Blood Pressure Medication Treatment Options

In the pharmacy, it is not uncommon to have a patient call in for their blood pressure medication refill only to see that they are 1-2 weeks late filling their prescription.  Quite often, when queried about the reason for the late refill, I get one of two answers.
  • “I don’t feel like my blood pressure is high, why do I need to take my medications?”
  • “I don’t like how I feel after I take this medication.”
In answer to the first question, I like to share a plumbing analogy.  Similar to the plumbing system in our house, we have a circulatory system in our body comprised of a pump (our heart), water pipes (our blood vessels), and a faucet (our kidneys and urinary tract).  If the water pressure gets too high in our house, we need to adjust the system to keep the plumbing from breaking down.  Similarly, we have medications that will decrease the amount of fluid the heart pumps, medications that will relax our blood vessels, and medications that will increase the flow of fluid out of our kidneys.  All Three of these mechanisms will decrease our blood pressure; however, your doctor needs to evaluate your entire system to see which mechanism is most appropriate for any given situation.

Simple answer, if high blood pressure is left untreated, the blood vessels will harden and this will eventually lead to a heart attack or a stroke.  Increased blood pressure will damage the vessels that supply the retina with blood and lead to vision problems.  Furthermore, the filtering cells in the kidneys will become damaged and lead to kidney failure.  Lastly, the heart will tire from pumping against the increased pressure and eventually lead to heart failure.

During the first 2-4 weeks of treatment with any blood pressure medication it is a good idea to monitor your blood pressure on a daily basis.  This can be done with your own blood pressure machine, with an automatic machine in a store, or at the doctor's office.  It is recommended that you keep a log of the results and the time of day the reading is taken so that you can pass the information on to your doctor.  Let your doctor know as soon as possible if your blood pressure remains high.

In response to the second question, I like to first find out a few more specifics about what “feeling” is uncomfortable.  In general, medications used to treat high blood pressure may have a tendency to cause some dizziness, light headedness or tiredness.  Different categories of blood pressure medications have their own set of specific side effects.  If a patient feels uncomfortable on one particular category of medication, it is possible that a different category may work just as well at lowering the blood pressure while providing a much more pleasant side effect profile.

Patients do not always realize that they have options.  Quite often, a patient will take their medication, not like how they feel, and then just stop taking the medication.  I regularly encourage folks to engage their health care provider in educated conversations about their medication treatment.  With the intent of helping patients engage their practitioner in an educated discussion about their blood pressure medication, AudibleRxTM has developed Medication Specific Counseling SessionsTM on many of the currently available treatment options.

Following is a brief description of many different blood pressure medication categories and a listing of the medications that currently have counseling sessions available at the AudibleRxTM website.

Angiotensin Converting Enzyme Inhibitors (ACEI’s):  Please follow this link to read the blog about this category of medications.  This category of medication relaxes the pressure on blood vessels which allows the blood to flow more smoothly.

  • Benazepril (Lotensin-TM)
  • Enalapril (Vasotec-TM)
  • Lisiniopril (Prinivil-TM, Zestril-TM)
  • Quinapril (Accupril-TM)
  • Ramipril (Altace-TM)

Angiotensin Receptor Blockers (ARB’s):  Please follow this link to read the blog about this category of medications.  This category of medication relaxes the pressure on blood vessels which allows the blood to flow more smoothly.

  • Candesartan (Atacand-TM)
  • Irbesartan (Avapro-TM)
  • Losartan (Cozar-TM)
  • Olmesartan (Benicar-TM)
  • Valsartan (Diovan-TM)

Beta Blockers:  Please follow this link to read the blog about this category of medications.  This category of medications works to block the body’s natural chemicals that affect blood vessels and the heart.  This medication may decrease blood pressure by relaxing blood vessels, slowing heart rate and decreasing the strain on the heart.

  • Atenolol (Tenormin-TM)
  • Carvedilol (Coreg-TM)
  • Carvedilol (Coreg CR-TM)
  • Metoprolol (Lopressor-TM)
  • Metoprolol XR (Toprol XR-TM)
  • Nadolol (Corgard-TM)
  • Nebivolol (Bystolic-TM)
  • Propranolol (Inderal-TM)   
  • Propranolol LA (Inderal LA-TM)

Calcium Channel Blockers:  Please follow this link to read the blog about this category of medications. This category of medication works by relaxing the blood vessels in both the vascular system and in the heart.  By doing this, the resistance that the heart needs to pump against is decreased, heart rate is decreased, and the heart does not need to work as hard to pump blood.

