This document contains a group assignment for a cardiology pharmacology course. It includes questions about blood pressure categories, types of blood pressure monitoring, classes of antihypertensive medications, differences in blood pressure guidelines, evaluating and managing a patient's blood pressure, and counseling points for the medication lisinopril.
This document contains a group assignment for a cardiology pharmacology course. It includes questions about blood pressure categories, types of blood pressure monitoring, classes of antihypertensive medications, differences in blood pressure guidelines, evaluating and managing a patient's blood pressure, and counseling points for the medication lisinopril.
This document contains a group assignment for a cardiology pharmacology course. It includes questions about blood pressure categories, types of blood pressure monitoring, classes of antihypertensive medications, differences in blood pressure guidelines, evaluating and managing a patient's blood pressure, and counseling points for the medication lisinopril.
This document contains a group assignment for a cardiology pharmacology course. It includes questions about blood pressure categories, types of blood pressure monitoring, classes of antihypertensive medications, differences in blood pressure guidelines, evaluating and managing a patient's blood pressure, and counseling points for the medication lisinopril.
*All answers that ask for a medication must include brand and generic names for full credit.
1. Fill out the chart below on the blood pressure (BP) categories:
Blood Pressure SYSTOLIC BP DIASTOLIC BP
Category
Normal Less than 120 and Less than 80
Elevated 120-129 and Less than 80
Stage 1 Hypertension 130-139 OR 80-89
Stage 2 Hypertension 140 or HIgher OR 90 or higher
Hypertension Crisis Higher than 180 and/or Higher than 120
2. Describe difference between ambulatory and home BP monitoring. Which is more accurate?
Ambulatory BP monitoring monitors a patient’s BP every 15-30 minutes throughout a 24 hour
period whereas home BP monitoring includes out-of-office BP readings taken by the patient themselves. Since the patient is responsible for their own BP readings and may omit or fabricate results, ambulatory BP monitoring is more accurate.
3. List the 4 classes of first-line recommendations for antihypertensive therapy. Include one example of a medication from each class. ● Thiazides ○ Ex. Hydrochlorothiazide (Microzide) ● Ace-I ○ Ex. Lisinopril (Zestril) ● Arbs ○ Ex. Losartan (Cozaar) ● CCB ○ Ex. Amlodipine (Norvasc)
4. List two antihypertensives which cause hyperkalemia.
5. Describe differences in BP goals between JNC8 and ACC/AHA guidelines.
JNC8: - Treat to < 150/90 mmHg in: >60 years or older - Treat to <140/90mmHg in: <60 years of age - With DM or CKD
ACC/AHA - Treat to <130/80 mmHg if: - Known CVD - 10 year ASCVD risk > 10% - Stage 2 HTN
6. BV has an average blood pressure reading of 145/88 mmHg over 2 separate clinic visits. What is BV’s blood pressure classification?
Normal Elevated Stage 1 Stage 2 Hypertensive crisis
7. GH is a 60-year-old female who presents to your ambulatory care clinic for management of her blood pressure. Her past medical history is significant for hypertension, obesity, hyperlipidemia, and stroke. She smokes 1 pack of cigarettes per day but does not drink alcohol. She has a sedentary lifestyle, but has been trying to reduce sodium and fat intake. Her average blood pressure reading is 156/96 mmHg over 2 previous clinic visits.
a. What is the most appropriate next step to manage TY’s blood pressure? Recommend non-pharmacological therapy only Calculate 10-year ASCVD risk Start non-pharmacological and pharmacological therapy today Promote optimal lifestyle habits and reassess in 1 year
b. Provide rationale for your answer in part A.
- I would advise the patient to consider smoking cessation as a part of further initiating her non-pharmacological therapies. I would encourage the patient to reduce sodium and fat intake, at this point and promote physical activity to reduce weight. I would also prescribe a first line anti-hypertensive because the patient is in stage 2 hypertension, and both non pharm and pharm treatment is recommended. Upon these steps, I would schedule an appointment the next month to reassess her BP.
8. A 42 year old male presents to the pharmacy with a new prescription for lisinopril 10mg daily.
a. List the brand name for this medication.
- Zestril
b. What is the mechanism of action?
- Inhibits the conversion of angiotensin I to angiotensin II - Inhibits the degradation of bradykinin
c. What are key monitoring parameters for this medication?
- Monitor for dry cough, hyperkalemia (within 2-4 weeks), BUN & SCr (for acute renal failure), changes to GFR (monitor SCr), angioedema
d. Provide counseling points for this patient.
- Potential dry cough - May cause hypotension - May cause angioedema (lip and tongue swelling, difficulty breathing) - Caution with taking other medications that can increase potassium or if taking lithium or cyclosporine.
Thomas J. Fogarty MD, Amitava Biswas MD (Auth.), Thomas J. Fogarty, Rodney A. White (Eds.) - Peripheral Endovascular Interventions-Springer-Verlag New York (2010)
