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Medication Reconciliation Is a Window into “Ordinary” Work
Published in Philip J. Smith, Robert R. Hoffman, Cognitive Systems Engineering, 2018
Example 2: A clinician in the orthopedic clinic is reviewing the medical record for a 55-year-old patient, a former college football player, who has come to discuss a possible knee replacement. The medical record indicates that, along with pain medications and a cholesterol-lowering drug, the patient has been prescribed an antihypertensive, that is, a medicine that reduces blood pressure. High blood pressure is common and patients commonly receive medication for its control. The clinician infers from this information that this patient has hypertension (high blood pressure). Like all medical records, this patient’s chart (actually a series of windows appearing on a computer display) contains a problem list showing the active medical conditions the patient is known to have. Most of these are not significantly related to the purpose of the clinic visit but the clinician notes that hypertension is not listed there. Reviewing the problem list further, the clinician finds the initials “BPH.” This is a common abbreviation for benign prostatic hyperplasia, a prostate enlargement condition that is common in men over age 50. BPH can make urination difficult. Returning to the medication list, the clinician notes that the antihypertensive medication is listed as “Hytrin.” Hytrin is a registered trademark name for the generic medicine terazosin. Terazosin is an antihypertensive medication but it also is used in the treatment of BPH. The clinician concludes that the patient is taking terazosin for benign prostatic hyperplasia rather than for hypertension.
Occurrence of Transformation Products of Pharmaceutical and Personal Care Products in the Aquatic Environment
Published in Leo M. L. Nollet, Dimitra A. Lambropoulou, Chromatographic Analysis of the Environment, 2017
Myrsini Papageorgiou, Eleni Evgenidou, Dimitra A. Lambropoulou
The antihypertensive drugs are used to treat high blood pressure. Valsartan and enalapril have been detected in WWTPs worldwide (Huerta-Fontela et al., 2010; López-Serna et al., 2010; Salgado et al., 2010; Gros et al., 2012; Verlicchi et al., 2012a; Cruz-Morató et al., 2014; Jelic et al., 2015; Kostich et al., 2014; Petrović et al., 2014; Acuña et al., 2015; Moreno-González et al., 2015). Kern et al. (2010) reported that during activated sludge treatment, valsartan undergoes a series of sequential transformations. Firstly, the oxidative dealkylation of valsartan takes place followed by the hydrolysis of the dealkylated valsartan, giving rise to the amino-valsartan, which is finally oxidized to 2-(2H-tetrazol-5-yl)-[1,1-biphenyl]-4-carboxylic acid, referred to as valsartan acid (VALA). The latter appears to be the most stable of the three TPs. VALA was detected in the influents (up to 320 ng L−1) and in the effluents (up to 1053 ng L−1) of WWTPs in Germany and Switzerland (Kern et al., 2010; Nödler et al., 2013). Kern et al. (2010) reported that when 80% of valsartan was removed during treatment with activated sludge, the concentrations of its TP VALA increased about eightfold from 140 to over 1000 ng L−1 due to the formation of the specific TP during treatment, as aforementioned. However, due to structural similarities, this compound could potentially be formed from selected pharmaceuticals different from valsartan but belonging to the same compound class.
Nanomedicine Therapeutic Approaches to Overcome Hypertension
Published in Sarwar Beg, Mahfoozur Rahman, Md. Abul Barkat, Farhan J. Ahmad, Nanomedicine for the Treatment of Disease, 2019
Md. Rizwanullah, Sadaf Jamal Gilani, Mohd Aqil, Syed Sarim Imam
Therefore, cost-effective approaches to optimally control blood pressure are very much needed (Selvam et al., 2010). There are many categories of antihypertensive agents, which lower blood pressure by different means; among the antihypertensive, most important and most widely used are the thiazide diuretics, β-blockers, the ACE inhibitors, calcium channel blockers and angiotensin II receptor antagonists. Most of the antihypertensive drug comes under BCS class II (low solubility and high permeability) which have low bioavailability as dissolution is the rate-limiting step.
