Pharmacy Practice III

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Author:
alvo2234
ID:
186068
Filename:
Pharmacy Practice III
Updated:
2012-11-29 13:27:37
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Pharmacy Practice III final home diagnostic care
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Pharmacy Practice III (home diagnostic care)
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  1. blood pressure
    pressure exerted on the walls of the blood vessels by the circulating blood due to the pumping of the heart
  2. Blood Pressure classifications
    • Normal < 120/80
    • Prehypertensive 120-139/80-89
    • stage 1 HTN 140-159/90-99
    • stage 2 HTN > 160/100
  3. stage 1 hypertension initial drug therapy
    • Thiazide diuretics for most
    • ACEI
    • ARB
    • BB
    • CCB
    • or Combination
  4. 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
  5. BP goal for patients with chronic kidney disease or diabetes
    < 130/80
  6. Benefits of BP lowering
    • Antihypertensive therapy has been associated with reductions in 
    • -stroke 35-40%
    • -MI 20-25%
    • -heart failure 50%
  7. 3 methods to measure BP
    • clinical or conventional 
    • ambulatory 
    • home or self-measurement
  8. clinic/conventional method
    auscultatory method - mercury or aneroid device
  9. home/self-measurment
    • auscultatory- mercury or aneroid monitor
    • oscillometric method- digital monitor
  10. 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"
  11. sphygmomanometer
    • medical instrument used to measure arterial blood pressure
    • measures in mmHg
    • manual devices
    • -mercury
    • -aneroid
    • digital devices
  12. 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
  13. mercury sphygmomanometer
    • gold standard
    • most accurate
    • rarely used
    • banned due to concern of mercury spillage
  14. 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
  15. Various types of digital BP monitors
    • arm (most accurate)
    • wrist (not as accurate; for patients with large arm)
    • finger (not recommended)
  16. BP monitors features to consider
    • Cuff size (most important factor)
    • display
    • stethoscope
    • cost 
    • accuracy
  17. BP self-monitoring technique
    • sit for 5 minutes resting
    • no talking
    • feet flat on the ground
    • arm at heart level
  18. Bp self-monitoring avoid prior to checkup
    • caffeine 
    • tobacco
    • alcohol
    • avoid food 30 min prior
  19. how often do you check BP
    twice daily
  20. Fasting plasma glucose results
    • normal <= 99
    • impaired fasting glucose 100-125
    • diabetes >= 126
  21. Gluconse test 2 hrs after ingesting 75mg glucose load
    • normal <= 139
    • impaired glucose140-199
    • diabetes >= 200
  22. definition of fasting
    no caloric intake for at least 8 hrs
  23. Blood glucose therapeutic goals
    • Preprandial capilary plasma glucose 70-130 mg/dL
    • peak postprandial capillary plasma glucose < 180 mg/dL
  24. self monitoring of Blood Glucose
    • track whether goals are being met
    • prevent or detect hypoglycemia
    • evaluate glycemic response
    • -diet
    • -physical activity
    • -medication changes
  25. Recommended SMBG 3 or more times per day
    • type 1 diabetic
    • pregnant woman on insulin
    • insulin pump
    • multiple insulin injections
  26. more frequent monitoring with oral diabetes meds if
    • prone to hypoglycemia
    • during illness
    • dose adjustments
  27. SMBG monitors
    • lancing device
    • Lancets
    • test strips
  28. 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)
  29. test strips storage
    • original container
    • room temp
    • avoid exposure to significant weather changes or humidity
    • check expiration dates
  30. 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
  31. Alternate BG testing sites not recommended
    • glucose concentrations are rapidly changing
    • -postprandial
    • -hypoglycemic episodes
    • -increased physical activity
  32. Alternative sites recommended 
    • fasting 
    • preprandial
  33. CGM
    sensor inserted into SQ tissue and records glucose concentrations every 5 min for 72 hours
  34. Advantages of CGM
    • better detect glucose fluctuations
    • better detect trends throughout the whole day
  35. Disadvantages of CGM
    • patient convenience
    • insurance coverage/cost

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