Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

IP1 > E3: HTN Therapeutics > Flashcards

E3: HTN Therapeutics Flashcards

1
Q

Define hypertension and what two things are increased with it

A

Hypertension: persistently elevated arterial blood pressure
-Increase cardiac output (CO)
-increased peripheral vascular resistance (PVR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define primary hypertension

A

Unknown cause but thought to be genetics, poor diet, lack of exercise & obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are 4 causes of secondary hypertension

A
  1. Obstructive sleep apnea (OSA)
  2. Hyperaldosteronism
  3. Medications
  4. Alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Short and long term complications of HTN (3)

A
  1. myocardial infarction
  2. heart failure
  3. stroke
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Long term complications of HTN (5)

A
  1. peripheral artery disease (PAD)
  2. chronic kidney disease (CKD)
  3. Retinopathy
  4. Sexual dysfunction
  5. Atrial fibrillation (Afib)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the goal of HTN therapy and what is the target BP for most patients per ACC?AHA

A

Reduce morbidity and mortality from CV events
BP Target: 130/80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What was the trial that established the target BP for most patients w/HTN and what was its findings

A

SPRINT trial, found that patients that had their BP brought down to 120 with medications experienced more side effects. Ultimately, it is better to be below 130 than 120 because the additional SE do not outweigh the benefits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Classification of BP (Normal to Stage 2)

A

Normal: <120/80
Elevated: 120-129/<80
Stage 1: 130-139/80-89
Stage 2: >140/90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Intervention and follow for various BP readings (Normal to Stage 2)

A

Normal: <120/80
Intervention: Lifestyle and follow up in 1 year

Elevated: 120-129/<80
Intervention: Lifestyle and follow up in 3-6 months

Stage 1: 130-139/80-89
Primary prevention & ASCVD 10 yr risk < 10%
Intervention: Lifestyle and follow up in 3-6 months

Stage 1: 130-139/80-89
Secondary prevention OR ASCVD 10-year risk >10%
Intervention: Lifestyle + 1 med and follow up in 2-4 weeks

Stage 2: >140/90
Intervention: Lifestyle + 2 med and follow up in 2-4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Define primary prevention
Define secondary prevention

A

Primary prevention: NO heart-attack, stroke, or heart failure
Secondary prevention: History of heart-attack, stroke, or heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is ASCVD

A

Atherosclerotic Cardiovascular disease risk
Pooled Cohort Equations preferred by guidelines to estimate 10-year risk of ASCVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Who is ASCVD valid for? What about those outside of the age range?

A

US adults age 40 to 79 in absence of concurrent statin therapy
Those >79 years old, the 10-year ASCVD risk is generally >10%
Uncertain utility in other racial groups

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Define established HTN

A

Anyone who is currently treated for hypertension or has failed lifestyle modifications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

For those with established HTN, if their SBP is <110, what should you do

A

consider decreasing BP meds, especially if polypharmacy or symptomatic hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

For those with established HTN, if their BP is 110-130/80, what should you do

A

Continue treatment plan, their BP is controlled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

For those with established HTN, if their BP is >130/80, what should you do? How to do you select which option is the best

A

1) Need to make a change to improve BP control
2) Verify adherence to current plan
3) Increase non-pharmacologic modifications
4) Increase medication dose
5) Add additional medication

Selection depends on patient factors
-current BP (>140/90 need med change)
-patient wishes, adherence, PMH, etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the 7 life-style changes

A
  1. weight loss
  2. physical activity
  3. DASH diet
  4. reduced salt intake
  5. increase potassium
  6. alcohol intake
  7. tobacco cessation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Lifestyle change: weight loss
Goal BMI, SBP reduction = x

A

Goal weight is BMI 18.5 to 24.9
1mmHg/1kg weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Lifestyle change: physical activity
Goal time, SBP reduction = x

A

90-150/wk
-4-8 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Lifestyle change: DASH diet

A

Increase consumption in fruits, vegetables, and low-fat dairy
-10mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Lifestyle change: reduced salt intake

A

at least 1 g reduction, ideally consume less than 1.5 g daily
-6mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Lifestyle change: increase potassium
Excluded population

A

3.5 to 5 g daily preferred in diet
NOT for patients w/CKD or hyperkalemia
-4mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Lifestyle change: alcohol intake

A

<2 drink for men daily
<1 drink for women daily
-4mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Lifestyle change: tobacco cessation

