HEALTH PROFESSIONALS

Pharmacology for Health Professionals





Pharmacology for Health Professionals

Name Student no

1. Mrs B. Luv is a 46 year old female of average height. She weighs 97 kg. She has recently been found to have a blood pressure of 159/98 mmHg and is pre-diabetic (impaired glucose tolerance - the stage before diabetes). Her nurse practitioner has advised her to make some lifestyle changes to reduce her blood pressure.

Briefly describe the lifestyle changes that can be used to reduce blood pressure?

If Mrs B. Luv have prehypertension — between 120/80 millimeters of mercury (mm Hg) and 139/89 mm Hg — or high blood pressure — 159/98 mm Hg or higher —I would suggest her try to get it under control with lifestyle changes before trying blood pressure medications. And even if she is on high medications, lifestyle changes can help in the effort to lower blood pressure, keep you healthy, and possibly reduce the amount of medication you need.

The following lifestyle changes can help reduce the pressure in your arteries: Maintain a healthy weight, Reduce your sodium intake, Limit alcohol intake, and smoking quit. 

Unfortunately, Mrs Luv only makes a minor attempt to decrease her blood pressure with lifestyle modification. Several successive visits over six months to the nurse practitioner have seen little reduction in blood pressure. The nurse practitioner believes it is in Mrs Luv's best interest to start antihypertensive treatment. The GP prescribed hydrochlorothiazide for Mrs Luv.

Unfortunately, Mrs Luv only makes a minor attempt to decrease her blood pressure with lifestyle modification. Several successive visits over six months to the nurse practitioner have seen little reduction in blood pressure. The nurse practitioner believes it is in Mrs Luv's best interest to start antihypertensive treatment. The GP prescribed hydrochlorothiazide for Mrs Luv.

What is the mechanism of action of hydrochlorothiazide? (2 marks)

Hydrochlorothiazide significantly diminishes blood pressure in rats with DCA hypertension. Infusion with hypertonic saline or dextrose failed to reverse the blood pressure effects of hydrochlorothiazide. Infusion of hypotonic saline failed to restore blood pressure to the levels of hypertension in untreated controls in one experiment but tended to do so in another. There was no significant diminution of the inulin space accompanying the hypotensive action of hydrochlorothiazide, nor any relation between the expansion of the extracellular and cardiovascular volumes by various infusions and their effects on blood pressures of thiazide-treated rats (Shinde, 2008). Plasma or extracellular fluid volume alteration was, therefore, not the primary action of hydrochlorothiazide in these rats. Analyses of the composition of plasma, aorta, stomach muscle, psoas muscle, or left ventricle did not support the theory that hydrochlorothiazide acts by decreasing the concentration of intracellular sodium or increasing the ratio of extracellular to intracellular sodium. Changes in composition of the left ventricle suggested that alterations in its function may have influenced some of the blood pressure changes noted. It is suggested that attention should be paid to the action of hydrochlorothiazide on other constituents in vascular and cardiac muscle.

Unfortunately Mrs Luv becomes hypokalemic when taking ...