  • Amlodipine (Norvasc-TM)
  • Diltiazem ER (Cardizem CD-TM, Dilacor XR-TM, Taztia XT-TM and others)
  • Felodipine (Plendil-TM)
  • Isradipine (Dynacirc CR-TM)
  • Nifedipine ER (Procardia XL-TM, Adalat CC-TM, and others)
  • Nisoldipine (Sular-TM)
  • Verapamil SR (Calan SR-TM, Isoptin SR-TM, and others)

Diuretics: Sometimes called water pills, these medications increase the volume of urine eliminated from your body.  Taking a diuretic helps the body rid itself of excess water and salt, thereby, decreasing blood pressure and excess strain on the heart.  
  • Bumetadine (Bumex-TM)
  • Furosemide (Lasix-TM)
  • Hydrochlorathiazide (Esedrix-TM)
  • Metolazone (Zaroxolyn-TM)
  • Torsemide (Demadex-TM)

To learn more about any of the medications listed in this review, please visit AudibleRxTM and register to become a member.  As a member, you will have full access to all of the Medication Specific Counseling SessionsTM for a full five years.

You may also be interested in learning more about:
Heart Rhythm


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Osteoporosis; Plain & Simple

Osteoporosis is a disease of the bone that happens when your body has lost too much bone, is not making enough bone, or both.  When your bones become osteoporotic they have a decreased density or mass and become thin, brittle and weak.  As your bones become less dense, they are much more likely to break. 

Proper nutrition and physical activity are vital during your teens and 20’s so that you may reach your highest potential of bone mass during your 30’s.  It is interesting to note that bone density peaks during your 30’s and begins to slowly decrease after that.  Osteoporosis can be a result of not reaching your peak bone mass during your 30’s and also from an increased bone loss later in life.

The two main factors that contribute to bone loss later in life, in both women and men, are aging and a decrease in estrogen.  Insufficient calcium or vitamin d intake or absorption, as well as a few different concomitant disease states, may contribute to a decrease of bone density at any point along this path. 

Fractures in bone structure from low impact situations, such as falling from a sitting or a standing position, are characteristic of the types of bone breaks you would see with an osteoporotic patient.  Osteoporosis sneaks up on people because they can’t necessarily fell their bones becoming weaker.  Quite often a patient does not even realize they have osteoporosis until they break a bone and then have a follow-up bone density test that shows osteoporosis in their bones. 

If you are over 50, or if you have noticed you have been getting shorter or your upper back is curving forward, please ask your doctor if you should have a bone density test. 


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Insomnia or Sleep Medication Tolerance

As my technician was processing a prescription the other day, she received an error message that indicated the patient she was typing the prescription for had recently filled a similar medication. This particular patient had been taking a sleep medication, and then had a new prescription for a different sleep medication from another physician.  The patient was not available in the store at the time to consult with, so I put in a phone call to the new physician.  I explained the situation; the patient had picked up a different sleep medication from his primary care physician only 5 days ago.  The new physician was unaware of this.

Evidently, the patient had gone to the new physician specifically for his sleep issue.  The new physician thanked me for the call and asked me to put a hold on the new medication until I heard back from him.  He stated that he would call the patient and discuss the process with him.  He let me know that he would be happy to handle the patients sleep medication therapy; however, only if he received all of his sleep medications from one doctor and one pharmacy.  He asked if I would take the time to call the patients primary care physician and explain the situation.  By the end of the day, it was all worked out and we were all on the same page. 

I don’t believe the patient was attempting to withhold any information from the pharmacy or the physician, the problem is that the patient was not sleeping well.  This particular patient had been receiving one particular sleep medication for some time and it had been progressively becoming less and less effective.  He then had an appointment with a sleep specialist who prescribed another medication to help him sleep.  At that point, it didn’t occur to the patient to let the physician know that he had just picked up the other sleep medication 5 days ago and has a full bottle of it at home. 

I appreciate when I have the opportunity to have a counseling session with a patient when it is their first time ever receiving a sleep medication.  We are able to discuss the concept that most sleep medications are indicated for short term treatment of insomnia and not indicated for daily dosing.  I explain that most of the medications used for sleep, with one or two exceptions, are used to help an individual fall asleep quicker, not necessarily keep them asleep longer.  We discuss the fact that if someone takes a sleep medication on a nightly basis for approximately 10 or more nights, the body becomes conditioned to the medication and it will be very difficult to fall asleep the next night without a sleep medication.

Most prescriptions for sleep medications are written to be taken “as needed” for sleep.  The “as needed” portion of the directions is where some reasonable pharmacist counseling should come in.  It is important for a patient to understand that if they want their medication to continue to work for them when they need it, it is a good idea to not take their sleep medication every night.   It is reasonable to use an “as needed” dose for a couple nights to get some good rest, and then try a night or two without the medication.  This “as needed” process helps keep the body from developing a tolerance to the sleep medication.

