buletin farmasi 06/2013
TRANSCRIPT
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ISU BULAN INI:
HYPERTENSION
ISI KANDUNGAN
EDISIJUN
2013
EDISIJUN
2013
EDISIJUN
2013
PKDPASIR
MAS
PKDPASIR
MAS
PKDPASIR
MAS
SIDANG EDITORIAL
PENASIHAT :
NOR AFIFAH RAHIMI
EDITOR
NURUNNUHA MOHD NAWI
PENGARANG
NORUL IZZA AB RAHMAN
WAN HAZNI TUAN AZIZ
ARINA LIANA ISMAIL
MUHAINI ABD HADI
FARAH HANNAN
MOHD MAZELAN
TOPIC PAGE
WHAT IS HYPERTENSION? 2
CHRONIC HYPERTENSION 2
PRE-ECLAMPSIA 3
ECLAMPSIA 4
MEDICATIONS USED IN HYPERTENSION 5 - 7
KUIZ 8
NEWLY HYPERTENSION DRUG IN CLINIC 9
PERGERAKAN KAKITANGAN DI PKD PASIR MAS 9
SEJENAK SEKETIKA DI LUAR 10
QUOTES 11
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High blood pressure is a common condition in which the force of the blood against your artery walls is
high enough that it may eventually cause health problems, such as heart disease.
Blood pressure is determined by the amount of blood your heart pumps and the amount of resistanceto blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the
higher your blood pressure.
You can have high blood pressure (hypertension) for years without any symptoms. Uncontrolled high
blood pressure increases your risk of serious health problems, including heart attack and stroke.
High blood pressure typically develops over many years, and it affects nearly everyone eventually. For-tunately, high blood pressure can be easily detected. And once you know you have high blood pres-
sure, you can work with your doctor to control it.
(source : mayoclinic.com)
is diagnosed when hypertension is confirmed before pregnancy or before 20 weeks gestation(blood pressure >140 mmHg systolic and/or >90 mmHg diastolic).
is frequently diagnosed when high blood pressure fails to resolve post-partum.
Women with chronic hypertension require careful
monitoring during pregnancy as they have an increased risk of adverse events, including superim-
posed pre-eclampsia, placental abruption, fetal growth restriction, premature delivery and still-
birth.
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is defined as:
New onset of hypertension(BP 140/90mmHG) after 20 weeks gesta-
tion.
No other features to suggest pre-eclampsia (no proteinuria)
Normalisation of blood pressure within three months postpartum.
Gestational hypertension is associated with adverse pregnancy out-
comes if it progresses to pre-eclampsia or if hypertension is severe
(170/110 mmHg)
Final diagnosis only made postpartum
Hypertension (140/90 mmHg) with onset after 20 weeks gestation with previously normal BP
Renal manifestations
- Significant proteinuria
- Serum creatinine >90 micromol/L (or renal failure)
- Oliguria
Haematological manifestations
Disseminated intravascular coagulation
Thrombocytopenia
Haemolysis
Hepatic manifestations
Raised serum transaminases
Severe right upper quadrant or epigastric pain
Neurological manifestations
Eclamptic seizure
Hyperreflexia with sustained clonus
Severe headache
Persistent visual disturbances
Stroke
Pulmonary oedema
Fetal growth restriction
Placental abruption
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seizures in woman with pre-eclampsia.
Occurs: 1/3 during pregnancy. 1/3 during labour.1/3 postpartum
Risk factors:
- 1st pregnancy
- History of PE
- Gestational Diabetes Mellitus
- Chronic HPT
- Underlying renal disease
- Obese
- Rhesus incompatibility
Characterized by :
New onset proteinuria (>300mg/24h) in pregnant woman but no proteinuria before 20 weeks
gestation
sudden increase proteinuria or BP
Platelet count
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Medications Starting Dose MaximumDaily Dose
Diuretics
Diuretic drugs increase urine output by the
kidney (i.e., promote diuresis). This is ac-
complished by altering how the kidney han-
dles sodium. If the kidney excretes more
sodium, water excretion will also increase.
Most diuretics produce diuresis by inhibiting
the reabsorption of sodium at different seg-
ments of the renal tubular system.
Chlorothiazide 250 mg od 500 mg od
Hydrochlorothiazide 25 mg od 200 mg odChlorthalidone 50 mg od 200 mg od
Amiloride/
hydrochlorothiazide 5
mg/50 mg
1 tablet od 4 tablet od
Indapamide SR 1.5 mg od 1.5 mg od
Indapamide 2.5 mg od 2.5 mg od
Triamterene/
hydrochlorothiazide
50 mg/25 mg
1 tablet bd 2 tablets bd
Beta-blockers
Beta-blockers decrease arterial blood pres-
sure by reducing cardiac output. Many
forms of hypertension are associated with
an increase in blood volume and cardiac
output. Therefore, reducing cardiac output
by beta-blockade can be an effective treat-
ment for hypertension, especially when
used in conjunction with a diuretic.
