HTN Flashcards
BP assessments should be based on an average of
at least two readings on two separate occassions
HTN stage one is defined as
130-139 OR 80-89
HTN stage two is defined as
> 140 or >90
When to start treatment?
stage 2
stage 1 + clinical CVD + 10 year ASCVD >10%
What is the BP goal?
<130/80
Initial drug selection for non-blacks
thiazide
CCB
ACE/ARB
initiatal drug selection for blacks
thiazide or CCB
initial drug selection for CKD all races
ACE or ARB
initial drug selection for diabetes with albuminuria all races
ACE or ARB
When do you initiate 2 first line drugs?
in stage 2 when average is >150/90
What is first line treatment in pregnancy?
labetalol
nifedipine ER
methyldopa - less effective
Brand: Zestoretic
generic: lisinopril/hctz
Brand: hyzaar
generic: losartan/hctz
Brand: Benicar HCT
generic: olmesartan/hctz
Brand: Diovan HCT
generic: valsartan/hctz
Brand: Lotrel
generic: benazepril/amlodipine
Brand: Exforge
generic: valsartan/amlodipine
Brand: tenoretic
generic: atenolol/chlorthalidone
Brand: Ziac
generic: bisoprolol/hctz
Brand: Maxzide, Maxzide-25, Dyazide
generic: triamterene/hctz
________ inhibit sodium reabsorption in the DCT causing increased excretion of sodium, chloride, water and potassium
thiazides
SULFA DRUG
Side effects of thiazides
decrease K Mg and sodium
increased calcium, UA, LDL, TG, BG
photosensitivity
Dosing for chlorthalidone
12.5-25mg daily
dosing for hctz (microzide)
12.5-50mg daily
thiazides + lithium -
thiazides decrease lithium renal clearance and increase risk of toxicity
these anti-hypertensive drugs inhibit Ca ions from entering vascular smooth muscle and myocardial cells; this causes peripheral arterial vasodilation
CCBs
Brand: Norvasc
generic: amlodipine
Brand: Cardene IV
generic: nicardipine IV
Brand: Adalat CC, Procardia XL
generic: nifedipine ER
side effects of CCBs
hypotension, peripheral edema, headache, flushing, palpitations, gingival hyperplasia
What is the drug of choice in pregnancy from CCB
nifedipine ER
also used in raynauds
Allergy to soybeans soy products or eggs contraindication to this CCB
clevidipine
Which are more selective for the myocardium? CCB or non DHP CCB?
non DHP CCB
brand: cardizem, Tiazac
generic: diltiazem
Brand: Calan SR
generic: verapamil
Brand: lotensin
generic: benazepril
Brand: Vasotec
generic: enalapril
Brand: prinivil, zestril
generic: lisinopril
Brand: accupril
generic: quinapril
Brand: Altace
generic: ramipril
What electrolyte should you monitor with ACEs?
potassium (hyperkalemia)
Brand: Avapro
generic: irbesartan
Brand: Cozaar
brand: losartan
Brand: Benicar
generic: olmesartan
Brand: Diovan
generic: valsartan
Which ARB can cause sprue like enteropathy (severe chronic diarrhea with substantial weight loss)
olmesartan
is there a washout period with entresto with ARBs?
no!
Brand: aldactone
generic: spirinolactone
Brand: Tenormin
generic: atenolol
Brand: Brevibloc
generic: esmolol
INJ
Brand: lopressor
generic: metoprolol tartrate
Brand: Toprol XL
generic: metoprolol succinate XL
Which BB should be taken with food?
oppressor and toprol XL
carvedilol (all forms)
What are the beta 1 selective drugs?
AMEBBA
atenolol
metoprolol esmolol bisoprolol betaxolol acebutolol
Brand: bystolic
generic: nebivolol
Non selective BB
propranolol
nadalol
Brand: Corgard
generic: nadolol
Non selective BB and alpha 1 blockers
carvediolol
labetolol
coreg 3.125mg BIG = Coreg CR __mg daily
10mg
Beta 1 selective blocker with NO-dependent vasodilation
nebivolol
What is the brand name of clonidine used in ADHD
Kapvay
Brand: catapres
generic: clonidine
What are side effects of clonidine?
dry mouth somnolence fatigue dizziness constipation dec HR hyptotension
Which of the centrally-acting Alpha 2 adrenergic agonists have a risk of DILE?
methyldopa
how often do you apply the clonidine patch?
weekly
Which of the centrally-acting Alpha 2 adrenergic agonists have a risk of hemolytic anemia?
methyldopa
coombstest
brand name of guanfacine IR used for ADHD
intuniv
hydralazine side effects
peripheral edema
headache/flushing
palpitations
reflex tachy
WARNING FOR DILE
direct vasodilators
hydralazine, minoxidil
What is defined as hypertensive crisis?
BP >180/120
patient has acute target organ damage + BP >180/120. what is this called?
hypertensive emergency
Treatment for hypertensive emergency
IV meds
decrease BP by no MORE than 25% within the first hour, then if stable decrease to 160/100 in the next 2-6 hours
patient has no evidence of acute target organ damage but BP >180/120
hypertensive urgency
how do you treat hypertensive urgency?
ORAL meds
decrease BP gradually over 24-48 hours
What are the key hypertensive medications?
chlorothiazide clevidipine diltiazem enalaprilat esmolol hydralazine labetolol metoprolol tartrate nicardipine NTG nitroprusside propranolol verapamil
what anti-hypertensives leave a ghost tablet?
adalat CC (take on empty stomach) Procardia XL
Where do you apply the clonidine patch?
upper outer arm or chest