Posted: May 4th, 2023
Disease Process 1: Hypertension
Power point presentation on both disease processes with focus on pharmacological treatment options, side effects and contraindications of medications, black box warnings. Deliniate between first line treatment options and alternate treatment options.
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Disease Process 1: Hypertension
Hypertension, also known as high blood pressure, is a condition in which the force of the blood against the artery walls is too high. It can lead to serious health problems, such as heart attack, stroke, and kidney failure.
Pharmacological Treatment Options:
There are several classes of drugs used to treat hypertension:
Diuretics: promote urination and reduce fluid volume in the body, such as hydrochlorothiazide and furosemide
Beta-blockers: reduce heart rate and the force of the heart’s contractions, such as metoprolol and atenolol
Calcium channel blockers: relax blood vessels and decrease the heart’s workload, such as amlodipine and diltiazem
Angiotensin-converting enzyme (ACE) inhibitors: relax blood vessels and decrease the production of angiotensin II, a hormone that constricts blood vessels, such as lisinopril and enalapril
Angiotensin receptor blockers (ARBs): block the action of angiotensin II, such as losartan and valsartan
Side Effects and Contraindications:
Diuretics: dehydration, electrolyte imbalance, low blood pressure, kidney problems; contraindicated in patients with severe kidney disease or low potassium levels
Beta-blockers: fatigue, depression, erectile dysfunction, low blood pressure, asthma exacerbation; contraindicated in patients with heart block, heart failure, or severe lung disease
Calcium channel blockers: constipation, dizziness, flushing, headache, ankle swelling; contraindicated in patients with heart block, heart failure, or severe liver disease
ACE inhibitors: cough, dizziness, rash, high potassium levels, kidney problems; contraindicated in patients with a history of angioedema (severe swelling of the face, lips, tongue, or throat) or bilateral renal artery stenosis
ARBs: dizziness, high potassium levels, kidney problems; contraindicated in patients with a history of angioedema or bilateral renal artery stenosis
Black Box Warnings:
ACE inhibitors and ARBs: fetal toxicity when used during pregnancy
First-line Treatment Options:
Diuretics: thiazide diuretics are recommended as first-line therapy for most patients with hypertension
ACE inhibitors, ARBs, and calcium channel blockers are also recommended as first-line therapy for certain patient populations
Alternate Treatment Options:
Beta-blockers may be used as an alternate first-line therapy for patients with certain coexisting conditions, such as angina, heart failure, or a recent heart attack
Combination therapy with two or more drugs from different classes may be necessary for patients with more severe hypertension or comorbidities
Disease Process 2: Type 2 Diabetes
Type 2 diabetes is a chronic condition in which the body becomes resistant to insulin or does not produce enough insulin to regulate blood sugar levels. It can lead to serious health problems, such as heart disease, kidney disease, and nerve damage.
Pharmacological Treatment Options:
There are several classes of drugs used to treat type 2 diabetes:
Metformin: decreases glucose production in the liver and improves insulin sensitivity
Sulfonylureas: stimulate insulin secretion from the pancreas, such as glyburide and gl
DPP-4 inhibitors: increase insulin secretion and decrease glucose production, such as sitagliptin and saxagliptin
GLP-1 receptor agonists: increase insulin secretion, decrease glucose production, and slow stomach emptying, such as liraglutide and dulaglutide
SGLT2 inhibitors: increase glucose excretion in the urine, such as canagliflozin and empagliflozin
Insulin: replaces or supplements the body’s natural insulin, such as regular insulin and long-acting insulin
Side Effects and Contraindications:
Metformin: gastrointestinal upset, lactic acidosis (rare); contraindicated in patients with kidney disease or liver disease
Sulfonylureas: low blood sugar, weight gain; contraindicated in patients with a sulfa allergy or severe liver or kidney disease
DPP-4 inhibitors: upper respiratory tract infection, joint pain; contraindicated in patients with a history of pancreatitis
GLP-1 receptor agonists: nausea, vomiting, diarrhea, injection site reactions; contraindicated in patients with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2
SGLT2 inhibitors: genital and urinary tract infections, dehydration, low blood pressure, increased risk of diabetic ketoacidosis; contraindicated in patients with severe kidney disease or a history of lower limb amputation
Insulin: hypoglycemia, weight gain, injection site reactions; contraindicated in patients with hypoglycemia unawareness or allergy to insulin
Black Box Warnings:
Sulfonylureas: increased risk of cardiovascular mortality
GLP-1 receptor agonists: risk of thyroid C-cell tumors
SGLT2 inhibitors: increased risk of lower limb amputations and bone fractures
First-line Treatment Options:
Metformin is recommended as first-line therapy for most patients with type 2 diabetes
Alternate Treatment Options:
Sulfonylureas, DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT2 inhibitors may be used as alternate first-line therapy for certain patient populations
Combination therapy with two or more drugs from different classes may be necessary for patients with more severe or uncontrolled diabetes
The treatment options for hypertension and type 2 diabetes involve several classes of drugs with different mechanisms of action, side effects, contraindications, and black box warnings. The selection of first-line and alternate treatment options depends on the patient’s individual characteristics, such as age, comorbidities, and medication adherence. It is important for healthcare providers to carefully evaluate each patient’s medical history and risk factors before prescribing any medication and to monitor their response to therapy and adverse effects regularly.
