HTN Flashcards
When are direct arterial vasodilators used?
last line for HTN
who is DAVs reserved for?
severe CKD or HD or difficulty controlling BP
what drugs are DAVs and which is more potent?
hydralazine and minoxidil (more potent)
what is used with a DAV?
diuretic and BB as needed
what is the frequency of the DAV drugs?
Hydralazine (2-4)
Minoxidil (1-3)
what are the adverse effects of DAVs?
- palpitations
- tachycardia
- chest pain
- GI SEs
- HA
- liver toxicity
what side effects are specialized to hydralazine and minoxidil?
- hydralazine (lupus-like syndrome/rash)
- minoxidil (hair growth)
what is the BBW for minoxidil?
- pericarditis and pericardial effusion –> tamponade progression
- exacerbate angina and increase oxygen demand
- should be given with diuretic AND beta blocker
what is contraindicated for hydralazine?
CAD
When do you use DAVs with caution?
CVA, renal impairment, CAD, Liver disease, SLE
what drugs are alpha-1 blockers?
doxazosin, prazosin, terazosin
when do we use alpha 1 blockers? are they recommended as first line? what is their association with in elderly?
- NEVER 1st line
2, 2nd line if BPH - orthostatic HTN
what drugs are a-2 agonists?
clonidine, methyldopa, guanfacine
when are a2 agonists used? what should you know about them? which one is preferred for prego people?
- last line do to AEs
- avoid abrupt cessation due to rebound HTN
- methyldopa for prego
what are the AEs for a1- agonists?
CNS depression, dizzy, fatique, anticholinergic, bradycardia, reflex tachycardia, fluid retention
what is good to know about the clonidine patch?
lower risk of rebound HTN and improved adherence
what are the doses of a2 agonists?
clonidine –> 2-3x
patch –> 7d
methyldopa –> 2x
guanfacine –>qd
what are some clinical pearls for clonidine?
- titrate off slow (half dose every 2-3 days)
- if on BB wean of BB first
- oral to patch? –> overlap for 2-3d
- patch to oral? –> no sooner than 8 hours after patch removal
what is monitoring parameter summary for HTN meds?
- ACE/ARB : BUN/SCr, K+
- CCBs : non-dihydro (HR)
- MRA : BUN/SCr, K+
- Other diuretics : BUN/SCr, uric acid (thiazides), electrolytes
- BBs : HR
what do you consider and do if patient not at goal?
- HS dosing of one antihypertensive
- assess adherence
- lifestyle changes education
- white coat HTN?
- d/c interaction meds
- resistant HTN
what is resistant HTN? when is it considered restistant?
- failure to attain BP while adherent with 3 agents at max dose or 4 or more as needed
- rule out secondary causes first (nonadherence, whitecoat, ect.)
what are the guidelines for treating resistant HTN?
- max lifestyle interventions and optimize 3 drug regimen (ace/arb, CCB, and diuretic)
- change thiazide to chlorthalidone
- add MRA
what are the guidelines for treating resistant HTN considering their HR?
- HR > 70, add BB ; HR < 70 (diltiazem) –> also if BB contraindicated
- add hydralazine
- switch to minoxidil
