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CDM1 > HTN > Flashcards

HTN Flashcards

1
Q

First line agents in HTN

A

ACEi, ARBs, CCB, Thiazide Diuretics

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2
Q

When do we initiate pharmacological therapy?

A

130-139/80-89 ASCVD >10%. 1 month FU
>140/90 in <10% risk, or STROKE

If <10% suggest non-pharm therapy and reasess in 3-6 months

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3
Q

Goal once started on pharmacological therapy

A

<130/80 unless medically unsafe to do so. Ex, fall risk

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4
Q

RAAS Inhibitors

A

ACEi
ARBs
Direct Renin Inhibitor
Aldosterone Antagonist

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5
Q

Excessive RAAS stimulation leads to

A

Increased sympathic activity
Increased PVR
Water/salt retention.

All leading to Elevated BP. Inhibiting RAAS lowers BP

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6
Q

Direct Renin Inhibitor Acts

A

Directly on Renin, less release from kidneys.

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7
Q

ACEi Acts

A

On ACE enzyme, converting AT1 to AT2

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8
Q

ARB Acts

A

Blcoks Angiotensin 2 On AT1 type receptor- vasoconstriction/dilation of arteries.

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9
Q

Aldosterone Antagonists Act

A

Decrease Aldosterone secretion from kidney. Increases NaCl and H2O excretion while conserving K+

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10
Q

ACE Clinical Pearls

A

Causes peripheral vasodilaton.

Increases bradykinin- cough SA

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11
Q

ACE Agents + Dosing

A

Enalapril 5-40mg 1-2xD

Linsinopril 10-40 mg D

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12
Q

ACE Clinical Considerations

A

Renal protective- use with DM, DKD, or CKD.
Use Post MI & HFrEF
Contraindicated in pregnancy, avoid in childbearing years.

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13
Q

ARB Agents + Dosing

A

Irbesaran 150-300mg D
Losartan 50-100mg 1-2xD
Valsartan 80-320mg D

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14
Q

ARB Clinical Considerations

A

Use is similar to ACEi, Do not use ACE/ARB together. Contraindicated in pregnancy.

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15
Q

ACE/ARB ADE

A 
Slight rise in SCr at iniiation
HYPERKALEMIA- monitor K- increased risk of CKD
Dry cough
RARE Angioedema
Pregnancy Cat D
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16
Q

ACE/ARB DDinx

A

K sparing diuretics

K supplements

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17
Q

ACE/ARB Monitoring

A

BP, SCr, Bun, K
Angioedema, cough
Assess blood test for elecrolytes and renal fxn 2-4 weeks after initating therapy

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18
Q

Direct Renin Inhibitor Considerations/ADE

A

Do not use with ACE/ARB, preg. Same considerations.
Slight rise in BUN, SCr at initiation.
HYPERKALEMIA

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19
Q

Aldosterone Antag Considerations/ADE

A

Avoid if Anuria, renal insufficency, High K

Hyponatremia, Gynecomastia, Impotence

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20
Q

Aldosterone Antag SP

A

Used in HFrEF, and Resistant HTN

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21
Q

Non-Dihydropyridine MOA

A

Decreasing contractility (decrease HR and conduction across AV node), decreasing SV, decreases CO. CARDIAC Smooth Muscle Ca Channels. Inhibits Ca2+ Influx

22
Q

Dihydropyridine MOA

A

Dilating peripheral arterioles, decreasing PVR. PERIPHERY smooth muscle ca channels. Inhibiting Ca2+ Influx.

23
Q

Dihydropyridine Agents & Dosing

A

Amlodipine 5-10mg D

Nifedipine 60-120mg D

24
Q

Non-Dihydropyridine Agents & Dosing

A

Diltiazem 120-540mg D

Verapamil (LA/SR) 120-480mg D/BID

25
Q

DHP Clinical Considerations

A

First line therapy. Preffered in Black patients. Effective in olderpatients with isolated systolic Hypertension.

