Najla Ahmed

1
Presented By

• Najla Ahmed
• Mariam Juma
• Hissa Sultan
• Asma Ahmed

Clinical Pharmacology
Urogenital Module Case I
2
The Case

• CC A 59-year-old male visits his family doctor
  for a routine check-up. He states that he is
  feeling as new. On repeated questioning he
  complains of occasional shortness of breath (SOB)
  on exercise.

What are the causes of shortness of breath???
3
The Case

• Physical exam (PE) Vital Signs (VS)
• Height169 cm
• Weight 92 kg
• RR 175 / 95 mmHg
• HR 96 beats/min

Diagnosis???
4
Hypertension
Definition of hypertension High blood
pressure? transitory or sustained elevation of
systemic arterial blood pressure to a level
likely to induce cardiovascular damage or other
adverse consequences ( 140 / 90 mmHg )
5
Hypertension
Blood Pressure Classification
List forms/causes of hypertension???
6
Hypertension
Essential hypertension (primary)

• Genetic factors
• Fetal
• Environmental
• Humoral
• Insulin resistance

lower birth weight ? higher blood pressure
obesity, alcohol , sodium intake, stress
autonomic nervous system, renin-angiotensin, ANP
7
Hypertension
Secondary Hypertension

• Renal 80
• Endocrine
• Cardiovascular
• Drugs
• Pregnancy

Diabetic nephropathy, chronic glomerulonephritis,
chronic tubulointerstitial nephritis,
Conns, CAH, phaeochromocytoma, cushings,
acromegaly
Coarctation of the aorta
OCP, steroids, carbenoxolone, vasopressin
1st half of pregnancy ? pre-existing essential
hypertension 2nd half ? pregnancy induced
hypertension that resolve after delivery
8
Hypertension
Malignant Hypertension BP rises rapidly ?
sever hypertension (diastolic blood pressure
140 mmHg)
What is the most common form of hypertension???
9
The Case
A diagnosis of essential hypertension is made.
The family doctor decides to use a diuretic to
treat his condition.
10
The Case
Major classes of diuretics

• Loop diuretics
• Furosemide, Torsemide, Bumetanide,
• Ethacrynic Acid
• Thiazide diuretics
• Chlorothiazide, Hydrochlorothiazide
• Chlorthalidone, Indapamide

11
The Case
Major classes of diuretics (cont.)

• Potassium sparing
• 1. Aldosterone Antagonists
• Spironolactone, Canrenone
• 2. Cycloamidine Derivatives
• Triamteren, Amiloride
• Carboanhydrase Inhibitors
• Acetazolamide
• Xanthine Derivatives
• Caffeine, Theophylline, Theobromine

12
Diuretics
Comparison
13
Diuretics
14
The Case
TREATMENT The family doctor decides to use
Chlorthalidone 25 mg to treat his condition.
15
The Case

• Later
• CC chronic fatigue, muscle weakness, cramps and
  dizziness.
• HPI receiving chlorthalidone 25 mg for Tx of
  essential hypertension for more than one year.
• PE VS
• HR 105
• RR 110/50 standing
• Tilt test
• Skin turgor reduced

• Somnolent
• Muscle weakness ( left right)
• Deep tendon reflexes slow ( left right)

16
The Case

• The requested lab results revealed as

17
The Case

• Immediate treatment

• Would you change his medication????
• Long term treatment
• Chlorthalidone 25 mg potassium oral supplement

• K at discharge was 4.2 mmol/l

18
The Case
10 days later his K 3.2 On repeated questioning
he tells you that he did not like the potassium
supplements so he decided not to take
them. Would you change his medication?
19
The Case
You discharge the patient on Chlorthalidone 25 mg
and Amiloride 10 mg.
20
The Case

• 4 weeks later he presents to AE of the local
  hospital with cardiac dysrhythmias.
• On repeated questioning he tells the admitting
  resident that he took in addition to the
  prescribed medication the potassium oral
  supplements he had at home because he felt that
  it would be a waste of money not to use them. He
  also eats a lot of meats and dates.
• K 6.4 mmol/l

21
Causes of hyperkalemia
The Case

• Pseudohyperkalemia
• Redistribution
• Excessive endogenous potassium load
• Excessive exogenous potassium load
• Diminished potassium excretion
• Laboratory error

22
How to manage hyperkalemia?
The Case
23
Treatment of hyperkalemia
The Case

• Ca2 Gluconate(10 ml)
• InsulinGlucose(20 U soluble insulin50 ml
  glucose)
• Nebulized Salbutamol(2.5mg)
• Polystyrene Sulfonate resin(15g/8hrs)
• Dialysis

24
QUESTION???
A
K
T
N
S
H