There are indications where the physician will have their patient take sleep medication on a nightly basis; however, when taken on a nightly basis, it is likely that the patient will develop a tolerance to the medication over time.  As tolerance develops, it will appear that the medication is not working as well and the patient may ask the doctor if they may increase the dose.  An increased dose may then be effective for some length time; however, tolerance may then build up and once again it will appear that the medication is not working as well. 

At this point, the patient may be asking their physician if there is any other medication they may try for sleep, or perhaps they may be referred to a sleep specialist.  For more information on what to do if you are unable to fall asleep at night or if you would like to learn about sleep hygiene, please read this previous blog I wrote about sleep.  If you would like to learn about any of the medications used to help people sleep, please register to becomea member of AudibleRxTM, and then have full access to all of the Medication Specific Counseling SessionsTM for a full five years.


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Life as a Pharmacy Student

As of today, there are approximately 3.1 million RN’s and approximately 950,000 physicians practicing in the United States.  These are staggering numbers when compared to the fewer than 275,000 practicing pharmacists in the United States.  Through the last couple years, pharmacist jobs have appeared to be decreasing; however, based on data from the U.S. Bureau of Labor Statistics, pharmacist jobs will rise at an increased rate of 25% between 2010 and 2020.  This rate is twice the national average.  I believe this is a fantastic and exciting time to be entering into the pharmaceutical world. 

Last summer we had the opportunity to have one of the up and coming pharmacy students work with us for a couple months.  Whitney will soon be starting her final of the Doctorate in Pharmacy program.  She graciously agreed to put down in words a short synopsis of her life as a pharmacy student.   Thank you Whitney for taking the time to share your experience with us.

Life as a pharmacy student. 

As I approach my fourth and final year of pharmacy school, I finally have a moment to breathe and reflect. Born and raised on the west coast, I decided to venture out east to experience a change in culture.  Before I knew it, I found myself in Philadelphia at Thomas Jefferson University School of Pharmacy.  I quickly found myself immersed in a completely foreign culture only to be amplified by the most challenging years of my life.  I had no idea what I was in for three years ago when I began the next chapter in my life but could not be happier that I chose this career path. 

Most people do not realize the variety of career options available to a pharmacist.  There are opportunities in not only retail but also hospital, industry, long-term care, ambulatory care, academia, and contracting are just a few to name.  Pharmacy schools are structured to expose students to as many disciplines as possible guided by the students’ interests.

The first year of school was focused on laying a foundation for the pharmacology to come with courses such as pathophysiology, biochemistry and molecular biology.  This is intended to review undergraduate, prerequisite courses. Students come from a variety of background educations so this enforces the important points necessary to build the appropriate knowledge. Though this was somewhat a review, the amount of detail we were required to learn was far beyond my undergraduate coursework.  I knew school would be challenging, but for me, it was more intense than I would have ever imagined.  Our first year was also focused on basic patient counseling on over-the-counter medications and medication safety. We had at least one exam almost every week and I had no time for anything but school and studying.  We also started our first introductory pharmacy practice experience, or IPPE.  Each semester we are placed at a different pharmacy site for diverse exposure.  My first site was a small, independent retail pharmacy in the middle of downtown Philadelphia.  As first year students, our knowledge was minimal so our initial community rotation is mostly observational.  For the second semester, I was placed at an under served health center where the pharmacist’s role was focused on preventative medicine such as diet, exercise, medication reconciliation and adherence.

For the summer following our first year, we were advised to obtain an intern position at a pharmacy to accumulate hours necessary for our future licenses.  I spent my summer working at Dominican Hospital in Santa Cruz where I worked with pharmacists, technicians and management exposing me to the inter working of a hospital pharmacy.  Here I completed projects, shadowed pharmacists and worked alongside of technicians in both inpatient and outpatient settings.

During our second year, we began applying our basic knowledge of the body’s kinetics and dynamics to pharmacology and therapeutics.  My school was organized by organ systems (eg. Cardiac, pulmonary, etc.) including medication selection, treatment, monitoring and side effects.  We also learned compounding, bio statistics and drug information and literary review.  By the second year, I began to understand what was expected of us, how to effectively study, and manage my time so my life could have a bit more balance.  In addition, we had our ambulatory care and hospital IPPE.  My ambulatory care site was at the Mazzoni Center, which is the city’s largest LGBT wellness center.  This site consisted of a very diverse population of various racial, religious, ethnic and socio-economic statuses.  Here the pharmacist spent time counseling patients on diabetes, warfarin regimens, diet, exercise, and medication adherence.  The following summer I worked at Dominican Hospital to further expand my experience and education.

