Exam 1: Hypertension Flashcards
What classifies as elevated blood pressure?
120-129 systolic AND <80 diastolic
What classifies stage 1 hypertension?
130-139 systolic OR 80-89 diastolic
What classifies as stage 2 HTN?
> 140 systolic OR >90 diastolic
What is secondary hypertension?
Increased BP resulting from an identifiable medication or medical condition
What are the major conditions that can cause secondary Hypertension?
Renal disease, renovascular disease, OSA, thyroid disease, coarctation of the aorta, primary hyperaldosteronism, Cushing, pheocromocytoma, or medication induced
What is the gold standard for diagnosing HTN?
Ambulatory blood pressure monitoring
What is the basic testing you should order for patients with primary HTN?
Fasting blood glucose, CBC, lipid profile, serum creatinine with GFR, serum sodium/K+/Ca+, TSH, urinalysis, and EKG
What should you order in patients with DM or CKD when testing for primary HTN?
Urinary albumin
What is the first line treatment for all patients with essential HTN?
Lifestyle changes
What are the 4 first line medications for treatment for HTN?
Diuretics, Angiotensin Converting Enzyme Inhibitors (ACE inhibitors), Angioteninogen Receptor Blockers (ARB), and calcium channel blockers (CCB)
For stage 1 HTN, what is the recommended pharmacologic treatment?
A single antihypertensive drug, titrations up or adding a second medication as needed to reach target BP
For stage 2 HTN, what is the recommended pharmacologic treatment?
2 first line agents of different classes
If the patient has CKD and albuminuria, what should the first medication be for HTN?
An Ace inhibitor
If a patient has DM and albuminuria, what medications should be given for HTN?
ACE or ARB
If a patient has heart failure, what medication for HTN should be avoided if the EF is low?
CCBs
What are the 4 types of diuretics?
Thiazide-type diuretics, loops diuretics, potassium sparing diuretics, and aldosterone antagonists
What is the MOA of Diuretics?
Decreases the body’s sodium stores by inhibiting sodium reabsorption in the nephron.
They reduce plasma volume and peripheral vascular resistance
What are the contraindications for thiazide type and loop diuretics?
Hypersensitivity to sulfas
What is the preferred diuretic in heart failure?
Loop diuretics
What is the preferred diuretic in primary aldosteronism?
Aldosterone antagonists
What are the contraindications for aldosterone antagonists?
Renal impairment
What is the MOA of ACE inhibitors?
Inhibit the RAAS system and stimulate bradykinin which has a vasodilator effect
What kind of drug is spironolactone?
Aldosterone antagonist
What kind of drug is furosemide?
Loop diuretic
What kind of drug is triamterene?
Potassium sparing diuretic
What kind of drug is chlorthalidone?
Thiazide type diuretic
What kind of drugs are lisinopril, quinapil, and enalapril?
ACE inhibitors
What are the contraindications of ACE inhibitors?
Pregnancy, angioedema, renal artery stenosis
YOU CANNOT COMBINE WITH ARB
What are the compelling indications for ACE inhibitors?
DM, CKD, post MI, and heart failure
What is the MOA of ARBs?
Inhibit the RAAS system
What are the contraindications of ARBs?
CANNOT COMBINE WITH ACE INHIBITORS
Pregnancy and renal artery stenosis
What are the two kind of calcium channel blockers?
Non-dihydropyridine (more of a cardiac depressant) and dihydropyridine (more of a vasodilator)
What is the MOA of CCBs?
Inhibition of calcium influx into arterial smooth muscle cells, which reduces peripheral vascular resistance
What are the contraindications of Non-dihydropyridines?
Avoid use with beta blockers, heart failure with reduced EF
What are the contraindications of dihydropyridines?
Avoid in heart failure with reduced EF
What are the two types of Beta blockers?
Cardioselective (B1) and noncardioselective (B1 and B2)
What is the MOA of beta blockers?
Blocks the activity of catecholamines at B adrenoreceptors, which leads to decreased cardiac output, some decreased PVR, and decreased renin activity
What kind of drugs are verapamil and diltiazem?
Non-dihydropyridine
What kind of drugs are amlodipine, nifedipine, and felodipine?
Dihydropyridines
What kind of drugs are propanalol, atenolol, and metoprolol?
Beta blockers
What are the contraindications of beta blockers?
Bronchospastic disease, conduction abnormalities, and acute decomp of CHF
What is the MOA of central alpha agonists?
Stimulate a2 adrenergic receptors in the brain which reduces CNS sympathetic outflow.
**generally reserved for last line due to CNS adverse effects
What are the contraindications of central alpha agonists?
Methydopa in liver disease
What is the MOA of alpha blockers?
Targets a1 receptors on vascular smooth muscle, causing peripheral vascular resistance to decrease, thus decreases BP
What is the compelling indication for alpha blockers?
BPH
What is the MOA of direct renin inhibitors?
Inhibit enzyme activity of renin, reducing the activity of angiotensin 1 and 2 and aldosterone
What are the contraindications of direct renin inhibitors?
Use with an ACE or ARB in DM, pregnancy
What are the side effects of direct renin inhibitors?
Hyperkalemia, renal impairment, hypersensitivity reactions
What are the side effects of alpha blockers?
Orthostatic HTN, reflex tachycardia
What are the side effects of beta blockers?
Bradycardia, bronchospasm
What are the side effects for Ace inhibitors?
Hyperkalemia, acute renal failure, and angioedema
What are the side effects of thiazide type loop diuretics?
Electrolytes imbalances and gout
What are the side effects of ARBs?
Hyperkalemia, acute renal failure, and angioedema
What are the side effects of CCBs?
Cardiodepressant, dizziness, HA
What is hypertensive urgency?
Asymptomatic severe HTN and no evidence of end organ damage (Diastolic greater than 120)
What is hypertensive emergency?
Severe HTN and evidence of acute end organ damage
What is cardiogenic shock?
A status of cellular and tissue hypoxia that most commonly occurs when there is circulatory failure that manifests as hypotension
What kind of drug is Aliskiren?
Direct renin inhibitor
What kind of drugs are the “Zosins”?
Alpha blockers
Wha kind of drugs are verapamil and diltiazem?
Non-dihydropyridines
