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957 Block 3 > 5. Hypertension > Flashcards

5. Hypertension Flashcards

1
Q

At what age does the incidence of HTN in women, surpass the incidence in men?

A

65

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2
Q

What gender is more likely to develop HTN?

A

male

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3
Q

As age increases, likelihood of HTN increases. (T/F)

A

True

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4
Q

What race is more likely to develop HTN?

A

African American

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5
Q

What is the cause of primary HTN?

A

unknown

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6
Q

What is the most common etiology of HTN?

A

primary HTN

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7
Q

What are the potential causes of secondary HTN? (7)

A
  • CKD
  • diabetes
  • pheochromocytoma
  • hyper or hypothyroidism
  • Cushing’s disease
  • primary aldosteronism
  • sleep apnea
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8
Q

What tool is used to measure BP?

A

sphygmomanometer

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9
Q

What medications can cause HTN? (8)

A
  • sympathomimetics
  • excess synthroid
  • NSAIDs
  • glucocorticoids
  • oral contraceptives
  • immunosuppressants
  • MAOIs
  • antidepressants
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10
Q

What legal or illegal substances can cause HTN?

A
  • chronic alcohol use
  • nicotine
  • cocaine
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11
Q

In what ways can HTN increase risk for damage to the brain?

A
  • hemorrhage

- stroke

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12
Q

In what ways can HTN increase risk for damage to the eyes?

A

retinopathy

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13
Q

In what ways can HTN increase risk for damage to the heart?

A
  • LV hypertrophy
  • chronic heart disease
  • chronic heart failure
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14
Q

In what ways can HTN increase risk for damage to the vasculature?

A

peripheral artery disease

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15
Q

In what ways can HTN increase risk for damage to the kidneys?

A
  • renal failure

- proteinuria

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16
Q

What is the recommended BMI for patients with HTN?

A

18.5 – 24.9

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17
Q

What modification has the overall greatest reduction in BP?

A

weight loss

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18
Q

What are dietary modifications to reduce BP?

A
  • DASH diet

- sodium restriction

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19
Q

In order to lower BP, what is the recommended amount of NaCl that should be consumed in a day?

A

< 6 g (1 tsp)

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20
Q

What is the exercise recommendation for lowering BP?

A

At least 30 minutes of aerobic activity most days of the week

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21
Q

In order to lower BP, what is the maximum amount of alcohol that can be consumed in one day for males?

A

2

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22
Q

In order to lower BP, what is the maximum amount of alcohol that can be consumed in one day for females?

A

1

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23
Q

What is the pharmacological treatment for prehypertension?

A

none

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24
Q

What is the JNC 8 blood pressure recommendation for patients ≥ 60 years old?

A

< 150/90

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25
Q

What is isolated systolic HTN?

A

systolic BP > 150

diastolic BP < 90

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26
Q

Treatment is recommended for patients who have a SBP > 150 and a DBP < 90. (T/F)

A

True

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27
Q

What is the highest recommended thiazide diuretic?

A

Chlorthalidone

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28
Q

What are the thiazide diuretics used to treat HTN?

A
  • chlorthalidone
  • indapamide
  • HCTZ
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29
Q

At what CrCl are thiazides generally not effective?

A

< 30 ml/min

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30
Q

What are the electrolytes that may be decreased by thiazides?

A

K, Mg, Na

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31
Q

What is the risk of electrolyte depletion?

A

arrhythmias

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32
Q

Combining what other drug with thiazides may help prevent dangerous electrolyte depletion?

A

ACE-I

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33
Q

Why might a thiazide diuretic be combined with triamterene?

A

to prevent dangerous electrolyte depletion

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34
Q

Triamterene has little effect on BP. (T/F)

A

True

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35
Q

What class of medication does triamterene belong to?

A

K sparing diuretic

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36
Q

Thiazides can cause what condition to precipitate in patients who are already at risk?

A

gout

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37
Q

Thiazides can cause hyperglycemia and diabetes. (T/F)

A

True

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38
Q

Patients with a sulfa allergy are contraindicated for any diuretic medications that contain a sulfa group. (T/F)

A

False: only patients who experienced angioedema or anaphylaxis with sulfa drugs are contraindicated

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39
Q

What is the only diuretic that lacks a sulfa group?

A

ethacrynic acid

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40
Q

What is orthostatic hypotension?

A

supine-to-standing BP decrease
> 20 mmHg systolic
> 10 mmHg diastolic

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41
Q

If a patient is experiencing orthostatic hypotension, what medications should that patient avoid if possible?

