Earley > Anti-HTN Therapy Flashcards
(130 cards)
1
Q
What is NORMAL BP (in mmHg)?
A
<120 systolic
<80 diastolic
2
Q
What is prehypertension (in mmHg)?
A
120-139 systolic
OR
80-89 diastolic
3
Q
What is Stage 1 HTN in mmHg?
A
140-159 systolic
OR
90-99 diastolic
4
Q
What is Stage 2 HTN in mmHg?
A
160+ systolic
OR
100+ diastolic
5
Q
What is the therapeutic HTN goal for a pt LESS than 60 yo?
A
<140 systolic
AND
<90 diastolic
6
Q
What is the therapeutic HTN goal for pts GREATER than 60 yo?
A
<150 systolic
AND
<90 diastolic
7
Q
what is the HTN goal for pts w/ diabetes &/or CKD (of any age)?
A
<140 systolic
AND
<90 diastolic
(same as HTN pts under 60 yo)
8
Q
What is essential HTN?
A
HTN w/ unknown cause
9
Q
What percentage of cases of HTN are essential?
A
85-90%
10
Q
How do you treat essential HTN?
A
sx treatment to reduce BP
no cure
11
Q
What is secondary HTN?
A
HTN d/t some underlying cause
Can be sleep apnea, drugs, CKD, aldosteronism, renovascular disease, chronic steroid tx & Cushing’s, pheochromocytoma, coarctation of the aorta, thyroid/parathyroid disease
12
Q
What are the 6 contributing factors for essential HTN?
A
- obesity
- stress
- lack of exercise
- diet (XS salt)
- alcohol
- smoking
13
Q
what is the prevalence of HTN in the US?
A
30% of all adults (this is HIGH!)
14
Q
Are men or women affected at higher rates of HTN?
A
similar rates for men & women
15
Q
What age group has the highest prevalence of HTN?
A
elderly
60-80% by age 80
16
Q
among adults w/ HTN, what percentage are aware they have it?
A
83%
17
Q
among adults w/ HTN, what percentage take meds to lower their BP?
A
76%
18
Q
among adults w/ HTN, what % of pts were controlled?
A
52%
19
Q
what are the 3 CVS disease complications of HTN?
A
stroke
atherosclerosis
heart failure
20
Q
what is the risk of CVS disease w/ HTN?
A
starting at 115/75 mmHg, risk DOUBLES for each increase of 20/10 mmHg
21
Q
what are the 2 organs/organ systems that can be heavily damaged d/t HTN?
A
renal
retinal
22
Q
what are the 3 basic tenets of HTN tx?
A
lifestyle modification
antihypertensive drugs
follow-up & monitoring
23
Q
what lifestyle modification has the greatest impact on HTN?
A
reducing weight to a normal BMI
for every 10kg loss, BP is reduced 5-20 mmHg
24
Q
What are the 6 lifestyle modifications that can help HTN?
A
- reduce weight to normal BMI (<25)
- DASH eating plan
- dietary sodium reduction
- increase physical activity
- reduce alcohol consumption
- stop smoking
25
how much does the DASH meal plan change BP?
8-14 mmHg
26
How much does dietary sodium reduction change BP?
2-8 mmHg
27
How much does physical activity change BP?
4-9 mmHg
28
what does DASH stand for?
**_D_**ietary **_A_**pproaches to **_S_**top **_H_**ypertension
29
what should you eat on the DASH diet?
fruit
veggies
low fat dairy foods
reduced sodium
includes whole grains, poultry, fish, & nuts
30
what should you AVOID on the DASH diet?
red meat
sugar
total & sat fat
cholesterol
31
what is the mathematical formula for mean arterial pressure?
MAP = CO x PVR
32
what is the mathematical formula for cardiac output?
CO = HR x SV
33
what are the circulating factors involved in BP?
NE
Angiotensin II
34
what impacts heart rate & contractility? (3 factors)
ANS
blood volume
venous tone
35
what are the 4 classes of antihypertensive drugs?
1. diuretics
2. agents affecting adrenergic fxn (sympathoplegics)
3. vasodilators
4. agents affecting the **_R_**enin-**_A_**ngiotensin Aldosterone **_S_**ystem (RAS)
36
What are the 3 types of diuretics?
1. Thiazides
2. Loop
3. potassium sparing
37
which type of diuretics are most commonly used?
thiazide
38
what are the 2 types of thiazide diuretics?
chlorothiazide
hydrochlorothiazide (HCTZ)
39
what are the 3 loop diuretics?