Acebutolol 200 mg bd 400 mg bd
Atenolol 50 mg od 100 mg od
Betaxolol 10 mg od 40 mg od
Bisoprolol 5 mg od 10 mg od
Metoprolol 50 mg bd 200 mg bd
Propranolol 40 mg bd 320 mg bd
ACE inhibitors
ACE inhibitors are effective in the treatment
of primary hypertension and hypertension
caused by renal artery stenosis, which
causes renin-dependent hypertension ow-
ing to the increased release of renin by the
kidneys. Reducing angiotensin II formation
leads to arterial and venous dilation, which
reduces arterial and venous pressures. By
reducing the effects of angiotensin II on thekidney, ACE inhibitors cause natriuresis and
diuresis, which decreases blood volume and
cardiac output, thereby lowering arterial
pressure.
Captopril 25 mg bd 50 mg tds
Enalapril 2.5 mg od 20 mg bd
Fosinopri 10 mg od 40 mg od
Lisinopril 5 mg od 80 mg od
Perindopril 2 mg od 8 mg od
Quinapril 2.5 mg od 40 mg bd
Ramipril 2.5 mg od 10 mg odImidapril 2.5 mg od 10 mg od
Angiotensin receptor blockers (ARBs)
ARBs are receptor antagonists that block
type 1 angiotensin II (AT1) receptors on
bloods vessels and other tissues such as the
heart. These receptors are coupled to theGq-protein and IP3 signal transduction path-
way that stimulates vascular smooth muscle
contraction.
Candesartan 8 mg od 16 mg od
Irbesartan 150 mg od 300 mg od
Losartan 50 mg od 300 mg od
Telmisartan 20 mg od 80 mg od
Valsartan 80 mg od 160 mg od
Olmesartan 20 mg od 40 mg od
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-blockers
Newer alpha-blockers used in treating
hypertension are relatively selective 1-
adrenoceptor antagonists. They have
favourable effects on lipid metabolism.
Postural hypotension is a known side
effect, especially at initiation of therapy
Doxazosin 1 mg od 16 mg od
Prazosin 0.5 mg bd 10 mg bd
Terazosin 1 mg od 5 mg od
Combined -blockers
Combined -blockers offer enhanced
neurohormonal blockade.
Labetalol* 100 mg bd 800 mg tds
Carvedilol 12.5 mg od 50 mg od
Medications Starting
Dose
Maximum
Daily Dose
Amlodipine 5 mg od 10 mg odCalcium channel blockers (CCBs)
CCBs decrease systemic vascular resis-
tance by causing vascular smooth mus-
cle relaxation, which lowers arterial
blood pressure. There are 2 major
classes of CCBs. They differ in their rela-tive selectivity toward cardiac versus
vascular L-type calcium channels
Dihydropyridines
Because of their high vascular selectiv-
ity, these drugs are primarily used to
reduce systemic vascular resistance
and arterial pressure, and therefore
are primarily used to treat hyperten-
sion. (ie Amlodipine, Felodipine, Is-
radipine, Lacidipine, Nicardipine,Nifedipine)
Non-dihydropyridines
Verapamil (phenylalkylamine class),
is relatively selective for the myo-
cardium, and is less effective as a
systemic vasodilator drug. This
drug has a very important role in
treating angina (by reducing myo-
cardial oxygen demand and re-
versing coronary vasospasm) andarrhythmias.
Diltiazem (benzothiazepine class) is
intermediate between verapamil
and dihydropyridines in its selec-
tivity for vascular calcium chan-
nels. By having both cardiac de-
pressant and vasodilator actions,
diltiazem is able to reduce arterial
pressure without producing the
same degree of reflex cardiac
stimulation caused by dihydro-
pyridines.
Diltiazem 30 mg tds 60 mg tds
Diltiazem SR 90 mg bd 90 mg bd
Diltiazem R 100-200 mg
od
100-200 mg
od
Felodipine 2.5 mg od 10 mg od
Isradipine 1.5 mg bd 2.5 mg bd
Lacidipine 2 mg od 6 mg od
Lercanidipine 10 mg od 20 mg od
Nicardipine 10 mg tds 20 mg tds
Nifedipine 10 mg tds 30 mg tds
Nifedipine SR 30 mg od 120 mg od
Verapamil 80 mg bd 240 mg tds
Verapamil CR 200 mg od 200 mg bd
* In the elderly, start with 50 mg bd
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EFFECTIVE ANTIHYPERTENSIVE COMBINATION
Effective combina-
tion
Comments
Beta-blockers + diu-
retics
Benefits proven in the elderly, cost-effective. However, may increase
the risk of new onset diabetes.
Beta-blockers +
CCBs
Relatively cheap, appropriate for concurrent CHD
CCBs + ACEIs/ARBs Appropriate for concurrent dyslipidaemias and diabetes mellitus
ACEIs + diuretics Appropriate for concurrent heart failure, diabetes mellitus and stroke
ARBs + diuretics Appropriate for concurrent heart failure and diabetes mellitus
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NON-PHARMACOLOGICAL :
BMI or weight
Salt intake
Alcohol
Exercise
Diet
Smoking
As far as possible aim for an ideal Body Mass Index [Weight(kg)/Height2 (m)] forAsians, the normal range has been proposed to be 18.5 to23.5 kg/m2. However a weight loss as little as 4.5 kgsignificantly reduces BP.
