 to 4 mg orally once daily


 

Aldosterone receptor blocker  


 

EPLERENONE  

Adults: 50 to 100 mg orally once daily


 

SPIRONOLACTONE  

Adults: 25 to 50 mg orally once daily


 

Beta blocker  


 

ACEBUTOLOL HYDROCHLORIDE  

Adults: 200 to 800 mg orally in divided doses twice daily


 

ATENOLOL  

Adults: 25 to 100 mg orally once daily


 

BETAXOLOL HYDROCHLORIDE  

Adults: 5 to 20 mg orally once daily


 

BISOPROLOL FUMARATE  

Adults: 2.5 to 10 mg orally once daily


 

METOPROLOL TARTRATE  

Adults: initial dose 100 mg orally daily in single or divided doses taken with or immediately following meals; increase dose weekly until optimal blood pressure reduction is achieved; effective dosage range 100 to 450 mg orally daily


 

NADOLOL  

Adults: 40 to 120 mg orally once daily


 

PENBUTOLOL SULFATE  

Adults: 10 to 40 mg orally once daily


 

PINDOLOL  

Adults: 10 to 40 mg orally in 2 divided doses daily


 

PROPRANOLOL HYDROCHLORIDE  

Adults: 60 to 180 mg (sustained-release) orally once daily


 

TIMOLOL  

Adults: initial dose 10 mg orally twice daily; titrate to desired effect based on heart rate and blood pressure response; allow at least 7 days between dose increases; maintenance dose 20 to 40 mg daily in 2 divided doses; maximum daily dose 60 mg in 2 divided doses


 


 

Nondihydropyridine calcium channel blocker  


 

DILTIAZEM HYDROCHLORIDE  

Adults: 120 to 540 mg (sustained release) orally once daily


 

VERAPAMIL HYDROCHLORIDE  

Adults: 120 to 480 mg (sustained release) orally in 1 or 2 divided doses daily


 


 

Dihydropyridine calcium channel blocker  


 

AMLODIPINE BESYLATE  

Adults: 2.5 to 10 mg orally once daily


 

FELODIPINE  

Adults: 2.5 to 20 mg orally once daily


 

ISRADIPINE  

Adults: 2.5 to 10 mg orally in 2 divided doses daily


 

NICARDIPINE HYDROCHLORIDE  

Adults: 60 to 120 mg (Cardene SR) orally in 2 divided doses daily


 


 

Alpha-blocker  


 

DOXAZOSIN MESYLATE  

Adults: 1 to 16 mg orally once daily


 

PRAZOSIN HYDROCHLORIDE  

Adults: 2 to 20 mg orally in 2 or 3 divided doses daily


 

TERAZOSIN HYDROCHLORIDE  

Adults: 1 to 20 mg orally daily in 1 or 2 divided doses


 


 

Combined alpha-blocker and beta-blocker  


 

CARVEDILOL (Related toxicological information in CARVEDILOL)  

Adults: 12.5 to 50 mg orally divided into 2 doses daily


 

LABETALOL HYDROCHLORIDE  

Adults: 200 to 800 mg orally daily in 2 divided doses


 


 

Angiotensin II receptor blocker/antagonist  


 

CANDESARTAN CILEXETIL  

Adults: 8 to 32 mg orally once daily


 

EPROSARTAN MESYLATE  

Adults: 400 to 800 mg orally in 1 or 2 divided doses daily


 

IRBESARTAN  

Adults: 150 to 300 mg orally once daily


 

LOSARTAN POTASSIUM  

Adults: 25 to 100 mg orally in 1 or 2 divided doses daily


 

OLMESARTAN MEDOXOMIL  

Adults: 20 to 40 mg orally once daily


 

TELMISARTAN  

Adults: 20 to 80 mg orally once daily


 

VALSARTAN  

Adults: 80 to 320 mg orally in 1 or 2 divided doses daily


 

Central alpha-2 agonist or other centrally-acting agent  


 

CLONIDINE

Adults: 0.1 to 0.8 mg tablet orally in 2 divided doses daily OR 0.1 to 0.3 mg patch transdermally once weekly


 

METHYLDOPA \

Adults: initial dose 250 mg orally 2 to 3 times daily in the first 48 hours; titrate at intervals of at least 2 days; maintenance dose 500 to 2000 mg daily in 2 to 4 divided doses; maximum daily dose 3000 mg in divided doses


 