A

Recommend tobacco cessation at every visit
No reduction but is a risk factor for CVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
First line HTN agents (4) What is the benefit of them
1. ACE inhibitors 2. ARB 3. CCB 4. Thiazide diuretics Additional mortality benefit in HTN
26
Second line HTN agents (2) What is the benefit of them
1. Aldosterone antagonists 2. Beta Blockers (BB) Mortality benefit in other diseases
27
Third line HTN agents (3)
1. α-1 blockers 2. Central α-2 agonists 3. Direct vasodilators
28
What is the ACE inhibitor we specifically mentioned and its max dose
Lisinopril 40mg
29
When is it best to use ACEi When should you avoid them
Best: first line in HTN especially if patients have signs or risks of chronic kidney dysfunction AVOID: 1. acute kidney injury 2. hyperkalemia (K>5.5 mEq/mL) 3. pregnancy 4. severe bilateral renal artery stenosis
30
Key monitoring for ACE inhibitors and response
1. Angioedema: D/C & document as allergy 2. Cough: D/C & document as allergy 3. BMP ran 1-2 weeks after start or dose increase to monitor for ↑SCr or ↑K
31
-pril
ACE inhibitors
32
After labs are ran 1-2 weeks after starting an ACEi or dose is increased what do you do for the following results in SCr and K ↑ <30%: ↑ 30-50%: ↑50%:
↑ <30%: continue therapy w/labs PRN ↑ 30-50%: continue therapy BUT redraw labs 1-2 weeks ↑50%: put therapy on hold, redraw labs, can retrial lower dose once labs normalize
33
-artan
ARB
34
When is it best to use ARBs When should you avoid ARBS
Best: first line HTN especially if patients have signs or risks of chronic kidney dysfunction (same as ACEi) AVOID: 1. acute kidney injury 2. hyperkalemia (K >5 mEq/mL) 3. pregnancy 4. severe bilateral renal artery stenosis (same as ACEi except K >5.5 mEq/mL)
35
Key monitoring for ARBs and response
1. Angioedema: D/C, document as allergy (same as ACEi) 2. BMP 1-2 weeks after start or dose increase to monitor for ↑SCr or ↑K
36
After labs are ran 1-2 weeks after starting an ARB or dose is increased what do you do for the following results in SCr and K ↑ <30%: ↑ 30-50%: ↑50%:
↑ <30%: continue therapy w/labs PRN ↑ 30-50%: continue therapy BUT redraw labs 1-2 weeks ↑50%: put therapy on hold, redraw labs, can retrial lower dose once labs normalize
37
CCB NonDHP: (2) DHP: (3 we care about) Drug w/dose we MUST know
NonDHP: verapamil & diltiazem DHP: amlodipine, nifedipine, nicardipine MUST KNOW: Amlodipine max dose = 10mg
38
When to use CCB When to avoid CCB
Best: 1. Suitable first line HTN for most patients 2. Preferred in Black patients and isolated systolic HTN AVOID: 1. NonDHP in heart failure patients
39
Key monitoring for CCB and the proper response
1. hypotension, dizziness, flushing, nausea --dose reduce, slower titration as tolerated 2. NonDHP: bradycardia --dose reduce to maintain HR >60 3. DHP: Dose related pedal edema --dose reduce or D/C and list as intolerance
40
Thiazide diuretics (3) Doses for 2 of them
Hydrochlorothiazide: 25 mg Chlorthalidone: 25 mg Indapamide
41
When to use thiazide diuretics When to avoid thiazide diuretics
Best -First line for HTN, best to take in AM -Take w/ACEi, ARB, or aldosterone antagonist to reduce potassium levels AVOID -CrCl less than 30mL/min (less effective -patients w/gout
42
Key monitoring and response for thiazide diuretics
BMP 1 to 2 weeks after starting or dose increase to monitor for ↓Na+, ↑Scr, or ↓K+ Response: if one of the following, put therapy on hold, redraw labs, and may retrial at lower dose once labs normalize Na <135 Scr-50% ↑ K < 3.5
43
When to use beta blockers When to AVOID beta blockers
Second line agent used for many cardiac conditions such as myocardial infarctions, heart failure, atrial fibrillation Avoid in DM and those at high risk for hypoglycemia, because it can mask symptoms; avoid in uncontrolled asthma and COPD because you want to avoid ß2 selectivity
44
Key monitoring for beta blockers and response
1. BRADYCARDIA: dose reduce to maintain HR >60 2. Beta blocker blues (fatigue, tiredness): continue dose if able, should improve w/time 3. Adherence for rebound HTN if stopped; titration off if stopping medication
45
Aldosterone antagonist agents
Spironolactone, Eplerenone
46
When to use aldosterone antagonists When to AVOID aldosterone antagonists
Use for resistant HTN or HTN from primary aldosteronism; can also use in myocardial infarctions, heart failure AVOID in hyperkalemia (K>5mEq/mL) and POOR kidney function (CrCl <30 mL/min)
47
