HTN

Question 1

When are direct arterial vasodilators used?

Answer 1

last line for HTN

Question 2

who is DAVs reserved for?

Answer 2

severe CKD or HD or difficulty controlling BP

Question 3

what drugs are DAVs and which is more potent?

Answer 3

hydralazine and minoxidil (more potent)

Question 4

what is used with a DAV?

Answer 4

diuretic and BB as needed

Question 5

what is the frequency of the DAV drugs?

Answer 5

Hydralazine (2-4)
Minoxidil (1-3)

Question 6

what are the adverse effects of DAVs?

Answer 6

1. palpitations
2. tachycardia
3. chest pain
4. GI SEs
5. HA
6. liver toxicity

Question 7

what side effects are specialized to hydralazine and minoxidil?

Answer 7

1. hydralazine (lupus-like syndrome/rash)
2. minoxidil (hair growth)

Question 8

what is the BBW for minoxidil?

Answer 8

1. pericarditis and pericardial effusion –> tamponade progression
2. exacerbate angina and increase oxygen demand
3. should be given with diuretic AND beta blocker

Question 9

what is contraindicated for hydralazine?

Answer 9

CAD

Question 10

When do you use DAVs with caution?

Answer 10

CVA, renal impairment, CAD, Liver disease, SLE

Question 11

what drugs are alpha-1 blockers?

Answer 11

doxazosin, prazosin, terazosin

Question 12

when do we use alpha 1 blockers? are they recommended as first line? what is their association with in elderly?

Answer 12

1. NEVER 1st line
   2, 2nd line if BPH
2. orthostatic HTN

Question 13

what drugs are a-2 agonists?

Answer 13

clonidine, methyldopa, guanfacine

Question 14

when are a2 agonists used? what should you know about them? which one is preferred for prego people?

Answer 14

1. last line do to AEs
2. avoid abrupt cessation due to rebound HTN
3. methyldopa for prego

Question 15

what are the AEs for a1- agonists?

Answer 15

CNS depression, dizzy, fatique, anticholinergic, bradycardia, reflex tachycardia, fluid retention

Question 16

what is good to know about the clonidine patch?

Answer 16

lower risk of rebound HTN and improved adherence

Question 17

what are the doses of a2 agonists?

Answer 17

clonidine –> 2-3x
patch –> 7d
methyldopa –> 2x
guanfacine –>qd

Question 18

what are some clinical pearls for clonidine?

Answer 18

1. titrate off slow (half dose every 2-3 days)
2. if on BB wean of BB first
3. oral to patch? –> overlap for 2-3d
4. patch to oral? –> no sooner than 8 hours after patch removal

Question 19

what is monitoring parameter summary for HTN meds?

Answer 19

1. ACE/ARB : BUN/SCr, K+
2. CCBs : non-dihydro (HR)
3. MRA : BUN/SCr, K+
4. Other diuretics : BUN/SCr, uric acid (thiazides), electrolytes
5. BBs : HR

Question 20

what do you consider and do if patient not at goal?

Answer 20

1. HS dosing of one antihypertensive
2. assess adherence
3. lifestyle changes education
4. white coat HTN?
5. d/c interaction meds
6. resistant HTN

Question 21

what is resistant HTN? when is it considered restistant?

Answer 21

1. failure to attain BP while adherent with 3 agents at max dose or 4 or more as needed
2. rule out secondary causes first (nonadherence, whitecoat, ect.)

Question 22

what are the guidelines for treating resistant HTN?

Answer 22

1. max lifestyle interventions and optimize 3 drug regimen (ace/arb, CCB, and diuretic)
2. change thiazide to chlorthalidone
3. add MRA

Question 23

what are the guidelines for treating resistant HTN considering their HR?

Answer 23

1. HR > 70, add BB ; HR < 70 (diltiazem) –> also if BB contraindicated
2. add hydralazine
3. switch to minoxidil