My third and recently completed year completed the pharmacology and therapeutics of the remaining organ systems including oncology, infectious disease, and psychiatric pharmacotherapy.  We also completed an immunization course as well as sterile product and chemotherapy preparation.  This was our final year of classroom work and felt like the homestretch!  My first IPPE was direct inpatient at Thomas Jefferson University Hospital where I participated in rounds with physicians and residents, interviewed patients and collaborated with the pharmacist on patient’s medication regimen.  During the following semester I was at Friends Hospital, which is an inpatient psychiatric hospital.  There I had the opportunity to spend the day at each unit such as adolescent, geriatric, and intensive adult. I even observed mental health court where both the patient and hospital are represented and sit in front of a judge regarding whether or not a patient can safely be discharged.  Our third year closed with a week long course on pharmacy law and our assignments for the next year’s advanced pharmacy practice experience (APPE). 

I am now about to begin my final year of school consisting of full time experiential rotations. We have six 6-week blocks, each at a different field of pharmacy.  These rotations are intended to give us the opportunity to really dial into what specific area we may want to go into.  I look forward to this year’s exposure and further exploring my options to determine the career that follows.
Whitney Saulsberry, Pharm.D. Candidate, 2014
Thomas Jefferson University School of Pharmacy

Please post your questions or comments for Whitney, in the comment section below.


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MTM and AudibleRx Consumer Medication Information

The other day I received an email from a pharmacist asking how AudilbeRx could be involved in MTM service provision.   Perhaps, before I answer this question, I will take a moment to describe what MTM is all about.

For those of you who are not familiar with the term Medication Therapy Management,   this is a program of drug therapy management that may be furnished by a pharmacist and is designed to assure that the drugs are appropriately used to optimize therapeutic outcome and reduce adverse drug events.  The overall idea is to enhance a patients’ understanding of their medication usage, increase their compliance and adherence to therapy and improve the detection of adverse drug events.

Medication Therapy Management (MTM) was authorized with the passing of the Medicare Modernization Act (MMA) of 2003.  All Medicare Advantage and Medicare Part D prescription medication providers are now required to provide MTM services to their beneficiaries.  These services have been shown to be so effective at lowering overall health care costs that many non-Medicare based prescription drug plans are beginning to pay for this service for their clients.

When a patient is scheduled for their first MTM appointment with a pharmacist, they may expect to receive the most complete Medication Therapy Review counseling session they have ever had.  While the pharmacist and the patient meet they will assess medication therapy to identify medication related problems including clinical, dose, duplication, adherence, treatment, cost and access issues.  The pharmacist then develops a prioritized list of med-related problems and creates a plan to resolve them.

The process continues with the pharmacist creating a comprehensive record of the patient’s medications (Rx & non-Rx) and dietary/herbal supplements.  The patient is educated and empowered to keep it up to date and share it with all of their health care providers.  While at the visit the pharmacist will also, with the patient’s assistance, create an action plan for the patient.  This is a patient centered document, for the patient, containing a list of actions for the patient to use in tracking progress.

At the end of the appointment the pharmacist will then document the visit and follow up with the patients other health care providers to keep them all in the loop.  In this particular model, a patient would receive an annual comprehensive MTM review with a pharmacist that lasts about 45 minutes and additional MTM visits to address new or ongoing medication related problems as identified by the patients physician, another health care provider, or the patient them self.

Two MTM Businesses currently use AudibleRx with their patients.  Here is what they each said at their three month evaluation.

"My client base is comprised mostly of socially and economically disadvantaged people aged 65 years of age and older. vision impairment and poor literacy are common. your shareable audio monographs on my android phone are a perfect answer.
"This has worked well with my current client base and with my future health and wellness utilization in the employer/employee benefits arena as it applies to the PP-ACA in preventative illness and health and wellness initiative along with medication adherence as a wellness benefit for employees in the workplace.

So, how could AudibleRx be incorporated into an MTM program?  Each MTM program includes the development of a patient action plan.  This is the portion of the MTM plan where the patient is empowered to become educated about their therapy and take any specific follow up action as necessary. 

At this point, the pharmacist providing the MTM services would promote the use of AudibleRx to the patient.  AudibleRx is free for consumers.  They simply visit or use the Android, iPhone, or HTML5 Web app.  

The patient would then be responsible for listening to the Consumer Medication Information for each of their medications.  After listening, the patient would have a clear idea of what they do and don’t know about their medications and would be in a position to take educated questions back to their MTM provider.

Collaboration in health care is the process where multiple health care providers work in concert with each other to provide meaningful, useful and cost-effective therapy to patients.  AudibleRx is another tool to utilize in this collaborative health care model.  

Please visit the, and click on the Provider Page to access the licensing agreement.  Currently, a six month FREE TRIAL is available for health care providers wishing to offer AudibleRx to their clients.


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