Exam 6 - HTN Olenik Flashcards
HTN treatment for pt with stable ischemic heart disease
ACE/ARB and beta blocker first, then can add DHP CCB if still uncontrolled
HTN treatment for pt with HfrEF (Heart failure with reduced ejection fraction)
ACE/ARB/ARNI, mineralocorticoid receptor antagonists, diuretics and beta blocker are first line
what class should be avoided in pts with HfrEF?
a. thiazides
b. beta blockers
c. DHP CCBs
d. non-DHP CCBs
d. non-DHP CCBs
first line agents for initial HTN treatment (3)
-thiazide diuretics (best)
-CCBs
-ACEs/ARBs
preferred combination therapy treatment for HTN
an ACE/ARB with a CCB or diuretic, basically any combo of those
(CCB/diuretic is acceptable but not preferred)
HTN treatment for pt with HfpEF (preserved ejection fraction)
diuretics first line (if symptomatic); if persistent HTN, ACE/ARB or BB (if HR elevated)
HTN treatment for pt with CKD
ACEi (or ARB if intolerant)
HTN treatment for pt with kidney transplant
DHP CCBs first line over ACEi
(CCB reduces graft loss and maintains higher GFR)
HTN treatment for secondary stroke prevention
ACEi/ARB, thiazide diuretic, or combo of those two
what BP is needed to start antihypertensive treatment for secondary stroke prevention?
140/90+
what is the preferred agent for pt with HTN and diabetes, in the presence of albuminuria?
ACEi or ARBs
3 preferred agents for pregnant HTN patients
-methyldopa
-nifedipine
-labetalol
what is the preferred HTN treatment for black patients without HF or CKD, including those with diabetes? (2 options)
thiazide or CCB
true or false: an ARB may be useful for prevention of recurrence of A-Fib
true
what drug class can help improve survival in pts with HTN and aortic disease? (from slide 19)
beta blockers
LH is a 52 year old African American male who you are seeing in clinic for type 2 diabetes follow up. His medications include metformin and glipizide. While reviewing his chart you notice his blood pressure was 135/79 at his last PCP visit and today is 133/81. His ASCVD risk is 8.2% and kidney function is normal.
Which medication classes would be first-line for LH? (2)
thiazide diuretic or CCB
TT is a 62 year old white female with a PMH significant for stroke and heart burn. Her medications include omeprazole and atorvastatin. Her primary care physician puts in a pharmacy consult for her newly diagnosed HTN. BPs for her last two clinic visits are 147/81 and 150/90.
What combo would you recommend to treat TT’s HTN?
thiazide and ACE inhibitor combo
thiazides are more effective than loop diuretics with CrCl > ___ mL/min
> 30 mL/min
how many times per day are all thiazide diuretics dosed?
a. once
b. twice
c. four times
d. as needed
a. once
drug interaction for thiazide diuretics
lithium toxicity with concurrent use
two CIs for thiazide diuretics
sulfa allergy, anuria
CI for loop diuretics (1)
sulfa allergy (except for ethacrynic acid)
first-line diuretic for resistant HTN
spironolactone
do not initiate aldosterone antagonist with potassium > _____ mEq/L
> 5
