1 / 24

Najla Ahmed Mariam Juma Hissa Sultan Asma Ahmed

Presented By:. Najla Ahmed Mariam Juma Hissa Sultan Asma Ahmed . Clinical Pharmacology. Urogenital Module : Case I. The Case.

freeman
Download Presentation

Najla Ahmed Mariam Juma Hissa Sultan Asma Ahmed

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Presented By: • Najla Ahmed • Mariam Juma • Hissa Sultan • Asma Ahmed Clinical Pharmacology Urogenital Module : Case I

  2. The Case CC: A 59-year-old male visits his family doctor for a routine check-up. He states that he is feeling “as new”. On repeated questioning he complains of occasional shortness of breath (SOB) on exercise. What are the causes of shortness of breath???

  3. The Case Physical exam (PE) + Vital Signs (VS): • Height:169 cm • Weight: 92 kg • RR: 175 / 95 mmHg • HR: 96 beats/min Diagnosis???

  4. Hypertension Definition of hypertension: High blood pressure transitory or sustained elevation of systemic arterial blood pressure to a level likely to induce cardiovascular damage or other adverse consequences ( 140 / 90 mmHg )

  5. Hypertension Blood Pressure Classification: List forms/causes of hypertension???

  6. Hypertension Essential hypertension (primary): • Genetic factors • Fetal • Environmental • Humoral • Insulin resistance lower birth weight  higher blood pressure obesity, alcohol , sodium intake, stress autonomic nervous system, renin-angiotensin, ANP

  7. Hypertension Secondary Hypertension: • Renal 80% • Endocrine • Cardiovascular • Drugs • Pregnancy Diabetic nephropathy, chronic glomerulonephritis, chronic tubulointerstitial nephritis, Conn’s, CAH, phaeochromocytoma, cushing’s, acromegaly Coarctation of the aorta OCP, steroids, carbenoxolone, vasopressin 1st half of pregnancy  pre-existing essential hypertension 2nd half  pregnancy induced hypertension that resolve after delivery

  8. Hypertension Malignant Hypertension: BP rises rapidly  sever hypertension (diastolic blood pressure >140 mmHg) What is the most common form of hypertension???

  9. The Case A diagnosis of essential hypertension is made. The family doctor decides to use a diuretic to treat his condition.

  10. The Case Major classes of diuretics • Loop diuretics: • Furosemide, Torsemide, Bumetanide, • Ethacrynic Acid • Thiazide diuretics: • Chlorothiazide, Hydrochlorothiazide • Chlorthalidone, Indapamide

  11. The Case Major classes of diuretics (cont.) • Potassium sparing: • 1. Aldosterone Antagonists: • Spironolactone, Canrenone • 2. Cycloamidine Derivatives: • Triamteren, Amiloride • Carboanhydrase Inhibitors: • Acetazolamide • Xanthine Derivatives: • Caffeine, Theophylline, Theobromine

  12. Diuretics Comparison:

  13. Diuretics

  14. The Case TREATMENT: The family doctor decides to use Chlorthalidone 25 mg to treat his condition.

  15. The Case • Later • CC: chronic fatigue, muscle weakness, cramps and dizziness. • HPI: receiving chlorthalidone 25 mg for Tx of essential hypertension for more than one year. • PE & VS: • HR 105 • RR 110/50 standing • Tilt test + • Skin turgor reduced • Somnolent • Muscle weakness ( left & right) • Deep tendon reflexes slow ( left &right)

  16. The Case • The requested lab results revealed as:

  17. The Case • Immediate treatment Would you change his medication???? • Long term treatment • Chlorthalidone 25 mg + potassium oral supplement • K+ at discharge was 4.2 mmol/l

  18. The Case 10 days later his K = 3.2 On repeated questioning he tells you that he did not like the potassium supplements so he decided not to take them. Would you change his medication?

  19. The Case You discharge the patient on Chlorthalidone 25 mg and Amiloride 10 mg.

  20. The Case • 4 weeks later he presents to A&E of the local hospital with cardiac dysrhythmias. • On repeated questioning he tells the admitting resident that he took in addition to the prescribed medication the potassium oral supplements he had at home because he felt that it would be a waste of money not to use them. He also eats a lot of meats and dates. K = 6.4 mmol/l

  21. Causes of hyperkalemia: The Case • Pseudohyperkalemia • Redistribution • Excessive endogenous potassium load • Excessive exogenous potassium load • Diminished potassium excretion • Laboratory error

  22. How to manage hyperkalemia? The Case

  23. Treatment of hyperkalemia: The Case • Ca+2 Gluconate(10 ml) • Insulin+Glucose(20 U soluble insulin+50 ml glucose) • Nebulized Salbutamol(2.5mg) • Polystyrene Sulfonate resin(15g/8hrs) • Dialysis

  24. QUESTION??? A K T H N S

More Related