Please enable JavaScript.

Coggle requires JavaScript to display documents.

Uncontrolled hypertension, HTN PBL - Coggle Diagram

- - - - Test daily to monitor
        
        Wrist Blood Pressure Monitor
        
        Bluetooth Blood Pressure Monitor
- - - - CO2- borderline high (23-29 mEq/L)
        
        BUN- borderline high (6-24 mg/dL)
        
        SCr- Adult men, high (0.74-1.35 mg/dL)
        
        Glucose- high (100-125 mg/dL)
        
        Hgb- low, male (14.0-18.0 g/dL)
    - - HDL- low (>60 mg/dL)
        
        SPIROMETRY
        
        FVC-adults, low (80-100%)
        FEV1- low (80-120%)
      - LDL- low (125-200 mg/dL)
    - - hydrochlorothiazide and triamterene
        
        oral, tablets
        
        25 mg/day for hydrochlorothiazide
        
        37.5 mg/day triamterene
        
        diuretics (water-pills)
        
        used in combinations causes hyponatremia
        
        by urination frequently (excrete salt & water in body)
        
        Allopurinol
        
        patient still having hyperuricemia
        
        hydrochlorothiazide increase uric acid level
        
        Diuretics can increase risk of hyperuricemia, a type of arthritis caused by the buildup of uric acid crystals in a joint.
        
        This may happen because diuretics increase urination, which reduces the amount of fluid in body.
        
        Cause the remaining fluid is more concentrated, which can increase the risk develop crystals
        
        Carvedilol
        
        beta blockers
        
        agents that inducing hyperglycaemia
        
        by impairing the release of insulin from the pancreatic β-cell.
        
        Carvedilol worsens the existing hyperglycaemia in diabetics and prediabetics
        
        hydrochlorothiazide with hyperglycemia
        
        diuretics that promote hyperglycemia
        
        thiazide diuretics are postulated to down-regulate peroxisome proliferator-activated receptor gamma, thereby decreasing insulin release in addition to activating the reninangiotensin-aldosterone system, thus resulting in elevated levels of aldosterone and resulting hyperglycemia.
        
        naproxen with hemolytic anemia
        
        NSAIDs drug
        
        cause low levels of hemoglobin in red blood cells
- - - - The body produces enough insulin in this condition, but the cells in the body have become resistant to insulin's beneficial effects
      - When the ER is overburdened with nutrients, it sends an alarm signal to the cell, instructing it to turn off the insulin receptors on the cell surface.
      - Obesity and physical inactivity are both dependent risk factors for type 2 diabetes
    - - A family history of diabetes is linked to a variety of metabolic abnormalities and is a powerful predictor of type 2 diabetes (T2D) development
      - increased risk of T2D is most likely mediated in part by both genetic and shared environmental factors among family
    - - Black people are an ethnic group with a high risk of diabetes, according to the Diabetes Association.
      - Black people have a 1.4- to 2.3-fold higher prevalence of type 2 diabetes
      - Black people endure a disproportionate burden of diabetes-related illness and mortality.
    - - More over a quarter of the world's population over the age of 60 has diabetes, and the global population's ageing is a major cause of the diabetes epidemic.
      - Diabetes in older persons is connected to higher mortality
    - - Having blood pressure over 140/90 mm Hg may increase our risk of developing diabetes and other health complications.
  - - - You're more prone to have heart disease or a stroke if you have diabetes.
    - - The filtering system of the kidneys can be harmed by diabetes
    - - Diabetic retinopathy causes damage to the blood vessels in the retina, which can lead to blindness
    - - Damage to the nerves (neuropathy). Sugar in excess can harm the walls of the tiny blood arteries (capillaries) that nourish your nerves, particularly in your legs.
    - - Foot nerve injury or inadequate blood flow increases the risk of a variety of foot problems.
  - - - Insulin glargine
        
        Insulin glargine comes only as an injectable solution.
        
        Insulin glargine injectable solution is used to control high blood sugar (hyperglycemia) in people type 2 diabetes.
        
        Side effects : weight gain
      - Insulin lispro
        
        Insulin lispro is a fast-acting injectable product that is used to treat type 2 diabetes patients who require insulin to control their condition.
        