1. furosemide
2. bumetanide
3. ethacrynic acid
40
when do you use loop diuretics?
severe HTN
heart failure
41
what are the 3 potassium sparing diuretics?
1. spironolactone
2. triamterene
3. amiloride
42
what good thing happens when you use potassium sparing diuretics?
reduction in heart failure mortality! yay!
43
what are the initial effects of diuretics?
increase Na+ & water excretion
this decreases blood volume
which decreases CO
44
what happens after 6-8 weeks of diuretic use?
CO returns to normal
PVR declines (poorly understood)
45
how much do diuretics typically lower a pt's BP?
10-15 mmHg
46
what are the toxic effects of diuretics?
**K+** depletion (not w/ K-sparing meds obviously)
**Mg2+** depletion
impaired **glucose** tolerance
increased serum **lipid** conc
**gout** (increased uric acid)
47
How can you minimize K+ depletion w/ diuretics?
limit Na+ intake
48
where are beta1 receptors?
heart
cardiomyocytes, SA, AV node
49
where are alpha1 receptors?
vascular smooth muscle
50
what are the 4 types of agents affecting adrenergic fxn?
1. prevent adrenergic transmission
2. selective alpha1 adrenergic receptor blockers
3. beta-adrenergic blockers
4. CNS agents
51
what drug prevents adrenergic transmission?
reserpine
52
what drugs are selective alpha1 adrenergic receptor blockers?
_prazosin_
terazosin
doxazosin
53
what is the important beta blocker? (according to Earley)
_propranolol_
& others
54
which drugs affect adrenergic fxn by acting directly on the CNS?
methyldopa
clonidine
55
what is the mechanism of reserpine?
depletes NT (NE) in the nerve endings in the _brain & periphery_
56
what are the main effects of reserpine?
depress SNS fxn centrally & peripherally
causes decreased HR, contractility, & PVR
57
what are the adverse effects of reserpine?
_depression, nightmares, orthostatic hypotension, impotence_
insomnia, ulcers, diarrhea, abdominal cramping, nasal stuffiness, dry mouth
58
T/F: reserpine is fast acting
FALSE
slow onset
full effect takes weeks!
59
how often is reserpine used?
infrequently
60
what is the mechanism of selective alpha1 antagonists?
block alpha1 receptors in vasculature
61
what are the main effects of selective alpha1 antagonists?
decreased PVR \> decreased BP
62
what are the adverse effects of selective alpha1 antagonists?
_1st dose phenomenon, dizziness_
HA, fluid retention
63
when are selective alpha1 antagonists used?
stage 1 & 2 HTN *in combo* w/ a diuretic & a beta blocker
64
what are the classifications of beta blockers?
nonselective
cardioselective
65
what generation of beta blockers are nonselective?
1st gen
66
what generation of beta blockers are cardioselective?
2nd gen
beta1 selective
67
what is the mechanism of beta blockers?
block cardiac beta1 receptors \> lower CO
block renal beta1 receptors \> lower renin \> lower PVR
68
is propranolol cardioselective?
nope
it's nonselective
69
what is the main effect of propranolol?
decrease HR
70
what are the adverse effects of propranolol?
_bradycardia, asthma aggravation_ (beta2 blockade in airways)
depression
71
when do you use propranolol?
stage 1 & 2 HTN alone OR *in combo* w/ a diuretic &/or vasodilator
72
what drugs does propranolol interact w/?
verapamil
diltiazem
digitalis (possible AV block)
73
are metoprolol & atenolol cardioselective?
yes
74
what are the 2 most widely used beta blockers for HTN?
metoprolol & atenolol
75
what receptor are metoprolol and atenolol selective for?
beta1
not so much beta2 so less bronchoconstriction
76
what is labetalol used for?
IV for HTN emergencies
77
is labetalol cardioselective?
NOPE
it's a combined nonselective beta & alpha1 blocker
beta blocking action is more prominent
78
what is the mechanism for alpha-methyldopa?
metabolized to alpha-methyl NE which is an alpha 2 agonist \> suppresses SNS output from CNS
79
what is the mechanism for clonidine?
direct alpha2 agonist that acts on the CNS
80
what are the main effects of alpha-methyldopa & clonidine?
decrease PVR & HR
81
what are the adverse effects of agents that act on the CNS?
_sedation, dry mouth, impotence, rebound HT__N_
drowsiness, bradycardia, withdrawal syndrome
82
when should you use clonidine?
stage 1 & 2 HTN
83
when should you use methyldopa for BP?
HTN of pregnancy
84
what are the 3 types of vasodilator drugs?
