Alab ama Univ ersit y NUR 521 Phar macology Study Gui de Latest Update 100% Complete Solution Final Exam Information and Study Recommendations Your final exam will contain 75 questions and you will have 2 hours to take it with an approved proctor. It is closed book, closed notes/other resources. It will be offered as scheduled and posted in Blackboard. Your final is comprehensive, and so you will have content from each module on the final. There will be an average of 8 questions from each module, with more emp hasis on antibiotics and drugs of choice for various diagnoses . The questions on your final were provided by the lecturer on that content. So while it is comprehensive, and anything covered in the lectures or required readings is fair game for the final, you should know the following content well. Please Note: This study guide has been provided to you as a courtesy and is not group work. It is not to be shared in any manner and it is NOT to be used while you are taking the final exam, as it is cl osed book and closed notes. The final exam must be proctored. 1. DOCs for common diagnoses are always important to know. You will have multiple questions on your exam that ask about DOCs for specific common diagnoses. Please use your primary care and psych iatric medication assignments as study aids . 2. Classes of hypertension and hypertension emergency definitions. Pg.257,270 Essential Hypertension Etiology & Classification A. Primary Essential Hypertension “Essential hypertension” is the term applied to the 95% of hypertensive patients in which elevated blood pressure results from complex interactions between multiple genetic and environmental facto rs. The proportion regarded as “essential” will diminish with improved detection of clearly defined secondary causes and with better understanding of pathophysiology. Essential hypertension occurs in 10 –15% of white adults and 20 –30% of black adults in the United States. The onset is usually between ages 25 and 50 years; it is uncommon before age 20 years. The best understood pathways underlying hypertension include overactivation of the sympathetic nervous and renin -angiotensin -aldosterone systems (RAAS), blunting of the pressure -natriuresis relationship, variation in cardiovascular and renal development, and elevated intracellular sodium and calcium levels. Exacerbating factors include obesity, sleep apnea, increased salt intake, excessive alcohol use, cigarette smoking, polycythemia, nonsteroidal anti -inflammatory drug (NSAID) therapy, and low potassium intake. Obesity is associated with an increase in intravascular volume, elevated cardiac output, activation of the renin -angiotensin system, and, probably, increased sympathetic outflow. Lifestyle -driven weight reduction lowers blood pressure modestly, but the dramatic weight reduction following bariatric surgery results in improved blood pressure in most patients, and actual remission of hypertension in 20–40% of cases Secondary Hypertension: Secondary Hypertension Approximately 5% of patients have hypertension secondary to identifiable specific causes (Table 11 –
2). Secondary hypertension should be suspected in patients in whom hypertension develops at an early age or after the age of 50 years, and in those previously well controlled who become refractory to treatment. Hypertension resistant to three medications is another clue, although multiple medications are usually required to control hypertension in persons with diabetes. Secondary causes include CKD,genetic syndromes; kidney disease; renal vascular disease; primary hyperaldosteronism; Cushing syndrome; pheochromocytoma; coarctation of the aorta and hypertension associated with pregnancy, estrogen use, hypercalcemia, and medications · Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 130 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg. · Stage 2 hypertension. More severe hypertension, stage 2 hypertension is a systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher. Hypertensive Emergency/Urgency Hypertensive crisis or malignant hypertension is def ined as an extremely high SBP and/or DBP according to JNC -7. Hypertensive was not addressed by JNC 8 guidelines. Hypertensive crisis is further divided into two catagories based upon evidence of target organ damage. If end organg damage is present, the condition is classified as hypertensive ermergency. Hypertensive crisis without evidence of organ damage is classified as hypertensive urgency. In hypertensive emergencies, the therapeutic goal is to protect remaing end organ functi on, reduce risk of co mplications, and improve outcomes. 