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Foundations 2 exam 2 > HTN 2 > Flashcards

HTN 2 Flashcards

1
Q

Under what circumstances/which patients should you initiate anti-hypertensives?

A
  • All patients w/ Stage 2 HTN
  • Patients w/ Stage 1 HTN w/ 1+ of the following:
    • ASCVD (atherosclerotic cardiovascular disease)
    • DM type 2
    • CKD (chronic kidney disease)
    • 10 year ASCVD risk at least 10%
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2
Q

What is the goal BP of a patient on anti HTN meds?

A

< 130 / 80

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3
Q

What is the goal BP for a patient with “low risk Stage 1 HTN” who does not qualify for medications?

A

< 140 / 90

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4
Q

Patients over age 60 yrs w/ isolated systolic HTN, what BP value do you need to be careful with?

Why?

A
  • CAUTION, do not lower DBP <55 to 60 mmHg
  • Low DBP is assocated w/ increassed risk of MI and stroke
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5
Q

3 treatment options for HTN

A
  • Patient Education
    • 20% unaware of dx
    • 54% who have HTN do not have it controlled
  • Lifestyle changes / “Non-Pharm”
  • Pharmacologic interventions
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6
Q

What are 3 “Dietary Modifications” HTN patients can make?

A
  • Salt restriction (decrease of 5/3)
  • DASH diet (decrease of 6/4)
  • ETOH reduction (decrease of 2-4 SBP)

DASH - dietary approach to stop HTN

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7
Q

What are 3 Non-Pharm tx options for HTN other than dietary changes?

A
  • Weight loss (1 mmHg per 1 lb)
  • Exercise (4-6 / 3 mmHg)
  • Smoking cessation
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8
Q

8 pharmacologic tx options for HTN

“BRADACAA”

A

B: Beta Blockers

R: Direct Renin Inhibitor

A: ACE-I

D: Diuretics

A: ARB

C: Calcium Channel Blockers

A: Central Alpha Agonists

A: Alpha Blockers

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9
Q

Which med for HTN?

  • works well for most people/good starting point
  • Inhibits Na reabsorption in the nephron (increasing Na and H2O excretion)
A

Diuretics

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10
Q

Which med for HTN?

  • Will control BP in 50% of pts w/ mild - moderate HTN
  • Can effectively be used in combo w/ ALL other agents
  • More potent in blacks, elderly, obese, smokers
A

Diuretics

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11
Q

What are the 4 types of Diuretics?

A
  • Thiazides
  • Loop diuretics
  • K sparing
  • Aldosterone antagonists
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12
Q

Which HTN med?

  • Side effects:
    • Hyperuricemia (gout)
    • Dyslipidemia
    • Hypokalemia
  • **If pt is placed on this med, consider regular screening of glucose and lipids**
  • **DO NOT supplement w/ potassium**
A

Thiazide Diuretics

(Hydrochlorothiazide)

(Hydrodiuril)

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13
Q

Contraindications of Thiazide Type Diuretics?

A

Hypersensitivity to sulfonamide derived drugs

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14
Q

Which HTN med?

  • Side Effects:
    • Hypokalemia
    • Hypercholesterolemia
  • **SUPPLEMENT w/ potassium**
  • Poor antihypertensive
  • Reserved for patients w/ what 2 things??
A

Loop Diuretics

  • Reserved for pts w/ kidney disease or fluid retention
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15
Q

Which HTN med?

  • Not AS GOOD at lowering HTN (weak anti-HTN)
  • Not commonly 1st line (usually)
  • Usually an “add on” to Loop Diuretic
  • Side effects:
    • Nephrolithiasis
    • Renal dysfunction
    • Hyperkalemia (esp w/ CKD or DM)
A

Potassium Sparing Diuretics

(Triamterene)

(Dyrenium)

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16
Q

What are 4-ish contraindications of Potassium Sparing Diuretics?

A
  • CAUTION combining w/:
    • ACE-I
    • ARB
    • DRI (direct renin inhibitor)
    • K supplements
  • Hepatic disease
  • Renal failure
  • Hyperkalemia
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17
Q

Which HTN med?