Key monitoring for Aldosterone antagonists Key monitoring for spironolactone specifically
BMP 3 to 7 days after starting or increased dose then additional testing in 1 to 2 weeks to monitor for ↑Scr and ↑K+ Gynecomastia and impotence for men, switch to eplerenone
48
After labs are ran 3 to7 days and 1-2 weeks after starting an aldosterone antagonist or dose is increased what do you do for the following results in SCr and K ↑ <30%: ↑ 30-50%: ↑50%:
↑ <30%: continue therapy w/labs PRN ↑ 30-50%: continue therapy BUT redraw labs 1-2 weeks ↑50%: put therapy on hold, redraw labs, can retrial lower dose once labs normalize * same as ACEi and ARB *
49
Third line agents (3)
Alpha-1 antagonist Alpha-2 agonist Vasodilator
50
Alpha-1 antagonists suffix and examples
zosin doxazosin, terazosin, prazosin
51
Alpha-1 antagonist counseling and SE
Doxazosin, terazosin, prazosin take at nighttime d/t orthostatic hypotension S/E: dizziness and headaches
52
Alpha-2 agonist agent and counseling
Clonidine S/E sedation, drowsiness, headache
53
Vasodilator agent, dose frequency/disadvantage, S/E
Hydralazine Dosed TID or BID difficult for adherence S/E: orthostatic hypotension, edema, reflex tachycardia
54
4 key points in the hypertension algorithm
1. adults 18 yro or older w/NO compelling indications 2. TZ diuretic, ACEi/ARB, or CCB 3. Follow up in 2 to 4 weeks after adding or increasing medication 4. If uncontrolled, check adherence and continue to increase dose or add first line agents as appropriate
55
When selecting a first line agent, what 3 things must be considered
1. Safety 2. Efficacy 3. Patient preference
56
What are the home blood pressure monitoring guidelines for those actively adjusting medications (3)
1. Test 3-7 days before appointment 2. Test 2 times 1 minute apart 3. Test before taking medications in morning and in the evening
57
What are the home blood pressure monitoring guidelines for those with long-term follow ups
1. Test 1-2 measurements/week
58
What are the 3/4 compelling indications
1. CKD 2. DM + proteinuria 3. Pregnancy
59
First line agents and alternative agents for CKD
First line: ACEi/ARB Alternative: CCB or TZ diuretic
60
First line agent and alternative agent for DM + proteinuria
First line: ACEi/ARB Alternative: CCB or TZ diuretic
61
First line agent and alternative agent for pregnancy
First line: Nifedipine or labetalol Alternative: Methyldopa
62
Define CKD and its treatment goal
Chronic Kidney Disease: eGFR <60ml/min w/proteinuria >300mg/g Goal: <130/80
63
Those w/CKD are at high risk for ______ and ______, so we must be cautious and have _____ dose adjustments
high risk for hyperkalemia and hypotension slow dose adjustments
64
Those w/CKD must avoid ______ or ______ _______ if CrCl is <30ml/min
Avoid TZ diuretics or aldosterone antagonists
65
Diabetes + HTN BP goal and treatment Preferred treatment if microalbuminuria (>30mg/g)
Goal: 130/80 Treatment: All are appropriate Microalbuminuria: ACEi/ARB
66
What class of agents are to be used w/caution in diabetics because they can mask hypoglycemia
beta-blockers
67
HTN in pregnancy: Pre-eclampsia
medical emergency, HTN crisis that can be deadly to mother and baby
68
What agents can NOT be used in pregnancy (3)
ACEi ARB Renin inhibitors
69
Are anti-HTN medications excreted into the breastmilk
YES, consider withholding antihypertensive for a few months
70
What agents (4) are recommended for lactation and which agents (3) are to be avoided
Recommended: Methyldopa, hydralazine, beta blockers (Propranolol or labetalol) AVOID: ACEi, ARBs, diuretics
71
Given the current guidelines, what agents are recommend in black patients w/HTN and no other compelling indications
Thiazide diuretics or CCB
72
Define resistant HTN
patient is optimized on 3 HTN medications (at least 1 diuretic, all different classes) but not able to achieve goal
73
Risk factors of resistant HTN (5)
elderly obesity CKD Black DM
74
What agents should be added if a patient has resistant HTN
aldosterone antagonist
75
Medication induced HTN: volume retention Causes: Treatment:
Causes: NSAIDs, oral contraceptives, corticosteroids Treatment: ACEi/ARB or diuretic
76
Medication induced HTN: sympathomimetic activation Causes: Treatment:
Causes: decongestants, caffeine/nicotine, psychostimulants, SNRI (venlafaxine), bupropion Treatment: reduce exposure
77
Medication induced HTN: abrupt withdrawal Causes: Treatment:
Causes: B-blockers, alpha2 agonist Treatment: consistent adherence

IP1 (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions