Exam 1 - HTN Therapeutics - Longer Cards Only Flashcards
What can cause an increase in CO and/or SVR?
Increase in fluid volume caused by an increase in sodium intake or renal sodium retention
Increased RAAS activity
Increased SNS activity
Endothelial dysfunctions
Genetic mutations
common causes of secondary HTN
Drug/alcohol induced
Renal parenchymal disease
Renovascular disease
Obstructive sleep apnea
Primary aldosteronism
(DRROP)
uncommon causes of secondary HTN
Pheochromocytoma / paraganglioma
Cushing’s syndrome
Aortic coarction
Congenital adrenal hyperplasia
Hypothyroidism
Acromegaly
Mineralocorticoid excess syndromes other than primary aldosteronism
Primary hyperthyroidism
(People Crown A CHAMP)
meds that can cause drug induced HTN
Corticosteroids
Oral contraceptives
Caffeine
Amphetamines
Illicit drugs
NSAIDs
Erythropoietin
Antidepressants
Atypical antipsychotics
Anabolic steroids
Decongestants
(COCAINE = An Awful Awful Drug)
what are environmental risk factors of HTN
Excess sodium intake
Physical inactivity
Overweight/obese
Excessive alcohol use
Insufficient intake of K, Ca, Mg, protein, fiber, fish fats
modifiable risk factors of HTN
DM
Unhealthy diet
Current cigarette smoking
Overweight/obese
Physical inactivity
Dyslipidemia
(Don’t Upset COP Dave)
relatively fixed risk factors for HTN
CKD
Psychosocial stress
Obstructive sleep apnea
Family Hx
Increased age
Low socioeconomic/education status
Male
(Cinema + Photography On FILM)
if the first line recommendation for pts w/ stable ischemic heart disease does not help them meet their goal:
What should we do for pts WITH angina?
What should we do for pts WITHOUT angina?
With: add DHP CCB
Without: may use DHP CCB, thiazide type diuretic, and/or MRAs as needed
complications of persistent HTN
PAD
HF
Angina
Retinopathy
MI
Abdominal aortic aneurysm
Stroke
CVD
CKD
(PHARMAS + CC)
First line recommendation for pts w/ HF with reduced ejection fraction dealing with HTN
ACEI/ARB
Angiotensin receptor - neprilysin inhibitors
MRAs
Diuretics
Beta blockers
goals of therapy for HTN treatment
reduce morbidity associated with HTN
Reduce BP to target levels
nonpharmacological measures for HTN
Smoking cessation
Physical activity increase
Antihypertensives
Moderate/no alcohol use
Salt reduction
(SPAMS)
recommendation for reducing salt intake for pts w/ HTN
Aim to reduce by at least 1000 mg/day
Avoid processed & commercial foods
Limit use of condiments and addition of salt
what does ASCVD refer to
coronary heart disease (MI, angina, coronary artery stenosis)
CVD (TIA, ischemic stroke, carotid artery stenosis)
PAD (claudication)
Aortic atherosclerotic disease (abdominal aortic aneurysm and descending thoracic aneurysm)
what should you consider when picking a drug therapy for HTN pts
Age
Concurrent meds
Adherence
Drug interactions
Overall treatment regimen
Out of pocket cost
Comorbidities
when should you check up w/ HTN pts? Why?
Every month
Assess BP control
Reinforce nonpharm therapy and adherence
Adjust if necessary
Lab monitoring
what should you do when a pt presents w/ resistant HTN?
Confirm BP is truly uncontrolled; have pt self monitor at home
Inquire about adherence, use of meds that can affect BP, dietary salt intake
Consider secondary causes
Ensure adequate diuretic therapy using chlorthalidone over HCTZ
Management
what does management of resistant HTN include
Improved adherence
Detection & correction of secondary HTN
Address lifestyle factors
Maximize diuretic therapy & consider adding spironolactone
May use loop diuretics for pts w/ CKD
management of hypertensive emergency
avoid over aggressive management to avoid renal, cerebral, or coronary ischemia
In general, reduce BP by 25% in first hour and maintain DBP < 100 to to 160/110 over 2 hours
For inpatients w/ compelling indications: reduce SBP to < 140 and < 120 in aortic dissertion
continuous IV infusion
Fairly quick onset
More titratable
Possibly longer half life
May need PCU/ICU admission
Larger volume load from IV infusion