A
  • diuretics
  • α blockers
  • nitrates
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42
Q

When is it acceptable to increase systolic BP goal to < 160?

A
  • low DBP

- orthostatic hypotension

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43
Q

What are the ACE-I agents most commonly used to treat HTN?

A
  • lisinopril
  • enalapril
  • captopril
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44
Q

What is the only ACE-I or ARB that is IV?

A

enalapril

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45
Q

What is first line for CKD with proteinuria?

A

ACE-I

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46
Q

ACE-I should be discontinued if the BUN and/or SCr levels increase _____% baseline at 6 weeks.

A

> 30%

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47
Q

Concomitant use of what medication with ACE-I can cause increased BUN and SCr?

A

NSAIDs

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48
Q

How should ACE-Is be handled with pregnancy?

A

Avoid use: risk category C/D

49
Q

The incidence of angioedema in __________ patients is greater due to ______ circulating ACE.

A
  • African American

- lower

50
Q

What are the most common ARBs used to treat HTN?

A
  • Losartan
  • Valsartan
  • Irbesartan
51
Q

When might an ARB be a more appropriate therapeutic option than an ACE-I for HTN?

A

In individuals who are intolerant of ACE-I, such as cough.

52
Q

When would an ARB NOT be an appropriate therapeutic alternative to an ACE-I for HTN?

A

angioedema with ACE-I

53
Q

What is the MOA of CCBs?

A

Block voltage-sensitive calcium channels

54
Q

Which CCBs are more cardio-selective?

A

Non-dihydropyridines

  • verapamil
  • diltiazem
55
Q

Which CCBs are more vascular-selective?

A

Dihydropyridines

  • amlodipine
  • felodipine
  • nifedipine
56
Q

CCBs are a common first line therapy option for HTN. (T/F)

A

False

57
Q

In what patients are verapamil and diltiazem contraindicated?

A

heart failure

58
Q

In what patients do CCBs show the most benefit it?

A
  • atrial fibrillation/ flutter
  • angina
  • African Americans
59
Q

What are ADRs of CCBs?

A
  • heart block
  • constipation
  • rash
  • gingival hyperplasia
60
Q

In what populations does Amlodipine show the most benefit?

A
  • diabetics

- African Americans

61
Q

What are ADRs of Amlodipine?

A
  • ankle edema
  • headache
  • postural hypotension
62
Q

In what patients is Nifedipine contraindicated?

A

heart failure

63
Q

In what cases would you need to administer immediate release nifedipine?

A

acute BP reduction

64
Q

What are the 4 main physiologic differences that are present in African Americans?

A
  • stiffer central arteries
  • impaired endothelium-dependent and independent vasodilation
  • less diurnal BP variation
  • salt sensitivity more common and more severe
65
Q

What is the consequence of having stiffer central arteries?

A

Higher central and aortic pressures despite “normal” brachial BP

66
Q

What is the consequence of having impaired endothelium-dependent and independent vasodilation?

A

impaired response to and availability of NO

67
Q

What does it mean to be “salt sensitive”?

A

slower rates of Na excretion and more Na reabsorption

68
Q

What are the 2 medications that are recommended for monotherapy in African Americans?

A
  • thiazide

- dihydropyridine CCB

69
Q

What HTN medication is not recommended in African Americans?

A

ACE-I

70
Q

If target BP is not reached using one medication in African American patient, what is the next recommended option?

A

combine use of thiazide and DHP CCB

71
Q

What is the recommended alternative to ACE-I in African American patients with HF?

A

hydrazine + isosorbide dinitrate

72
Q

Thiazide diuretics increase the risk of _________ in women.

A

hip fracture

73
Q

(Men/Women) are more likely to develop hyponatremia and hypokalemia.

A

women

74
Q

(Men/Women) are more likely to develop cough with ACE-I.

A

Women

75
Q

Dihydropyridines cause LESS edema in (men/women).

A

Men

76
Q

What HTN medications are contraindicated in pregnancy?

A

ACE-I and ARBs

77
Q

What class of diuretics should be avoided in pregnancy and why?

A

thiazides: decreased placental perfusion and less electrolytes for the baby

78
Q

What medication should be started within first 24 hours after STEMI?

A

ACE-I or ARB

79
Q

What is the first line recommended medication for a patient with HTN and angina?

A

β blocker

80
Q

What are the β agents that are recommended for patients with HTN and angina?

A
  • metoprolol

- bisoprolol

81
Q

β blockers are the standard of care for what conditions?

A
  • angina/ coronary artery disease
  • migraine
  • post MI
  • LV dysfunction +/- HF symptoms
  • essential tremor
82
Q

What are the first line therapies for LVD and systolic HF?

