Disease States

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Disease States
2012-08-24 13:56:40

Understanding dz states and related concerns with HTN
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  1. Diabetes (disease)
    Chronic disease in where there is high levels of sugar in the blood. 

    Causes:  Not enough insulin; resistance to insulin, or both

    Symptoms:  blurry vision, excess thirst, fatigue, frequent urination, hunger, weight loss

    • Tests: 
    • -urine analysis (may suspect if blood sugar level >200mg/dL)
    • -fasting blood glucose level
    • -hemoglobin A1c
    • -oral glucose tolerance test
  2. Diabetes (RX)
    • ACE-I:  first line of therapy due to renal protective & cardiovascular protective qualities
    •       **Do not use for bilateral renal artery stenosis!**

    Beta blockers, ARBs - okay as first line

    Beta-blockers:  may mask signs of hypoglycemia (B1 preferred)

    • Microproteinuria = ACE-I/ARB
    • Gross proteinuria = ACE-I/ARB
    •        Don't use both together!

    Goal BP = 130/80
  3. Kidney Disease (Nephropathy)
    Most kidney diseases attack the nephrons and leaves them unable to remove of waste.

    • CrCL < 60 mL/min
    • SrCr > 1.5    
    • AND/OR gross proteinuria

    Want goal BP = 130/80
  4. Kidney Disease (RX)
    • ACE-I/ARB
    •        *do not use if:   SrCr >/= 2.5 (males) or 2.0 (females)
    •          or    K>5.0

    Loop diuretics may be needed later in the disease (CrCL < 30 generally)
  5. Metabolic Syndrome (disease & RX)
    Metabolic syndrome is a name for a group of risk factors that occur together and increase the risk for coronary artery disease, stroke, and type 2 diabetes

    • If "prediabetic" or at high risk for T2DM
    • -ACE-I/ARB may decrease incidence
    • -HCTZ or Beta-blocker may increase incidence

    ACE-I has better data for preventing progression to diabetes
  6. Heart Failure (disease & RX)
    Heart failure is when the heart can no longer pump enough blood to the rest of the body

    • RX USE:
    • -ACE-I/ARB (if ace is not tolerated)
    • & Beta-1 blocker  (or alpha/beta blocker-use B1)

    • Aldosterone antagonists if stage III or IV or if EF<40%
    • -or- hydralazine/isosorbide dinitrate (data for AA)

    • Can add loop diuretic if fluid overload occurs
    •        -peripheral edema
    •        -positional shortness of breath

    If diuretic resistance - can add thiazide to combat

    Do NOT use:  nonDHP, clonidine, alpha-blockers
  7. Post-Myocardial Infarction (disease)
    MI occurs when blood flow to part of your heart is blocked for long enough time that part of the heart muscle is damaged or dies

    • Causes:
    • -blood clot
    • -atherosclerosis
  8. Post-Myocardial Infarction/HTN (RX)
    • Start:
    • Beta1-blocker & ACE-I (ARB if not tolerated)

    *patient must be hemodynamically stable before adding B-blocker

    Aldosterone antagonists, thiazides may be added.

    Non-DHP may be used if B-blocker is contraindicated unless pregnacy