HTA tratament

Question 1

De ce terapia in HTA?

Answer 1

Reduce riscul de:

1. AVC 35-40%
2. IM 20-25%
3. IC 50%
4. Risc de mortalitate CV 21%

Question 2

Prima linie de tratament HTA

Answer 2

1. Modif stil de viata (Sare,dieta,fumat, acitv fizic etc)

2. Mono terapie / Dubla / tripla / tripla + spironolactona

Question 3

Monoterapia

Answer 3

Grad 1 de HTA (TAsis <150mmHG)
>80 ani
Fragil

Question 4

Terapia initiala (dublu combinatie)

Answer 4

IEAC/ARB (Sartan) + CCB/Diuretic

Question 5

Terapia cu triplu combinatie

Answer 5

IEAC/ARB(Sartan) + CCB + Diuretic

Question 6

Terapia cu triplu combinatie + Spironolactona/altele

Answer 6

La HTA Rezistenta:
Triplu terapie + Spironolactona (25-50mg) sau
Alt diuretic/ BB/A-bloc

Question 7

BB cand se folosesc?

Answer 7

Beta-blocantele se poate folosi oricand, dar fiind specific pt alta afect concomitent, adica:
Insuf cardiaca, Angina, Post-IM, FiA

Question 8

Diuretice Tiazidice

Answer 8

Hidroclorotiazida 12.5-25mg/zi
Indapamida 1.5mg/zi priza unica
Mda---> Inhiba reabsorbtia de Na & Cl in TCD
Ind: 
Dublu/triplu comb 
HTA varstnici 
Ef sec:
HipoK, Hiperuricemie,Hipercolest,HiperCa,Hipergli
Ci: 
IR (Clcr<20ml/min), pac cu sd metab

Question 9

Diuretice de Ansa

Answer 9

Furosemid 20-80mg/zi in 2-3 prize/zi
Mda—> Inhib Na/K/Cl co-transp din Ascendent Henle
Ind:
HTA asoc cu pat carac de retentie hidrosalin/IRC
Efsec: hipoVol, hipoK, Hiperuricemie, alcaloza metb
CI:
hTA, Hiperuricemie

Question 10

Diuretic economisitoare de Potasiu

Answer 10

Spironolactona 25-45mg/zi
Mda—> Antagonist de r.Aldosteron/Inhib pomp Na-H + in TCD
Ind:
HTA din hiperaldosteronism primar/HTA rezistenta
Efsec: HiperK
CI:
IR, Hiperpotasemie

Question 11

IECA

Answer 11

Captopril, enalapril (5-20mg/zi 2 prize), ramipril/perindopril (5-10mg/zi unica),
Lisinopril (5-20mg/zi unica)
Ind: 
HTA in general
HTA in IC, HTA asoc BC
Efsec:
Retentie azot in hipoperf renala, HiperK, Tuse, alergii
CI:
Sarcina , Stenoza bilat art renal, IR

Question 12

Sartani

Answer 12

Losartan (50-100mg/zi), Valsartan (80-160mg/zi), Candesartan (8-16mg/zi)
IND:
HTA in general
HTA cu IC, HTA cu BC, Nefroprotect la DZ
Efsec:
Retentie azot in hipoperf renal, HiperK
CI:
Sarcina, Stenoza bilat art renala, IR

Question 13

BCC (bloc- canale de Ca)

Answer 13

Dihidropiridine: 
Nifedipina retard 20-40mg/zi), Amlodipina (5-10mg/zi)
Non-Dihidropir: Verapamil (80-240mg/zi)
MDA---> Bloc can. Ca + relax musc neted vasc
IND:
HTA in general
HTA varstnici
HTA cu IR
Efsec:
Tahicardie, eritem facial, Tulb G-I, edeme, cefalee/BAV
CI:
ICC, BAV gr 2-3

Question 14

BB(Beta-blocante): Ef hTA

Answer 14

scade DC
Inhbi Reninei
Inhib alfa-recept presinap:
–> Scade elib Noradrenalina + Scd tonus vasomotor central

Question 15

BB

Answer 15

,Propranolol, Atenolol (50-100mg/zi), Metoprolol (50-200mg/zi)
BB cu act alfa-litic: Carvedilol (25-50mg/zi)
BB cu vasodilat mediat NO: Nebivolol
IND:
HTA cu BC
HTA cu IC
HTA cu FiA
HTA cu hiperstim Adrenergic/anxietate
EfSec:
Tulb metab
CI:
BRADIARITMII/ (hTA)