HTN Flashcards
what is secondary HTN
caused by renal disease, sleep apnea, or adrenal disease
what is primary or essential HTN
what most people have
cause is unknown but attributed to risk factors
which systems have increased activity in HTN
sympathetic nervous system
Renin-angiotensin-aldosterone system
Describe how the RAAS system increases blood pressure
low blood pressure signals the liver to release angiotensinogen and renin which converts to angiotensin I. ACE then converts this to Angiotensin II which causes aldosterone secretion and vasoconstriction. aldosterone prompts increase Na and water reabsorption increasing blood volume.
how does an ACE inhibitor affect blood pressure
it prevents ACE from inactivating bradykinin (which causes vasodilation) and prevents the conversion of angiotensin I to angiotensin II
how does the sympathetic nervous system cause increased blood pressure
low blood pressure signals the brain to release Norepi which causes vasoconstriction by activating the alpha-1 receptors as well as increased HR and contractility by activating the beta 1 receptors
What do DHP CCBs affect?
SVR (systemic ventricular resistance)
what do non-dhp ccbs affect
contractility and heart rate
Normal blood pressure
<120/<80
top or bottom number: systolic
top
top or bottom number diastoli
bottom
HTN values
> /= 130/ >/= 80
what should sodium intake be reduced to for HTN management?
<1500mg/daily
when to start drug treatment
stage 2 HTN (>140/>90)
or
stage 1 HTN + ASCVD risk >/=10% or clinical CVD
First-line agents: non-black patients
thiazide, CCB, ACE inhibitor, ARB
First-line agents: black patient
thiazide or CCB
First-line agents: CKD (all races)
ACEi or ARB
First-line agents: diabetes with albuminuria
acei or arb
First-line agents: stage 2 HTN with readings >150/90
start 2 first-line agents
which first line agents should not be used in combo
acei and arbs
can you add a second agent before the first one is titrated to max?
Yes! actually works better and can prevent side effects
which htn drugs have a boxed warning for fetal toxicity when used in pregnancy
acei, arbs, and aliskiren
what is recommened in patients with a high risk of preclampsia
low dose aspirin daily after first trimester
when to treat chronic htn in a pregnant patient
if >/= 160/105
First-line agents: pregnant patient
labetalol and nifedipine ER
MOA thiazide diuretics
inhibit sodium reabsorption in the distal convoluted tubules, increasing excretion of sodium, cl, water, and K
thiazides CI
sulfonamide allergy
at what Crcl should thiazides not be used
CrCl < 30
which thiazide is available IV
chlorothiazide
which drug should not be used with thiazides due to increased risk of toxicity
lithium
List of DHP CCBs
“-pine”
MOA DHP CCBs
inhibit Ca from entering vascular smooth muscle and myocardial cells, causes peripheral arterial vasodilation
Which side effects occur with CCBs due to peripheral vasodilation
reflex tachycardia/palpitations
headache
flushing
peripheral edema!
Which CCB is preferred in HF
amlodipine
CI Nicardipine
advanced aortic stenosis
Non-DHP CCBs indication
control HR/arrhythmias
Afib
MOA non-DHP CCBs
negative inotropic and chronotropic effects (decrease force of ventricular contractions and decrease HR)
Side effects with non-DHP CCBs
edema, constipation, gingival hyperplasia
CYP considerations with CCBs
CYP3A4 substrates
If a patient experiences angioedema with an ACEi or ARB, can you try the other class?
NO
ACEi/ARBs safe in pregnancy?
NO! Boxed warning
hypo or hyperkallemia with ACEi?
hyperkalemia!
why are K+ sparing diuretics used in combo with thiazides?
to combat K+ loss
Which K+ sparing is non-selective?
spironolactone - also blocks androgen
When are beta blockers recommended first line?
post-MI
ischemic heart disease
heart failure
Which beta blockers are preferred in heart failure
metoprolol succinate
bisoprolol
carvedilol
beta 1 selective beta blockers
atenolol
esmolol
metoprolol
nebivolol
Non-selective beta blockers
propranolol
nadolol
carvediolol
labetalol
CI beta blockers
hepatic impairment
What type of beta blockers are preferred in bronchospastic disease
selective
Why do we have to be cautious in diabetic patients on beta blockers
beta blockers can mask hypoglycemia
metoprolol tartrate IV:PO dosing
1:2.5
why does propranolol have more CNS effects
high lipid solubility = crosses BBB
what can help with orthostatic hypotension in carvedilol
taking with food!
alpha 2 adrenergic agonists list
clonidine
guanfacine
MOA alpha 2 adreergics
stimulating these receptors reduces outflow of norepi which causes decreased SVR and HR
which alpha 2 comes in a patch?
clonidine
*good for patients who can’t swallow
which alpha 2 is commonly used in resistant HTn
clonidine
which alpha 2 can be used in pregnancy
methyldopa
methyldopa warnings
hemolytic anemia
hepatic necrosis
list of direct vasodilators
hydralazine
hydralazine CIs
mitral valvular rheumatic HD
CAD
Alpha blocker list
-zosin
role of alpha blockers
can be used in men with HTN and BPH
HTN emergency or urgency - organ damage
emergency
HTN emergency or urgency which one needs IV treatment
emergency
How quickly do we need to decrease BP in emergency
NO MORE than 25% in first hour
IV meds for HTN
chlorothiazide diltiazem enalaprilat esmolol hydralazine labetalol metoprolol nicadipine propranolol verapamil