A
  • ACE-I or ARB
  • β blocker
  • aldosterone antagonist
83
Q

What are the second line therapies for LVD and systolic HF?

A
  • loop diuretics
  • nitrates
  • hydralazine/isosorbide dinitrate
84
Q

What medications are contraindicated in LVD and systolic HF?

A
  • verapamil/ diltiazem
  • clonidine
  • α blockers
85
Q

To what class does Spironolactone belong?

A

aldosterone receptor antagonist/ K sparing diuretic

86
Q

Spironolactone (does/does not) affect RAAS but (does/ does not) affect bradykinin.

A

Spironolactone does affect RAAS but does not affect bradykinin.

87
Q

Spironolactone (is/is not) initial therapy for HTN.

A

is not

88
Q

What are the CV indications for Spironolactone?

A
  • Class II-IV HFrEF
  • UA/NSTEMI
  • resistant HTN
89
Q

Spironolactone is a __ line agent for HTN.

A

4th

90
Q

What are the ADRs for Spironolactone?

A
  • hyperkalemia

- gynecomastia

91
Q

What is strategy A for resistant HTN?

A

Start one drug, titrate to max dose, then add a second drug.

92
Q

What is strategy B for resistant HTN?

A

Start one drug and then add a second drug before achieving max dose of initial drug.

93
Q

What is strategy C for resistant HTN?

A

Begin with 2 drugs at the same time

94
Q

When dealing with resistant HTN, medication adjustments should be made at __ week intervals.

A

4

95
Q

Most patients require more than one agent to control their BP. (T/F)

A

True

96
Q

What are the 2 preferred drug combinations for resistant HTN?

A
  • ACE-I/ARB + NonDHP CCB

- ACE-I/ARB + diuretic

97
Q

What are 2 acceptable but not preferred drug combinations for resistant HTN?

A
  • β blocker + diuretic

- thiazide + CCB/ K sparing diuretic

98
Q

What drug combination for resistant HTN is preferred in African American patients?

A

thiazide + CCB/ K sparing diuretic

99
Q

What are the α1 blocker agents?

A
  • prazosin

- doxazosin

100
Q

α1 blockers are often used in combination with what class of drugs?

A

diuretics

101
Q

α1 blockers are considered ____ line due to ADRs.

A

last

102
Q

What are the ADRs of α1 blockers?

A
  • dizziness/ postural hypotension
  • edema
  • worse CVA and HF
103
Q

In patients with HTN and what comorbidities are α1 blockers beneficial?

A
  • DM
  • gout
  • BPH
104
Q

What are the direct vasodilation agents?

A
  • hydralazine

- minoxidil

105
Q

Vasodilators should ALWAYS be used in combination with what and for what reason?

A

diuretics: limit fluid gain

106
Q

Vasodilators cause (more/less) orthostatic hypotension.

A

less

107
Q

Vasodilators can be used in combination with what to prevent SNS and RAAS activation?

A

β blockers

108
Q

What patient population may benefit from using direct vasodilators?

A
  • resistant HTN
  • isolated systolic HTN
  • Das with HF
109
Q

In what populations should direct vasodilators be used with caution?

A
  • elderly
  • recent MI
  • angina with CAD
110
Q

What is the MOA of clonidine?

A
  • α2 agonist

- decreases sympathetic outflow

111
Q

What are ADRs of clonidine?

A
  • sedation
  • dry mouth and eyes
  • sleep disturbances
  • bradycardia
  • withdrawal syndrome
112
Q

What are the symptoms of clonidine withdrawal syndrome?

A
  • headache
  • tremor
  • sweating
  • tachycardia
  • rebound HTN
113
Q

What patients might benefit from clonidine to treat HTN?

A
  • resistant HTN
  • pregnant women
  • poor compliance (weekly patch)
114
Q

Clonidine should be used with caution in what patients?

A
  • noncompliant (except patch)
  • recent MI
  • stroke patients
115
Q

What is the MOA of Aliskiren?

A

renin inhibitor

116
Q

Aliskiren is recommended for initial treatment of HTN. (T/F)

A

False

117
Q

What patients are at higher risk for hyperkalemia when taking Aliskiren?

A
  • renal dysfunction
  • DM
  • concomitant use of ACE-I/ARB/NSAID/ K sparing diuretic
118
Q

In what patients is Aliskiren contraindicated?

A
  • DM
  • LVSD
  • post MI
  • volume depletion
  • pregnant women

957 Block 3 (6 decks)

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