buletin farmasi 06/2013

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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


2/12

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.


3/12

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


4/12

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


5/12

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


8/12

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


9/12

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


10/12

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)


11/12

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


12/12

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

buletin farmasi 06/2013

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