1. calcium channel blockers
2. direct-acting
3. potassium channel openers
85
what kind of drug is nifedipine?
calcium channel blocker
86
what kind of drug is sodium nitroprusside?
a direct acting vasodilator
87
what kind of drug is minoxidil?
a potassium channel opener
88
what is the mechanismp of calcium channel blockers?
inhibit Ca2+ entry thru L-type voltage-gated Ca2+ channels
89
what class is verapamil?
phenylalkylamines
90
what class is diltiazem?
benzothiazepines
91
what class is amlodipine?
dihydropyridines
92
what is the mechanism of amlodipine?
selective blockade of _vascular_ Ca2+ channels
93
what is the main effect of amlodipine?
vasodilation \> lower PVR \> lower BP
94
what are the adverse effects of amlodipine?
_flushing, ankle edema, reflex tachycardia_
HA, nausea, dizziness
95
when should you use amlodipine?
HTN \> more effective in african americans
angina
96
what is the mechanism of verapamil & diltiazem?
block Ca2+ channels in the vasculature, heart, & AV node
97
what are the main effects of verapamil & diltiazem?
same as amlodipine
vasodilation \> lower PVR \> lower BP
98
what are the adverse effects of verapamil & diltiazem?
_ankle edema, flushing_
HA, nausea, dizziness
*(same as amlodipine but NO reflex tachycardia!)*
99
what are the drug interactions you should be concerned about w/ verapamil & diltiazem?
caution for AV block when used w/ beta blockers & digitalis!
## Footnote
*(amlodipine does not have this restriction)*
100
what is the mechanism of sodium nitroprusside?
generation of NO \> rapid acting venous & arteriolar vasodilator
101
what is the main effect of sodium nitroprusside?
vasodilation \> lower PVR \> lower BP
102
what are the adverse effects of sodium nitroprusside?
_reflex tachycardia, possible cyanide poisoning_
severe hypotension
103
is sodium nitroprusside fast acting?
YES!
IV drip
short plasma half-life
104
when do you use sodium nitroprusside?
hypertensive _emergencies_
105
what is the mechanism of minoxidil?
open K channels \> smooth muscle hyperpolarizaiton \> smooth muscle relaxation \> arterial dilation \> decreased PVR \> decreased BP
106
what are the 3 classes that affect the RAS?
ACEIs
Angiotensin II receptor blockers (ARBs)
renin inhibitors
107
what drugs are ACEIs?
_captopril_
enalapril
lisnopril
108
what drugs are ARBs?
_losartan_
valsartan
irbesartan
109
what is the mechanism of ACEIs?
inhibit ACE \> lower circulating Angio II \> decreased PVR \> decreased BP
110
what are the adverse effects of ACEIs?
_cough, hyperkalemia_
skin rash, taste
111
when should you use ACEIs?
stage 1 & 2 HTN
CHF
112
do ACEIs adversely affect plasma lipids or glucose?
nope
113
what is the drug of choice for HTN pts w/ diabetes?
ACEIs
114
when are ACEIs _contraindicated_?
pregnancy
115
what ethnic group is not as affected by ACEIs?
african americans
116
what is the mechanism of ARBs?
selectively block Angio II AT-1 receptor \> lower PVR \> lower BP
117
what are the adverse effects of ARBs?
_hyperkalemia, fetal toxicity_
skin rash, taste
**NO COUGH!**
118
what type of drug is aliskiren?
renin inhibitor
119
what is the mechanism of aliskiren?
inhibit conversion of angiotensinogen to angiotensin I (RLS of RAS)
120
what is the efficacy of aliskiren on lowering BP?
as good as or better than ACEIs & ARBs
121
what are the side effects of aliskiren?
_fetal toxicity_
diarrhea, stomach pain, heartburn, cough, rash, dizziness, HA, back pain
122
when is aliskiren contraindicated?
do not use w/ ARBs or ACEIs in pts w/ diabetes &/or CKD
123
when combining HTN drugs, what combo should you avoid?
ACEI + ARB
124
what is resistant HTN?
BP over 140/90 (130/80 w/ diabetes & CKD)
in pts prescribed 3+ antihypertensive meds at optimal doses
OR
BP controlled w/ 4+ antihypertensive drugs
125
how many HTN pts have resistant HTN?
10-40%!
126
what are the 1 year rates of adherence to BP meds?
20-80% (not helpful at all!)
127
what drug regimen has higher adherence?
single drug and/or lower number of doses/day
128
what drugs have higher adherence rates?
RAS drugs & CCBs
vs diuretics & beta blockers
129
what is adherence to dietary changes like?
worse than drug adherence
10-20% adherence for salt reduction
130
