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Block 9 Week 2 > Earley > Anti-HTN Therapy > Flashcards

Earley > Anti-HTN Therapy Flashcards

1
Q

What is NORMAL BP (in mmHg)?

A

<120 systolic

<80 diastolic

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2
Q

What is prehypertension (in mmHg)?

A

120-139 systolic

OR

80-89 diastolic

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3
Q

What is Stage 1 HTN in mmHg?

A

140-159 systolic

OR

90-99 diastolic

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4
Q

What is Stage 2 HTN in mmHg?

A

160+ systolic

OR

100+ diastolic

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5
Q

What is the therapeutic HTN goal for a pt LESS than 60 yo?

A

<140 systolic

AND

<90 diastolic

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6
Q

What is the therapeutic HTN goal for pts GREATER than 60 yo?

A

<150 systolic

AND

<90 diastolic

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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)

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8
Q

What is essential HTN?

A

HTN w/ unknown cause

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9
Q

What percentage of cases of HTN are essential?

A

85-90%

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10
Q

How do you treat essential HTN?

A

sx treatment to reduce BP

no cure

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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

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12
Q

What are the 6 contributing factors for essential HTN?

A
  1. obesity
  2. stress
  3. lack of exercise
  4. diet (XS salt)
  5. alcohol
  6. smoking
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13
Q

what is the prevalence of HTN in the US?

A

30% of all adults (this is HIGH!)

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14
Q

Are men or women affected at higher rates of HTN?

A

similar rates for men & women

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15
Q

What age group has the highest prevalence of HTN?

A

elderly

60-80% by age 80

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16
Q

among adults w/ HTN, what percentage are aware they have it?

A

83%

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17
Q

among adults w/ HTN, what percentage take meds to lower their BP?

A

76%

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18
Q

among adults w/ HTN, what % of pts were controlled?

A

52%

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19
Q

what are the 3 CVS disease complications of HTN?

A

stroke

atherosclerosis

heart failure

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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

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21
Q

what are the 2 organs/organ systems that can be heavily damaged d/t HTN?

A

renal

retinal

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22
Q

what are the 3 basic tenets of HTN tx?

A

lifestyle modification

antihypertensive drugs

follow-up & monitoring

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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

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24
Q

What are the 6 lifestyle modifications that can help HTN?

A
  1. reduce weight to normal BMI (<25)
  2. DASH eating plan
  3. dietary sodium reduction
  4. increase physical activity
  5. reduce alcohol consumption
  6. stop smoking
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25
Q

how much does the DASH meal plan change BP?

A

8-14 mmHg

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26
Q

How much does dietary sodium reduction change BP?

A

2-8 mmHg

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27
Q

How much does physical activity change BP?

A

4-9 mmHg

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28
Q

what does DASH stand for?

A

Dietary Approaches to Stop Hypertension

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29
Q

what should you eat on the DASH diet?

A

fruit

veggies

low fat dairy foods

reduced sodium

includes whole grains, poultry, fish, & nuts

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30
Q

what should you AVOID on the DASH diet?

A

red meat

sugar

total & sat fat

cholesterol

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31
Q

what is the mathematical formula for mean arterial pressure?

A

MAP = CO x PVR

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32
Q

what is the mathematical formula for cardiac output?

A

CO = HR x SV

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33
Q

what are the circulating factors involved in BP?

A

NE

Angiotensin II

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34
Q

what impacts heart rate & contractility? (3 factors)

A

ANS

blood volume

venous tone

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35
Q

what are the 4 classes of antihypertensive drugs?

A
  1. diuretics
  2. agents affecting adrenergic fxn (sympathoplegics)
  3. vasodilators
  4. agents affecting the Renin-Angiotensin Aldosterone System (RAS)
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36
Q

What are the 3 types of diuretics?

A
  1. Thiazides
  2. Loop
  3. potassium sparing
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37
Q

which type of diuretics are most commonly used?

A

thiazide

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38
Q

what are the 2 types of thiazide diuretics?

A

chlorothiazide

hydrochlorothiazide (HCTZ)

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39
Q

what are the 3 loop diuretics?

A
  1. furosemide
  2. bumetanide
  3. ethacrynic acid
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40
Q

when do you use loop diuretics?

A

severe HTN

heart failure

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41
Q

what are the 3 potassium sparing diuretics?

A
  1. spironolactone
  2. triamterene
  3. amiloride
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42
Q

what good thing happens when you use potassium sparing diuretics?

A

reduction in heart failure mortality! yay!

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43
Q

what are the initial effects of diuretics?

A

increase Na+ & water excretion

this decreases blood volume

which decreases CO

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44
Q

what happens after 6-8 weeks of diuretic use?