RESERPINE  

Adults: 0.1 to 0.25 mg orally once daily


 

GUANFACINE HYDROCHLORIDE  

Adults: 0.5 to 2 mg orally once daily


 


 

Direct vasodilator  


 

HYDRALAZINE HYDROCHLORIDE  

Adults: 50 to 100 mg orally in 2 divided doses daily


 

MINOXIDIL  

Adults: 2.5 to 80 mg orally in 1 or 2 divided doses daily


 

Non-Procedural Therapy  


 

Hypertension  

* Lifestyle measures

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SYSTEM BASED CLASSIFICATION OF DISEASES

SYSTEM BASED CLASSIFICATION OF DISEASES

Bone and Joint Diseases

  1. Gout and Hyperurecemia
  2. Osteoarthritis
  3. Rheumatoid Arthritis
  4. Acute coronary Syndroms

Cardiovascular Diseases

  1. Arrhymias
  2. Cardiopulmanary Resuscitation
  3. Heart Failure
  4. Hypertension
  5. Hyperlipidemia
  6. Ischemic Heart Diseases
  7. Shock
  8. Stroke
  9. Venous Thromboembolism

Dermatrologic Diseases

  1. Acne
  2. Psoriasis
  3. Skin Disorders and Cutaneous Drug Eruptions

Endocrine Diseases

  1. Cirrhosis
  2. Portal Hypertension

Gastrointestinal Diseases

  1. Irritable Bowel Syndrome
  2. Constipation
  3. Diarrhea
  4. Gastroesophagal Reflux Disease
  5. Hepatitis, Viral
    1. Hepatitis A
    2. Hepatitis B
    3. Hepatitis C
  6. Nausea and Vomiting
  7. Pancreatitis
  8. Peptic Ulcer disease

Gynecologic and Obstetric Diseases

  1. Contraception
  2. Hormone therapy

Hematologic Diseases

  1. Anemia
    1. Megaloblastic Anemia

i. Megaloblastic Anemia due to Folate Deficiency

ii. Megaloblastic Anemia due to Vitamine B12 Deficiency

    1. Sickle Cell anemia
    2. Hemolytic Anemia
    3. Iron Deficiency Anemia
    4. Aplastic Anemia
    5. Iron Deficiency Anemia

Infectious Diseases

  1. Central Nervous System infections
  2. Endocarditis
  3. Fungal infections, Invasive
  4. Gastrointestinal Infection
  5. HIV / AIDS
  6. Intra-Abdominal Infection
  7. Respiratory Tract infections, Lower
  8. Respiratory Tract infections, Upper
  9. Sepsis and Septic Shock
  10. Sexually transmited Diseases (STD)
  11. Skin and soft tissue infection
  12. Tuberculosis
  13. Urinary tract infection and prostatitis

Neurologic Diseases

  1. Epilepsy
  2. Headache
    1. Migraine
    2. Cluster Headache
  3. Pain management
  4. Parkinson’s Diseases
  5. Status epilepticus

Nutritional Diseases

  1. Enteral Nutrition
  2. Obesity
  3. Parentaral Nutrition

Onchologic Diseases

  1. Breast cancer
  2. Colorectal Cancer
  3. Lung cancer
  4. Lymphomas
  5. Prostate cancer
  6. Cervical Cancer
  7. Esophageal Cancer
  8. Gastric Cancer
  9. Head and Neck Cancer
  10. Lung Cancer
  11. Ovarian Cancer
  12. Pancreatic Cancer
  13. Primary bone Cancer
  14. Primary Brain cancer
  15. Testicular Cancer
  16. Thyroid Gland Cancer
  17. Urinar Bladder cancer
  18. Uterine Cancer

Ophtalmic Diseases

  1. Glaucoma

Psychiatric Diseases

  1. Alzhimer’s Diseases
  2. Anxiety Disease
  3. Bipolar Diseases
  4. Depressive diseases
  5. Schizophrenia
  6. Sleep Diseases
  7. Substance-Related Diseases

Renal Diseases

  1. Acid base Diseases
  2. Acute renal Failure
  3. Chronic Renal Failure
  4. Drug Dosing in renal insufficiency
  5. Electrolyte Homeostasis

Respiratory Diseases

  1. Allergic Rhinitis
  2. Asthma
  3. Chronic Obstructive Pulmonary Diseases

Urologic Diseases

  1. Benign Prostatic, Hyperplasia
  2. Erectile Dysfunction
  3. Urinary Incontinence