Extra Flashcards
Which diuretics are safe to use in patients with renal impairment?
loop diuretics
Which hypertensive mediation is first line for pregnant patients?
Methyldopa - Alpha 2 Agonist
JNC 8: goal
140/90; unless > 60 yo: 150/90
JNC 8: Non-black
thiazide, CCB, ACEI, or ARB
JNC 8: African Americans
thiazide or CCB
JNC 8: Chronic Kidney Disease
regimen should include an ACEI or ARB (including African Americans)
JNC 8: If goal not reached
stress adherence to medication and lifestyle
increase dose or add a second or third agent from one of the recommended classes.
choose a drug outside of the classes recommended above only if these options have been exhausted. Consider specialist referral.
Beta Blockers in Hypertension
not much evidence that it helps in hypertension
used with an ACE-I and ARB in patients with coronary artery disease or heart failure
ASH Goals
goal: <140/90; unless >80 yo 150/90 or 140/90 with diabetes or kidney disease
ASH first line of treatment
lifestyle changes
ASH Stage 1 Treatment
(140-159/90-99) consider delay in medication
black CCB or Thiazide
Non-black; under 60 – ACE-I or ARB; over 60 – CCB or Thiazide
ASH Stage 2 Treatment
(over160/100)
all patients start with two drugs: CCB or Thiazide plus ACE-I or ARB
ASH Hypertension + Diabetes Treatment
ACE-I or ARB
Black - okay to start with CCB or thiazide
ASH Hypertension + Chronic Kidney Disease Treatment
ACE-I or ARB
ASH Hypertension + Coronary Artery Disease Treatment
Beta Blocker plus ACE-I or ARB
ASH Hypertension + Stroke History Treatment
ACE-I or ARB
CCB may show better outcomes in black patients
ASH Hypertension + Heart Failure Treatment
ACE-I or ARB plus Beta Blocker + diuretic + spironolactone
add CCB if needed
What are the different classes of diuretics best at?
Thiazides - hypertension
loop diuretics - diuresis, relieving symptoms of heart failure
spironolactone (aldosterone antagonist) - improving symptoms of heart failure
ACC/AHA Heart Failure Treatment - Stage A
patients at high risk for heart failure but without structural heart disease or symptoms of heart failure
address risk factors: treat hypertension, encourage smoking cessation, treat lipid disorders, optimize diabetes treatment, encourage exercise, and discourage excessive alcohol use
drugs: ACE-I or ARB
ACC/AHA Heart Failure Treatment - Stage B
patients with cardiac disease but without limitations of physical activity; ordinary physical activity does not cause undue fatigue, dyspnea, or palpation
structural heart disease: previous MI, LV remodeling, low EF, valvular disease
address risk factors
Drugs: ACE-I or ARB + beta blocker
ACC/AHA Heart Failure Treatment - Stage C
HF symptoms
patients with known structural heart disease, and SOB, fatigue, reduced exercise tolerance
treatment plan: salt restriction
drugs: diuretics, ACE-I, and beta blockers
in selected patients: ARBs, digoxin, aldosterone receptor antagonists, hydralazine/nitrates, devices (biventricular pacing, implantable defibrillation)
ACC/AHA Heart Failure Treatment - Stage D
end-stage heart failure
patients with marked symptoms at rest despite medical therapy
treatment plan: continue interventions under stages A through C; end of life care/hospice; specialized interventions (heart transplant, chronic inotropes, mechanical support)
Initial Treatment of Acute Heart Failure
treat congestion: IV diuretics, IV vasodilators
IV diuretics: furosemide, torsemide, bumetanide, ethacrynic acid
IV vasodilators: nitroglycerin, nitroprusside, nesiritide
treat hypoperfusion: positive inotropes (make the heart beat harder – push blood around better)
IV: dobutamine, dopamine, phosphodiesterase inhibitors
Four Groups Targeted for Statin Treatment
established ASCVD (secondary prevention): 75 or under – high-intensity statin (moderate if not a candidate for high-intensity); older than 75 – moderate intensity
LDL >190 mg/dL: high-intensity statin (moderate if not a candidate for high-intensity)
diabetes mellitus, 40-75 yo, LDL 70-189: moderate intensity (high intensity if ASCVD risk is greater than 7.5)
primary prevention without DM, 40-75 yo, estimated 10 year risk of 7.5% or greater + LDL 70-189: moderate or high intensity statin
What is the only recommended treatment for hypercholesterolemia in pregnant women?
Bile Acid Sequestrants (Renins), but more commonly treatments are just held during pregnancy
Vaughn Williams Classification of Antiarrhythmic Drugs
Class I - Na channel blocker: IA—intermediate potency; IB—lowest potency, minimal effect on conduction velocity at normal heart rates; IC—greatest potential for slowing ventricular conduction
Class II - BB blockers
Class III - K channel blocker
Class IV - CCB (diltiazem, verapamil)
classes I and III affect depolarization and its rate; can slow down steps in the cardiac conduction process
classes II and IV have more of a rate control affect, although Ca is involved in the cardiac cycle as well (CCB)