3. Non-Black: Thiazide -type diuretic or ARB or ACE alone or in combo Black: Thiazide -type diuretic or CCB or in combo All Races with DM or CKD: ACE or ARB or combo with other *(Do not mix ACE w. ARB) Primary affect 95% of adults causes unknown contributing factors are environmental and genetic Secondary 5% of all hypertension. Causes chronic kidney disease, renovascular hypertension, hyperparathyroidism comma and primary aldosteronism. Idiopathi c has no identified cause Pg.270 Hypertension crisis or malignant hypertension is defined as an extremely elevated systolic blood pressure and or diastolic blood pressure. Hypertensive emergency is when there is end organ damage present. Avoid droppin g the blood pressure too fast it may result in an increase in organ damage Hypertensive crisis without organ damage is a hypertensive urgency usually due to noncompliance or inadequate treatment 3. DOC for hypertension based upon selected pop ulations, including races, diabetics, specified medical diagnoses, pregnancy, etc. pg.269 -270 Geriatrics if choosing a beta blocker for HTN than nebivolol and carvedilol are the most frequently used. If isolated hypertension is present start wit h the diuretics and calcium channel blockers may be used. Pregnancy methyldopa for pregnant woman with hypertension is most frequently used. Black population chlorthalidone and amlodipine are drugs of choice, and more receptive to monotherapy diuretics. Alpha blockers should not be used as initial treatment. Example; ace inhibitors causing angioedema. Diabetics RAAs beta blockers, diuretics , calcium channel blockers, ace inhibitors, a ARBs are the recommended treatment. ACE and AR Bs are the cornerstone of therapy for diabetics 4. Know how grapefruit may interact with the CYP 450 system and how it may affect the potency of certain medications such as antibiotics, calcium channel blockers and Alzheimer's drugs . Pg.42 Box 3.2 -Grapefruit juice increases the potency of: -benzos ( xanax, kolnopin, Librium, valium, Ativan, tranxene , triazolam ) -midazolam (versed) -dihydropyridine calcium channel blockers ( amlodipine, felodipine, nifedipine, nisoldipine, nitrendipine, verapamil ) -lovastatin ( cholesterol)
2). Secondary hypertension should be suspected in patients in whom hypertension develops at an early age or after the age of 50 years, and in those previously well controlled who become refractory to treatment. Hypertension resistant to three medications is another clue, although multiple medications are usually required to control hypertension in persons with diabetes. Secondary causes include CKD,genetic syndromes; kidney disease; renal vascular disease; primary hyperaldosteronism; Cushing syndrome; pheochromocytoma; coarctation of the aorta and hypertension associated with pregnancy, estrogen use, hypercalcemia, and medications · Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 130 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg. · Stage 2 hypertension. More severe hypertension, stage 2 hypertension is a systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher. Hypertensive Emergency/Urgency Hypertensive crisis or malignant hypertension is def ined as an extremely high SBP and/or DBP according to JNC -7. Hypertensive was not addressed by JNC 8 guidelines. Hypertensive crisis is further divided into two catagories based upon evidence of target organ damage. If end organg damage is present, the condition is classified as hypertensive ermergency. Hypertensive crisis without evidence of organ damage is classified as hypertensive urgency. In hypertensive emergencies, the therapeutic goal is to protect remaing end organ functi on, reduce risk of co mplications, and improve outcomes. 3. Non-Black: Thiazide -type diuretic or ARB or ACE alone or in combo Black: Thiazide -type diuretic or CCB or in combo All Races with DM or CKD: ACE or ARB or combo with other *(Do not mix ACE w. ARB) Primary affect 95% of adults causes unknown contributing factors are environmental and genetic Secondary 5% of all hypertension. Causes chronic kidney disease, renovascular hypertension, hyperparathyroidism comma and primary aldosteronism. Idiopathi c has no identified cause Pg.270 Hypertension crisis or malignant hypertension is defined as an extremely elevated systolic blood pressure and or diastolic blood pressure. Hypertensive emergency is when there is end organ damage present. Avoid droppin g the blood pressure too fast it may result in an increase in organ damage Hypertensive crisis without organ damage is a hypertensive urgency usually due to noncompliance or inadequate treatment 3. DOC for hypertension based upon selected pop ulations, including races, diabetics, specified medical diagnoses, pregnancy, etc. pg.269 -270 Geriatrics if choosing a beta blocker for HTN than nebivolol and carvedilol are the most frequently used. If isolated hypertension is present start wit h the diuretics and calcium channel blockers may be used. Pregnancy methyldopa for pregnant woman with hypertension is most frequently used. Black population chlorthalidone and amlodipine are drugs of choice, and more receptive to monotherapy diuretics. Alpha blockers should not be used as initial treatment. Example; ace inhibitors causing angioedema. Diabetics RAAs beta blockers, diuretics , calcium channel blockers, ace inhibitors, a ARBs are the recommended treatment. ACE and AR Bs are the cornerstone of therapy for diabetics 4. Know how grapefruit may interact with the CYP 450 system and how it may affect the potency of certain medications such as antibiotics, calcium channel blockers and Alzheimer's drugs . Pg.42 Box 3.2 -Grapefruit juice increases the potency of: -benzos ( xanax, kolnopin, Librium, valium, Ativan, tranxene , triazolam ) -midazolam (versed) -dihydropyridine calcium channel blockers ( amlodipine, felodipine, nifedipine, nisoldipine, nitrendipine, verapamil ) -lovastatin ( cholesterol)