        Insulin lispro injections operate by replacing the insulin that the body normally produces and by assisting in the movement of sugar from the bloodstream to other body tissues
        
        Side effects : low blood sugar
    - - Hydrochlorothiazide & Insulin lispro / Insulin Glargine
      - Albuterol & Insulin lispro / Insulin Glargine
      - Mucinex & Insulin Lispro
    - - Insulin glargine is continued with a lower dose together with oral antidiabetics and gradually withdrawn with only oral antidiabetic as treatment. .
  - - - Biguanides
        
        Only drug in this class is metformin
        
        Metformin helps insulin to work better
        
        Doesn't cause weight gain
        
        Comes in two forms, immediate-release pills and extended-release pills
        
        Suggested to start with a low dose
      - Thiazolidinediones
        
        Works by lowering insulin resistance
        
        Makes body to produce new fat cells
        
        Drugs : Pioglitazone and Rosiglitazone
    - - Medicine
        
        How to take, when to take, frequency
        
        Possible side effects of the medicine
      - Diet
        
        Avoid missing meals and it should be synchronised with time actions of medicines
        
        Total calories must be calculated based on patient's needs
      - Physical activity
        
        Improves blood glucose control, lowers cardiovascular disease and contributes to weight loss
      - Weight management
        
        5-10% weight loss from initial body weight over a 6 month period is recommended for overweight/ obese patients
      - Enough sleep
        
        Sleep approximately 7 hours per night to maintain energy level and well-being
      - Monitor
        
        Self-monitor blood sugar level at home
        
        Any symptoms
      - Keep up appointments
- - - - -Albuterol
        -Fluticasone/salmeterol
    - - Tiotropium DPI 18 mcg, one capsule inhaled daily
        
        Mucinex D® two tablets Q 12 H PRN cough/congestion
    - - Tiotropium
      - Fluticasone/salmeterol
      - Mucinex D®
      - Albuterol
    - - albuterol + salmeterol albuterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate.
  - - - ipratropium bromide
        
        Albuterol and Fluticasone/salmeterol can be replace with ipratropium bromide in this patient as it work better than the other drug to prevent or relieve the wheezing, shortness of breath, coughing, and chest tightness caused by lung disease
    - - Patient with copd should be informed of their side effects and the complications that they can have in future , and should be counseled about effective ways to lower their risk.
      - Diet
        
        Eat a good source of protein
        
        maintain strong respiratory muscles
      - Physical activity
        
        walking around the house
        
        make the heart and lungs to use oxygen more efficiently
        
        make the muscles stronger
        
        simple cardio
        
        stretching exercises
      - educated on the proper way to sleep
        
        should be sleeping in a slightly upright position to help take some stress off their lungs so its easy for them to breathe.
- - - - Diabetes affects more than 34 million individuals worldwide, and diabetes is responsible for about half of all kidney failure occurrences.
      - kidneys cannot be repaired after they have been damaged by diabetes.
    - - Blood travels through these blood arteries with a lot of force when you have high blood pressure. This can induce kidney disease by causing damage to these blood vessels
      - When your kidneys are damaged by high blood pressure, they are unable to control your blood pressure effectively.
    - - Being over age 60 increases your risk for kidney disease. As you get older, your kidneys naturally do not work as well as when you were younger
    - - People who smoke and drink heavily have a five-fold increased risk of getting CKD than those who do not smoke or drink excessively.
- - - - there is too much uric acid in the body. The body makes uric acid when it breaks down purines, which are found in your body and the foods you eat
  - - - patient uric acid level is 6.7mg/dL., patient is a male highlighted in the case.
    - - patient having 27.2 BMI reading, due to the height 6 feet 2 inch and 95kg
    - - patient have a hypertension with reading 162/90 consider high
  - - - Naproxen with hydrochlorothiazide, combination drink plenty of water. Blood pressure and kidney function should be monitored as well.
      - Carvedilol, Combining these medications may reduce the effects of carvedilol in lowering blood pressure and slower heart rate.
      - Doxazosin , no interaction
      - insulin glargine and lispro , no interaction
      - mucinex D , no interaction
        
        Albuterol HFA MDI, no interaction
        
        Tiotropium DPI no interaction
        
        Fluticasone/salmeterol , no interaction
    - - 16 major drug interactions
      - Hydrochlorothiazide cant be given with allopurinol because Combining these medications may increase the risk of severe allergic reactions and infections. Develop shortness of breath; throat tightness, swelling of the face, lips, or tongue, itching, rash, fever; and/or muscle pain or weakness.
      - 15 minor drug interactions
- - - - Low : HDL, ClCr
      - Normal : Na, Ca, K, Mg, Cl, Total Cholesterol, LDL. BUN, Glucose and Uric acid
      - High : TG, SCr,
  - - - Difficulty urinating
    - - Recovering cold
        
        Shortness of breath
        
        Two COPD exarbation
        
        Occasional gout pain
      - Agreed having Left ventricular hyperthropy