A

CO returns to normal

PVR declines (poorly understood)

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45
Q

how much do diuretics typically lower a pt’s BP?

A

10-15 mmHg

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46
Q

what are the toxic effects of diuretics?

A

K+ depletion (not w/ K-sparing meds obviously)

Mg2+ depletion

impaired glucose tolerance

increased serum lipid conc

gout (increased uric acid)

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47
Q

How can you minimize K+ depletion w/ diuretics?

A

limit Na+ intake

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48
Q

where are beta1 receptors?

A

heart

cardiomyocytes, SA, AV node

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49
Q

where are alpha1 receptors?

A

vascular smooth muscle

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50
Q

what are the 4 types of agents affecting adrenergic fxn?

A
  1. prevent adrenergic transmission
  2. selective alpha1 adrenergic receptor blockers
  3. beta-adrenergic blockers
  4. CNS agents
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51
Q

what drug prevents adrenergic transmission?

A

reserpine

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52
Q

what drugs are selective alpha1 adrenergic receptor blockers?

A

prazosin

terazosin

doxazosin

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53
Q

what is the important beta blocker? (according to Earley)

A

propranolol

& others

54
Q

which drugs affect adrenergic fxn by acting directly on the CNS?

A

methyldopa

clonidine

55
Q

what is the mechanism of reserpine?

A

depletes NT (NE) in the nerve endings in the brain & periphery

56
Q

what are the main effects of reserpine?

A

depress SNS fxn centrally & peripherally

causes decreased HR, contractility, & PVR

57
Q

what are the adverse effects of reserpine?

A

depression, nightmares, orthostatic hypotension, impotence

insomnia, ulcers, diarrhea, abdominal cramping, nasal stuffiness, dry mouth

58
Q

T/F: reserpine is fast acting

A

FALSE

slow onset

full effect takes weeks!

59
Q

how often is reserpine used?

A

infrequently

60
Q

what is the mechanism of selective alpha1 antagonists?

A

block alpha1 receptors in vasculature

61
Q

what are the main effects of selective alpha1 antagonists?

A

decreased PVR > decreased BP

62
Q

what are the adverse effects of selective alpha1 antagonists?

A

1st dose phenomenon, dizziness

HA, fluid retention

63
Q

when are selective alpha1 antagonists used?

A

stage 1 & 2 HTN in combo w/ a diuretic & a beta blocker

64
Q

what are the classifications of beta blockers?

A

nonselective

cardioselective

65
Q

what generation of beta blockers are nonselective?

A

1st gen

66
Q

what generation of beta blockers are cardioselective?

A

2nd gen

beta1 selective

67
Q

what is the mechanism of beta blockers?

A

block cardiac beta1 receptors > lower CO

block renal beta1 receptors > lower renin > lower PVR

68
Q

is propranolol cardioselective?

A

nope

it’s nonselective

69
Q

what is the main effect of propranolol?

A

decrease HR

70
Q

what are the adverse effects of propranolol?

A

bradycardia, asthma aggravation (beta2 blockade in airways)

depression

71
Q

when do you use propranolol?

A

stage 1 & 2 HTN alone OR in combo w/ a diuretic &/or vasodilator

72
Q

what drugs does propranolol interact w/?

A

verapamil

diltiazem

digitalis (possible AV block)

73
Q

are metoprolol & atenolol cardioselective?

A

yes

74
Q

what are the 2 most widely used beta blockers for HTN?

A

metoprolol & atenolol

75
Q

what receptor are metoprolol and atenolol selective for?

A

beta1

not so much beta2 so less bronchoconstriction

76
Q

what is labetalol used for?

A

IV for HTN emergencies

77
Q

is labetalol cardioselective?

A

NOPE

it’s a combined nonselective beta & alpha1 blocker

beta blocking action is more prominent

78
Q

what is the mechanism for alpha-methyldopa?

A

metabolized to alpha-methyl NE which is an alpha 2 agonist > suppresses SNS output from CNS

79
Q

what is the mechanism for clonidine?

A

direct alpha2 agonist that acts on the CNS

80
Q

what are the main effects of alpha-methyldopa & clonidine?

A

decrease PVR & HR

81
Q

what are the adverse effects of agents that act on the CNS?

A

sedation, dry mouth, impotence, rebound HT__N

drowsiness, bradycardia, withdrawal syndrome

82
Q

when should you use clonidine?

A

stage 1 & 2 HTN

83
Q

when should you use methyldopa for BP?

A

HTN of pregnancy

84
Q

what are the 3 types of vasodilator drugs?

A
  1. calcium channel blockers
  2. direct-acting
  3. potassium channel openers
85
Q

what kind of drug is nifedipine?

A

calcium channel blocker

86
Q

what kind of drug is sodium nitroprusside?