An intake of
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1. Hypertension dikenali sebagai pembunuh senyap kerana
Ia datang tanpa simptom yang nyata
Ia adalah perkataan Greek yang bermaksud pembunuh senyap
Orang dengan hipertension adalah pembunuh
2. Ubatan hipertension boleh dihentikan apabila tekanan darah kembali normal.
Betul
Salah
3. Tekanan darah kurang dari 120/80 dikira tekanan darah normal untuk orang dewasa.
Betul
Salah
4. Diagnosis tekanan darah tinggi selalunya dibuat selepas beberapa kali peningkatan tekanan
darah direkod.
Betul
Salah
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UBAT BARU LIST A/KK DI KLINIK KESIHATAN UNTUK DI-
AGNOSIS HIPERTENSI
Telmisartan/Amlodipine terdapat dalam 2 kekuatan amlodipine:
~ Twynsta 80mg/10mg
~ Twynsta 80mg/5mg
PERGERAKAN ANGGOTA FARMASI
DI PKD PASIR MAS
Jawatan/Gred Nama Dari Ke
Penolong Pegawai Farmasi U29 Azira binti Ahmed
Klinik Kesihatan
Dabong
(PKD Kuala Krai)
Klinik Kesihatan
Kubang Kual
(PKD Pasir Mas)
Penolong Pegawai Farmasi U32
(KUP)
Nik Amnah binti Nik
Idris
Klinik Kesihatan
Penambang
(PKD Kota Bharu)
Klinik Kesihatan
Meranti
(PKD Pasir Mas)
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S ejenak S eketika D i L uar
POLITIK
Remaja hipertensi pintar?KESIH
ATAN
TEKANAN darah tinggi atau hipertensi bukan sahaja
dialami oleh golongan dewasa bahkan remaja.Namun,
remaja yang menghidap penyakit ini didakwa lebih bijak
serta pintar di sekolah berbanding rakan sebaya yang
normal.
Ini berdasarkan penyelidikan sekumpulan pakar pe-
rubatan di Universiti Gottingen, Jerman terhadap 7,688
remaja lelaki dan wanita yang berusia antara 11 hingga
17 tahun. Sebanyak 11 peratus responden menderita
tekanan darah tinggi.
EKON
OMI
Harga emas jatuh
DUNIA
Pihak berkuasa di beberapa negara Asia mengetatkan saringan terhadap pelan-
cong dari China dalam usaha mengekang penyebaran virus selesema burung
H7N9 di negara masing-masing. Sehingga Mei, H7N9 telah menjangkiti 109
orang di China sejak virus itu mula dikesan pada Mac lalu dengan 23 orang
maut. dan penyakit maut itu telah menjangkiti seorang warga Taiwan.
Susulan perkembangan tersebut, pihak berkuasa Taiwan memberitahu, mereka
akan melakukan ujian kesihatan ke atas pelancong di pintu masuk lapanganterbang yang menunjukkan simptom seperti panas badan atau demam.
Pihak berkuasa Vietnam mula menyaring suhu badan penumpang di lapangan terbang negara itu manakala kerajaan Jepun
akan membenarkan pihak berkuasa lapangan terbang dan pelabuhan memeriksa suhu badan pelawat dari China bermula
bulan depan.
Di Thailand, Menteri Kesihatan Pradit Sintawanarong berkata, negara itu perlu meningkatkan langkah berjaga-jaga dengan
pelan menangani wabak itu akan diserahkan kepada Perdana Menteri Yingluck Shinawatra tidak lama lagi. "Berdasarkan
pemerhatian kami, terdapat risiko virus H7N9 merebak ke Thailand," kata Sintawanarong.
Dalam pada itu, di Singapura, institusi-institusi kesihatan di pulau tersebut kini diletakkan dalam keadaan siapsiaga ber-
hubung penularan wabak H7N9.
Langkah tersebut dilaksanakan sehari selepas seorang pakar Pertubuhan Kesihatan Sedunia menyatakan, virus H7N9 meru-
pakan virus selesema burung yang paling berisiko membawa maut kepada manusia.
Setakat ini, jangkitan virus berbahaya itu dilaporkan berpunca daripada unggas yang sakit manakala saintis-saintis semakin
Asia berjaga-jaga penularan selesema H7N9
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The existing body of evidence ... favors
t h e n o t i o n t h a t p o t a s s i u m
supplementation should be considered as
part of recommendations for prevention
and treatment of hypertension.
PAUL WHELTON
Treatment doesn't bring back the risk to that of
someone without hypertension, ... High blood
pressure raises the risk threefold and treatment
reduces it by 25 percent.
Walter Willett