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Therapeutics P2 > Exam 6 lecture 1 > Flashcards

Exam 6 lecture 1 Flashcards

1
Q

1st line agents for initiation of hypertension agents

A

Thiazides, CCBs, ACE inhibitors, ARBs

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2
Q

Did SPRINT trial include patients with diabetes?

A

no

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3
Q

Patients who can not take thiazides should take

A

CCBs or ACE/ARB

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4
Q

Are all 1st line combinations acceptable for HTN?

A

no

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5
Q

What are the preferred combinations for 1st line tx for HTN

A

ACE/CCB

ARB/CCB

ACE/Diuretic

ARB/Diuretic

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6
Q

What combo can we never do for 1st line tx for HTN

A

ACE/ARB

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7
Q

For a patient with HTN and a patient specific factor for stable ischemic heart disease what is 1st line therapy? What should be added next? And after that?

A

1st line- B blocker

next should be ACE/ARB

Additional needed- DHP CCB

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8
Q

For a patient with HTN and a patient specific factor for HFrEF, what drug should we avoid?

A

Non DHP CCB

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9
Q

For a patient with HTN and a patient specific factor for preserved ejection fraction with fluid overload what should we use to treat

A

Diuretics

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10
Q

For a patient with HTN and a patient specific factor for preserved ejection fraction with elevated BP what should we use to treat

A

ACEi/ARB

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11
Q

For a patient with HTN and a patient specific factor for preserved ejection fraction with elevated HR what should we use to treat

A

B blocker

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12
Q

For a patient with HTN and a patient specific factor for stage 1 or stage 2 CKD and albuminuria (>300mg.day) or >300mg/g-creatine ratio what should we use to treat

A

ACEi (Or ARB if no tolerance)

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13
Q

For a patient with HTN and a patient specific factor for CKD stage 3 or 4 treatment

A

ACEi (or ARB)

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14
Q

eGFR cut off for stage 3 or 4 CKD

A

<60

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15
Q

For a patient with HTN and a patient specific factor for post kidney transplant

A

DHP CCBs

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16
Q

when to initiate therapy for a patient with HTN and a patient specific factor for secondary CVD (stroke) prevention

A

> 140/90 BP

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17
Q

For a patient with HTN and a patient specific factor for secondary stroke (CVD) prevention what should treatment be

A

Thiazides (1st line)
ACe/ARB
Combo of the above

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18
Q

For a patient with HTN and a patient specific factor for diabetes patients

A

If albuminuria (>300 mg/day OR >300 mg/g albumin-to-creatine ratio >300 -ACE/ARB

If not- Thiazide or CCB

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19
Q

IMPORTANT For a patient with HTN and a patient specific factor for pregnancy how to tx

A

Methyldopa
Nifedipine
Labetalol

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20
Q

Pregnancy is CI in which HTN drugs

A

ACE/ARB
Direct renin inhibitors

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21
Q

For a patient with HTN and a patient specific factor for black people without CKD or HF treatment

A

Thiazide or CCB

2nd line- ACE/ARB

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22
Q

how to treat HTN pts with stable ischemic heart disease

A

ACEi/ARB and BB 1st line

CCB add if uncontrolled

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23
Q

How to treat HTN pts with HFrEF

A

ACEi/ARB, Diuretic BB(1st)

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24
Q

How to treat HTN pts with HFpEF

A

Diuretic 1st line (if symptomatic)
if persistent HTN, ACE or ARB

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25
Q

how to treat CKD if albuminuria present

A

ACE (ARB if no tolerance to ACE)

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26
Q

How to treat HTN in renal transplant pts

A

CCB

27
Q

how to treat HTN for secondary stroke prevention

A

ONLY START IF BP >140/90
Thiazide, ACE or ARB

Combination

28
Q

how to treat HTN for DM patients`

A

Any 1st line option
but ACEi/ARB if albuminuria present

29
Q

How to treat HTN for black patients

A

Use thiazides or CCBs unless HF or CKD

30
Q

how to treat HTN for pregnant patients

A

methyldopa, nifedipine, labetalol

31
Q

What are the 2 K wasting diuretics

A

Thiazides and Loop diuretics

32
Q

Thiazide drug names

A

Chlorthalidone, hydrochlorothiazide, Indapamide, Metolazone

33
Q

Loop diuretic drug names

A

Furosemide, torsemide, bumetadine

34
Q

What are the 2 K sparring diuretics

A

Aldosterone antagonist
K sparring diuretics

35
Q

Aldosterone antagonist drug names

A

Spironolactone, eplerenone

36
Q

K sparring drug names

A

Amiloride, Triamtrene

37
Q

What are the antihypertensive effects of diuretics due to?

A

Initially a decrease in SV, but long term a decrease in PVR.

38
Q

Most commonly used thiazide? Most potent thiazide?

A

HCTZ most common
Chlorthalidone most potent

39
Q

In what CRCL are thiazides more effective than loop diuretics

A

CrCl>30

40
Q

when to dose thiazides

A

Morning (Avoid nocturnal diuresis)

41
Q

When are thiazides dosed?

A

All dosed once a day in the AM

42
Q

CI of thiazides

A

sulfa allergy

43
Q

Drug interaction with thiazides

A

Li toxicity

44
Q

Adverse effects of thiazides

A

Hypokalemia, Hypomagnesia, Hypercalcemia, hyperuricemia

45
Q

When are loop diuretics more effective than thiazide drugs

A

When CrCl<30

46
Q

What do we mean by loop diuretics have a high ceiling dose response curve

A

May need higher doses in patients with severely reduced renal function. Switching to another loop diuretic or form PO to IV can help

47
Q

Most commonly used loop diuretic

A

Firosemide

48
Q

Loop diuretic that can be used in sulfa allergy

A

Ethacrynic acud

49
Q

adverse effects of loop diuretics

A

Ototoxicity, hypomagnesimia, hypokalemia

50
Q

Aldosterone antagonist drugs

A

Spironolactone, eplerenone

51
Q

What drug is preferred in resistant HTN? adverse effect of this drug? WHat to replace it with

A

Spironolactone, Replace with eplerenone, gynecomastia develops in upto 10% of pts

52
Q

NEVER INITIATE aldosterone antagonist if

A

K>5

53
Q

When to hold or reduce spironolactone dose

A

K>5.5 or Scr increase by 25%

54
Q

Adverse effcets of aldosterone antagonists

A

Hyperkalemia, Hyponatremia, gynecomastia

55
Q

Drug i/a of aldosterone antagonists

A

ACE/ARB/Renin inhibitors/ NSAIDs

56
Q

contraindications of eplerenone

A

Eplerenone-impaired renal function (CrCl<50 or Scr>2 for males >1.8 for female)

T2DM and proteinuria

57
Q

name the K sparring diuretic drug name

A

Amidoride triamtrene

58
Q

Use of AMidoride triamtrene? What side effects could it cause?

A

Used in combo with thiazide to combat hypokalemia. Could cause gout (uric acid increase) and hyperkalemia

59
Q

most diuretics are dosed

A

1 or 2 times a day (thiazide once)

60
Q

Diuretic monitoring paraneters

A

electrolyte and kidney function

61
Q

Steps to monitoring diuretic

A
  1. Get baseline before starting therapy
  2. check 1-2 weeks after initiation (1 week for CKD pts and elderly pts)
  3. 3-4 weeks after initiation check again for loop diuretics and aldosterone antagonist

Check every 6-12 months

62
Q

what diuretic is 1st line for resistant HTN patients

A

Spironolactone

63
Q
A

Therapeutics P2 (41 decks)

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