A

a direct acting vasodilator

87
Q

what kind of drug is minoxidil?

A

a potassium channel opener

88
Q

what is the mechanismp of calcium channel blockers?

A

inhibit Ca2+ entry thru L-type voltage-gated Ca2+ channels

89
Q

what class is verapamil?

A

phenylalkylamines

90
Q

what class is diltiazem?

A

benzothiazepines

91
Q

what class is amlodipine?

A

dihydropyridines

92
Q

what is the mechanism of amlodipine?

A

selective blockade of vascular Ca2+ channels

93
Q

what is the main effect of amlodipine?

A

vasodilation > lower PVR > lower BP

94
Q

what are the adverse effects of amlodipine?

A

flushing, ankle edema, reflex tachycardia

HA, nausea, dizziness

95
Q

when should you use amlodipine?

A

HTN > more effective in african americans

angina

96
Q

what is the mechanism of verapamil & diltiazem?

A

block Ca2+ channels in the vasculature, heart, & AV node

97
Q

what are the main effects of verapamil & diltiazem?

A

same as amlodipine

vasodilation > lower PVR > lower BP

98
Q

what are the adverse effects of verapamil & diltiazem?

A

ankle edema, flushing

HA, nausea, dizziness

(same as amlodipine but NO reflex tachycardia!)

99
Q

what are the drug interactions you should be concerned about w/ verapamil & diltiazem?

A

caution for AV block when used w/ beta blockers & digitalis!

(amlodipine does not have this restriction)

100
Q

what is the mechanism of sodium nitroprusside?

A

generation of NO > rapid acting venous & arteriolar vasodilator

101
Q

what is the main effect of sodium nitroprusside?

A

vasodilation > lower PVR > lower BP

102
Q

what are the adverse effects of sodium nitroprusside?

A

reflex tachycardia, possible cyanide poisoning

severe hypotension

103
Q

is sodium nitroprusside fast acting?

A

YES!

IV drip

short plasma half-life

104
Q

when do you use sodium nitroprusside?

A

hypertensive emergencies

105
Q

what is the mechanism of minoxidil?

A

open K channels > smooth muscle hyperpolarizaiton > smooth muscle relaxation > arterial dilation > decreased PVR > decreased BP

106
Q

what are the 3 classes that affect the RAS?

A

ACEIs

Angiotensin II receptor blockers (ARBs)

renin inhibitors

107
Q

what drugs are ACEIs?

A

captopril

enalapril

lisnopril

108
Q

what drugs are ARBs?

A

losartan

valsartan

irbesartan

109
Q

what is the mechanism of ACEIs?

A

inhibit ACE > lower circulating Angio II > decreased PVR > decreased BP

110
Q

what are the adverse effects of ACEIs?

A

cough, hyperkalemia

skin rash, taste

111
Q

when should you use ACEIs?

A

stage 1 & 2 HTN

CHF

112
Q

do ACEIs adversely affect plasma lipids or glucose?

A

nope

113
Q

what is the drug of choice for HTN pts w/ diabetes?

A

ACEIs

114
Q

when are ACEIs contraindicated?

A

pregnancy

115
Q

what ethnic group is not as affected by ACEIs?

A

african americans

116
Q

what is the mechanism of ARBs?

A

selectively block Angio II AT-1 receptor > lower PVR > lower BP

117
Q

what are the adverse effects of ARBs?

A

hyperkalemia, fetal toxicity

skin rash, taste

NO COUGH!

118
Q

what type of drug is aliskiren?

A

renin inhibitor

119
Q

what is the mechanism of aliskiren?

A

inhibit conversion of angiotensinogen to angiotensin I (RLS of RAS)

120
Q

what is the efficacy of aliskiren on lowering BP?

A

as good as or better than ACEIs & ARBs

121
Q

what are the side effects of aliskiren?

A

fetal toxicity

diarrhea, stomach pain, heartburn, cough, rash, dizziness, HA, back pain

122
Q

when is aliskiren contraindicated?

A

do not use w/ ARBs or ACEIs in pts w/ diabetes &/or CKD

123
Q

when combining HTN drugs, what combo should you avoid?

A

ACEI + ARB

124
Q

what is resistant HTN?

A

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
Q

how many HTN pts have resistant HTN?

A

10-40%!

126
Q

what are the 1 year rates of adherence to BP meds?

A

20-80% (not helpful at all!)

127
Q

what drug regimen has higher adherence?

A

single drug and/or lower number of doses/day

128
Q

what drugs have higher adherence rates?

A

RAS drugs & CCBs

vs diuretics & beta blockers

129
Q

what is adherence to dietary changes like?

A

worse than drug adherence

10-20% adherence for salt reduction

130
Q
A

Block 9 Week 2 (5 decks)

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