26
Q

Non-DHP Clinical Considerations

A

Cardiac Foucsed benefit: Angina, Afib, PSVT

27
Q

CCB ADE

A

More frequenly from VASODILATION (DHP)

Bradycardia (Non-DHP)
Constipation (Verapamil)

HA, OH, Dizzness

Reflex Tachycardia (DHP)
Pedal Edema (DHP)
28
Q

CCB Contraindications

A

Non-DHP: Heart Block, HF (amlodpine ok)
Beta blockers

DDinx: Verapamil, Diltiazem (Non-DHP) P450 Substates
EtOH increases CCB effects
Limit Dosing w/Simvastatin
     -Amlodipine- NTE 20mg
     -Verapamil/Dilt. NTE 10mg
29
Q

Direct Vasodilators MOA

A

Act Directly on Vascular smooth muscle Dilating ARTERIOLES. Decrease PVR

Compensatory stimulation of baroreceptors (Inc. HR, Inc. NE/Epi Release)

30
Q

Direct Vasodilators Agents & Dosing

A

Minoxidil 10-40mg 1-2xD

Hydralazine 20-200mg 2-4xD

31
Q

Direct Vasodilators Clinical Considerations

A

Considered 4TH LINE or LATER

Likely add-on in resistant HTN

32
Q

Direct Vasodilator ADE

A

Reflex Tachy, Palpations
HA, Dizziness
Na/H2O Retnetion
Lupus-like syndrome (high doses of Hydralazine)

33
Q

Direct Vasodilators Monitor

A

BP
HR
SCr
Edema

34
Q

Classes of Diuretics

A

Thiazide (HCTZ)
Loop (Furosemide)
K+ Sparing (Eplerenone)

35
Q

Diuretic MOA

A

Thiazides- inhibit NaCl reabsorption in DCT
Loops- Inhibit NaCl reabsorption in TA Loop of Henle
K+ Sparing- Limit Na+ reabsorption, K+ Secretion

36
Q

Thiazide Agents and Dosing

A

HCTZ 12.5-25mg D

Chlorthalidone 12.5-50mg D (much more potent, longer-acting)

37
Q

Thiazide Clinical Considerations

A

First Line therapy.
Do not use if allergy hx with Sulfonamides
HCTZ doses >25mg increase risk of ADE, with little BP improvement
Chlorthalidone doses >50mg could lead to HYPOKalemia
12.5mg Chlorthalidone=25mg HCTZ

38
Q

Loop Diuretics Agents and Dosing

A

Furosemide 20-80mg 1-2xD

39
Q

Loop Clinical Considerations

A

Preffered in symptomatic HF and mod to severe CKD eGFR<30
Can result in HYPOKalemia, give K+ if needed.
Bumetenide 1mg=Torsemide 20mg=Furosemdie 40mg

40
Q

K Sparing Agents

A

Amiloride
Triamterene
Triamterene/HCTZ

41
Q

K Sparing Clinical Considerations

A

Not 1st line treatment.
Weak diuretics, used to prevent HYPOKalemia caused by other agents
Avoid in pts with significant CKD

42
Q

a1 Blockers MOA

A

Selectively block a1-receptors on smooth muscle cells, decreasing PVR

43
Q

a1 Agents and Dosing

A

Doxazosin 1-8mg D

44
Q

a1 Clinical Considerations

A

No benefit in prevention of MI or CHD
Consider 2nd line for men with BPH
Give 1st dose in clinic d/t syncope

45
Q

a2 Agonists MOA

A

Stimulate presynaptic recepotrs in the brain, increasing inhibtory neuron activity and decreasing sympathetic outflow.

46
Q

a2 Agonists Agents

A

Clonidine & TTS

Methyldopa

47
Q

a2 Clinical Considerations

A

Not a first line therapy
Avoid in HF
Indicated for Resistant HTN (Clonidine)
Indicated for Pregnancy (Methyldopa)

48
Q

BB MOA

A

Competitvely inhibit catecholamine neurotransmitters at B1 receptors (Heart), and B2 receptors (SM and lungs)

49
Q

Nonselective BB options

A

Propranolol!

50
Q

Beta1selective Agents and Dosing

A

AMEBBA

Atenolol 25-100mg D
Metorpolol Suc 50-400mg 1-2xD
Metoprolol Tar 50-200mg BID
Esmolol

Betaxolol
Bisoprolol
Acebutolol

51
Q

Mixed a1/BB Agents Dosing

A

Carvedilol CR 20-80mg D

Labetalol 200-800mg BID

CDM1 (5 decks)

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