Hypertension COPD with

Nonselective 8-blockers should be avoided in hypertensive patients with asthma, chronic obstructive pulmonary disease (COPD), and peripheral vascular disease. //3-Blockers (carvedilol and labetalol) will not result in unopposed a constriction like pure -blockers can and may be used in peripheral arterial disease. However, similar to nonselective 8-blockers, they should be avoided in patients with asthma and COPD. If a hypertensive patient with mild to moderate asthma or COPD requires a 8-blocker to treat a compelling indication, a 8i-selective agent should be selected, and the lowest effective dose should be used. ... 

During COPD, the following symptoms occur, usually in the order mucus hypersecretion, ciliary dysfunction, airflow limitation, pulmonary hyperinflation, gas exchange abnormalities, pulmonary hypertension and cor pulmonale. Acute exacerbations appear to be mainly triggered by bacteria, viruses or environmental pollutants. They lead to a worsening of lung functions, wasting and increased mortality their psychosocial impacts include depression and anxiety that may be associated with the will to die. 

Pulmonary hypertension develops late in the course of COPD, usually after the development of severe hypoxemia. It is the most common cardiovascular complication of COPD and can result in cor pulmonale, or right-sided heart failure. Hypoxemia plays the primary role in the development of pulmonary hypertension by causing vasoconstriction of the pulmonary arteries and by promoting vessel wall remodeling. Destruction of the pulmonary capillary bed by emphysema further contributes by increasing the pressure required to perfuse the pulmonary vascular bed. Cor pulmonale is associated with venous stasis and thrombosis that may result in pulmonary embolism. Another important systemic effect is the progressive loss of skeletal muscle mass, which contributes to exercise limitations and declining health status. 

Significant for COPD (poorly controlled), GERD (controlled with PPIs), and moderate hypertension... 

The pharmacists of Care-Rite Pharmacy also developed patient educational tools to be used during the patient assessment and patient education components of the Pharmacy Check-up Service. Because many of the targeted patients have similar medical conditions, education materials were developed for specific disease states, including hypertension, ischemic heart disease, diabetes, asthma, chronic obstructive pulmonary disease (COPD), etc. Also, educational materials were developed for certain therapeutic classes of medications. The Care-Rite pharmacists also determined that many patients needed individualized education materials, so they implemented a drug information/educational service as part of the MTM service. With this service, patients can ask questions regarding their medical conditions and/or drug therapies. The pharmacists will research and provide an individualized written response for each patient. 

Caution Hyperthyroidism, hepatic or renal disease, hypertension, tachyarrhythmias, CHF, coronary artery disease, gastric ulcer, esophageal reflux or hiatal hernia associated with reflux esophagitis, infants, elderly persons, systemic administration in those with COPD... 

Atenolol, betaxolol, bisoprolol, and metoprolol are cardioselective /3 -blockers. Therefore, they are safer than nonselective fi -blockers in patients with asthma, COPD, peripheral arterial disease, and diabetes who have a compeUing indication for a /6-blocker. However, cardioselectivity is a dose-dependent phenomenon. At higher doses, cardioselective agents lose their relative selectivity for /6i-receptors and block /32-receptors as effectively as they block /6i-receptors. The dose at which cardioselectivity is lost varies from patient to patient. In general, cardioselective /6-blockers are preferred when using a /3-blocker to treat hypertension. 

In contrast, hypnotic doses of benzodiazepines may worsen sleep-related breathing disorders by adversely affecting control of the upper airway muscles or by decreasing the ventilatory response to CO2. The latter effect may cause hypoventilation and hypoxemia in some patients with severe COPD, although benzodiazepines may improve sleep and sleep structure in some instances. In patients with obstructive sleep apnea (OSA), hypnotic doses of benzodiazepines may exaggerate the impact of apneic episodes on alveolar hypoxia, pulmonary hypertension, and cardiac ventricular load. Caution should be exercised with patients who snore regularly partial airway obstruction may be converted to OSA under the influence of these drugs. 

Guanethidine (e.g., Esimel) Sequestered into adrenergic nerve endings. Initially releases norepinephrine (increase BP and HR). Then depletes norepinephrine from terminal and interferes with release. Reflex tachycardia is then impossible because of depletion of norepinephrine. Severe hypertension when other agents fail. Rarely used. Initial increase in neart rate and blood pressure (due to release of norepinephrine). Resting and orthostatic hypotension. Bradycardia, decreased cardiac output, dyspnea in COPD patients, severe nasal congestion. No depression (poor CNS penetration)... 

Placebo-controlled studies In a randomized placebo-controlled trial of bosentan in 30 patients with severe chronic obstructive pulmonary disease (COPD) without evidence of severe pulmonary hypertension at rest there was no evidence of improved exercise capacity in fact, hypoxemia and functional status deteriorated [84 ]. 

Sudden, unexpected death is usually classified as cardiac in etiology, assumed to be due to ischemic heart disease or an arrhythmia. Death Irom asphyxia caused by acute bronchospasm could be erroneously classified as a cardiac cause of death. In addition, exacerbations of COPD can precipitate cardiac arrhythmias or myocardial infarction in patients with significant underlying heart disease (6,42). Severe COPD is often complicated by cor pulmonale, or chronic failure of the right ventricle caused by pulmonary hypertension and hypoxemia. Deaths caused by cor pulmonale may be misclassified as primary cardiac deaths, although the precipitating event may be a pulmonary insult. 

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