ch 41 Flashcards by Tess Williams

stage 1 HTN

when diagnosis is made

130-139 or 80-89

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Stage 2 HTN

> 140 or >90

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lifestyle mods for HTN

sodium restriction
DASH diet
Restricting alcohol
aerobic exercise
Healthy body weight
smoking/tobacco cessation

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What determines BP

cardiac output and peripheral resistance - increase in either with increase BP

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What influences Cardiac output

Heart rate
myocardial contractility
blood volume
venous return of blood to heart

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what antihypertensive meds work in the brain stem

Clonidine
methyldopa
(indirect alpha 2 agonists ch.17)

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what antihypertensive meds work on the heart (B1 receptors)

B Blockers (-lol)

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what antihypertensive meds work renal tubules

Thiazide diuretics
furosemide
Potassium sparing diuretics

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what antihypertensive meds work on vascular A1 receptors

Prazosin
Terazosin
both BPH drugs that work on HTN

Labetalol

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what antihypertensive meds work on vascular smooth muscle

Hydralazine
minoxidil
Nitroprusside
CCBs 
Thiazides

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what antihypertensive meds work on the B1 receptors on juxaglomerular cells (component of RAAS)

B Blockers

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what antihypertensive meds work on Renin (component of RAAS)

Aliskiren

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what antihypertensive meds work on ACE in RAAS

Captopril
Enalapril
Ace inhibitors

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what antihypertensive meds work on Angiotensin II receptors in RAAS

Losartan
Valsartan
other ARBs

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what antihypertensive meds work on Aldosterone receptors on RAAS

Eplerenone

Spironolactone

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what are your classes of antihypertensive drugs

Diuretics
Sympatholytics (antiadrenergic drugs)
     -B Blockers (-lol), A1 blockers, centrally acting Alpha 2 
     agonists
CCBs
    -dihydropyridines (-pine)
    -nondihyropyridines (verapamil and diltiazem)
Drugs that suppress RAAS
    -ACE (-pril)

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HTN with no comorbidities - first line

Thiazide Diuretic

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nephrosclerosis secondary to HTN - what meds

ACE then ARB if cant tolerate ACE
Most cases a diuretic is also used
Loop diuretic

NOOOOO potassium sparing diuretics here

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HTN in a diabetic

Choices
ACEs
ARBs
(these can help slow progression of renal damage and reduce albuminuria in diabetic nephropathy pt)
CCBs (not high on the choice list - linked to increase risk of MI in this population)
diuretics in low doses (Thiazide and loop - promotes hyperglycemia)

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what diuretics promote hyperglycemia

Thiazide and loop

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what antihypertensive can mask the signs of hypoglycemia

B Blockers

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what race is at higher risk for HTN

African Americans

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Lifestyle mods and African Americans for HTN

high incidence of salt sensitivity and cigarette use. Lifestyle mods are important

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HTN treatment in African Americans

Diuretics
CCBs

(for more comorbidities consider - Alpha/B blockers and ACEs )

antihypertensive drugs to avoid in Heart failure

Verapamil Diltiazem act on heart to decrease myocardial contractility and can thereby further reduce Cardiac Output

antihypertensive drugs to avoid in AV heart block (3)

B blockers (-lol) Verapamil Diltiazem Act on heart to suppress AV conduction and can intensify AV block

Drug classes to consider for heart failure

``` Diuretic B Blocker Ace inhibitor ARB Aldosterone Antagonist ```

antihypertensive drugs to avoid in coronary artery disease (1)

Hydralazine Reflex tachycardia can precipitate a anginal attack

antihypertensive drugs to avoid in post MI

Hydralazine Reflex tachycardia can increase cardiac work and oxygen demand

antihypertensive drugs to avoid in dyslipidemia

B Blockers Diuretics may exacerbate dyslipidemia

antihypertensive drugs to avoid in renal insufficiency

Potassium sparing diuretics Potassium supplements can lead to dangerous accumulations of K+

antihypertensive drugs to avoid in asthma

B Blockers B2 blockade promotes Bronchoconstriction

antihypertensive drugs to avoid in Diabetes

Thiazides furosemide Both promote hyperglycemia B Blockers suppress glycogenolysis and can mask signs of Hypoglycemia

antihypertensive drugs to avoid in Gout

Thiazides Furosemide promote hyperuricemia

antihypertensive drugs to avoid in hyperkalemia

K+ sparing diuretics ACE inhibitors DRIs Aldosterone antagonists can cause potassium accumulation

antihypertensive drugs to avoid in hypokalemia

Thiazides can cause potassium loss

antihypertensive drugs to avoid in collagen diseases

Hydralazine can precipitate a lupus erythematosus - like syndrome

antihypertensive drugs to avoid in liver disease

Methyldopa hapatotoxic

antihypertensive drugs to avoid in preeclampsia

ACE ARBs DRIs can injure the fetus

Diuretic for Heart failure

Loops

drug choice for preeclampsia pregnancy

labetalol and methyldopa mag sulfate to prevent/treat seizures

older adults hypertension presents as

isolated systolic hypertension (diastolic is usually normal or low)

treat HTN in children

ACE diuretics B Blockers CCBS

HTN in breastfeeding

B blockers diuretics appear safe but may suppress lactation

treating HTN in older adults

ACE diuretics B Blockers Be carful with over diuresis in older adults. Central acting alpha agonists and peripheral alpha 1 antagonists should be avoided

left untreated HTN can cause

heart disease, kidney disease and stroke

adverse effects of chronic HTN in pregnancy

``` placental abruption maternal cardiac decompensation premature birth fetal growth delay CNS hemorrhage renal failure ```

If pt is already on a antihypertensive when they get pregnant, what should be done

They can remain on their med as long as its not an ACE, ARB or DRI

when do you treat hypertension in a pregnant pt

severe defined at SBP >160 or DBP >110 reducing BP does not lower the risk of preeclampsia someone who has chronic HTN is already at risk

What is determinants to designate preeclampsia

Combination of elevated BP>140/90 and proteinuria >or equal to 300mg in 24 hrs that develops after the 20th week of gestation

what is chronic HTN

HTN that was present before pregnancy or develops before the 20th week gestation

At what point does pre-eclampsia change to eclampsia

when they begin having seizures

Risk factors for preeclampsia

black race chronic HTN Collagen vascular disorders previous preeclampsia

Risks of preeclampsia to the fetus

intrauterine growth restriction premature birth death

The mother is at risk in preeclampsia for

``` seizures (eclampsia) renal failure pulmonary edema stroke death hemorrhage encephalopathy ```

suggested measures with preeclampsia

bed rest prolonged hospitalization treatment with antihypertensive drugs prophylaxis with an anticonvulsant

The definitive intervention for preeclampsia is

delivery

CAD such as MI and HTN

B Blocker - helps with cardiovascular remodeling

diabetic who is HTN

ACE - treating HTN and gives renal protection