Heart rate variability after bariatric surgery: The add-on value of exercise
Published in European Journal of Sport Science, 2023
D. Belzile, A. Auclair, J. Roberge, ME Piché, A. Lebel, M. Pettigrew, S. Marceau, L. Biertho, P. Poirier
The following comorbidities were assessed: 1) hypertension, 2) dyslipidemia, 3) type 2 diabetes, 4) coronary artery disease, and 5) obstructive sleep apnoea. Hypertension status was determined from the patient’s medical record and resolution was defined by the absence of antihypertensive medication and with a resting blood pressure <140/90 mmHg (Auclair et al., 2017). Dyslipidemia was defined by the presence of at least one lipid-lowering drug medication, and resolution was defined by the absence of any lipid-lowering medication post-bariatric surgery (Tardif et al., 2020). Diabetes baseline status was determined from the patient’s biochemistry and medical record in accordance with the American Diabetes Association guidelines. Diabetes remission was defined as fasting blood glucose <5.6 mmol/L and a HbA1c <6.0% in the absence of pharmacological treatment (Buse et al., 2009). Coronary artery disease was characterised by a history of myocardial infarction or revascularization. The presence of obstructive sleep apnoea was based on an abnormal polysomnography evaluation according to the American Academy of Sleep Medicine guidelines (Epstein et al., 2009). It was characterised by the occurrence of at least 5 obstructive respiratory per hour of sleep. Resolution of obstructive sleep apnoea was defined as an event index below 5 events per hour.
Environmental benign RP-HPLC method for the simultaneous estimation of anti-hypertensive drugs using analytical quality by design
Published in Green Chemistry Letters and Reviews, 2023
Naveenarani Dharuman, Karunanidhi Santhana Lakshmi, Manikandan Krishnan
Benidipine is a long-acting, dihydropyridine calcium channel blocker used as an anti-anginal and anti-hypertensive agent [6]. It is chemically (benidipine, (±)-(R*)−3- [(R*)−1-benzyl-3-piperidyl] methyl-1,4-dihydro-2,6-dimethyl- 4-(m-nitrophenyl)−3,5-pyridine dicarboxylate hydrochloride (Figure 1a). It inhibits L, T, and N-type calcium channels and has a strong vascular selectivity. The drug has anti-oxidant properties and an increase in nitric oxide production. In addition, it shows cardioprotective benefits in patients with ischemic heart disease. It also shows renal protective effects [7]. Chlorthalidone (Figure 1b) is a thiazide type diuretic used exclusively as antihypertensive. It is effective in BP reduction and improving cardiovascular outcomes [8]. The IUPAC name of chlorthalidone is benzenesulfonamide, 2-chloro-5-(2,3-dihydro-1-hydroxy-3-oxo-1H-isoindol-1-yl) [9]. It blocks the sodium-chloride cotransporter in the ascending loop of Henle's distal convoluted tubule [10]. The literature study reveals that few HPLC (High-performance liquid chromatography) techniques were reported for chlorthalidone [11–14], while for benidipine HPLC/UPLC (Ultra performance liquid chromatography) [15] and with the combination of BEN and CHD stability indicating HPLC [16] and RP-HPLC [17] technique has been discussed.
Association between iron exposures and stroke in adults: Results from National Health and Nutrition Examination Survey during 2007-2016 in United States
Published in International Journal of Environmental Health Research, 2022
Jingang Xu, Guofeng Xu, Junkang Fang
Based on the previous literatures on iron status and stroke (Gill et al. 2018; Hu et al. 2019), a wide range of covariates were evaluated in the analysis. The following demographic characteristics were included in this analysis: age (analyzed as continuous variable), gender, race/ethnicity (non-Hispanic White, non-Hispanic Black, and other race), education level (high school or below, above high school) and annual family income ($0–$19,999, 20,000 USD–$34,999, 35,000 USD–$74,999, ≥75,000 USD). Behavioral risk factors included smoking (serum cotinine level), alcohol consumption (having at least 12 alcoholic drinks per year or not) and physical activity (vigorous physical activity, no vigorous activity). The body mass index (BMI) was calculated as weight (kg) divided by height squared in m2 and categorized as under/normal weight (<25 kg/m2), overweight (25–29.9 kg/m2) and obese (≥30 kg/m2). Diabetes was defined according to self-reported diabetes history or glycosylated hemoglobin measurements of ≥6.5%. Participants were classified as having hypertension if he or she was taking antihypertensive medication or had systolic blood pressure ≥130 mmHg, or diastolic blood pressure ≥80 mmHg. High-density lipoprotein (HDL) and total blood cholesterol levels were also adjusted in the analyses. Dietary information on total energy intake was collected from 24-h dietary recall.