  • “Add on” / not 1st line
  • Rx for HTN which is hard to control
  • Side effects:
    • Gynecomastia
    • Hyperkalemia
  • This drug is technically a K sparing diuretic, but is more potent as an anti-HTN
A

Aldosterone Antagonists

(Spironolactone)

(Aldactone, Aldactazide)

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18
Q

3 Contraindications for Aldosterone Antagonists

A
  • Renal impairment
  • DM w/ proteinuria
  • Hyperkalemia
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19
Q

Calcium Channel Blockers

  • Inhibition of Ca influx into which 2 types of cells?
  • Decreased Ca inhibits the contractile process leading to what? What effect does it have?
A
  • Myocardial cells
  • Vascular smooth muscle cells
  • Leads to Vasodilation
  • Effect: reduced peripheral vascular resistance
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20
Q

What are the 2 types of Calcium Channel Blockers?

A
  • Non-dihydropyridines (verapamil, diltiazem)
  • Dihydropyridines
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21
Q

Which type of CCB?

  • More of a “cardiac depressant effect”
  • Decrease HR
  • Decrease CO
A

Non-dihydropyridines

(verapamil, diltiazem)

22
Q

Which type of CCB?

  • More selective as vasodilators
  • Less cardiac depressant effect
A

Dihydropyridines

“dipine”

23
Q

Ends in “dipine”

A

CCB - Dihydropyridines

(selective vasodilators)

24
Q

Has an increased efficacy in blacks and elderly

A

CCB

25
Q

Which CCB?

Side effects:

  • Bradycardia
  • Constipation
  • Gingival hyperplasia
  • Worsening HF
A

Non-DHP (dihydropyridine)

26
Q

Which CCB?

Contraindications:

  • Acute MI
  • AV block
  • Cardiogenic shock
  • HF
  • Hypotension
  • SSS
  • Ventricular dysfunction
  • V tach
  • WPW syndrome

(heart stuff….)

A

Non - DHP

27
Q

Which CCB?

Side effects:

  • Peripheral edema
  • HA
  • Flushing

(these do not go away, so need to change meds)

A

DHP

28
Q

Which CCB?

Contraindications:

  • Acute MI
  • In urgent / emergent HTN, ____ is contraindicated.
A

DHP (dihydropyridines)

  • Immediate release nifedipine
29
Q

Ends in “pril”

A

ACE - Inhibitors

30
Q

MOA:

  • inhibits the RAAS system
  • stimulates bradykinin (vasodilator effect)
A

ACE - Inhibitors

31
Q

What do ACE inhibitors do in the RAAS system?

A

Stops the conversion of Antiotensin 1 to Angiotensin 2

32
Q

What symptom does Bradykinin produce?

A

Cough

33
Q

Which med?

  • Helpful in pts w/ CKD, DM, HF, post MI
  • ***Less effective in blacks, elderly, prodominent systolic HTN***
A

ACE inhibitors

34
Q

Which med?

Side effects:

  • Cough
  • Hyperkalemia
  • Angioedema
  • Acute renal failure
A

ACE inhibitors

35
Q

3 contraindications of ACE inhibitors

A
  • ***Pregnancy***
  • angioedema
  • renal artery stenosis
36
Q

Ends in “sartan”

A

ARBs (angiotensin receptor blockers)

37
Q

MOA:

  • inhibits the RAAS system
A

ARBs

38
Q

Which med?

  • Helpful in patients w/ CKD, DM, HF
  • Not helpful in pts w/ Post-MI
A

ARBs

39
Q

Which med?

Side Effects:

  • Hyperkalemia
  • Angioedema
  • Acute renal failure
  • (NOT cough)
A

ARBs

40
Q

2 contraindications of ARBs

A
  • Pregnancy
  • Renal artery stenosis
41
Q

MOA:

  • inhibit enzyme activity of renin
  • (reduces activity of Ang 1, Ang 2, and Aldosterone
A

Direct Renin Inhibitors

(Aliskiren)

(Tekturna)

42
Q

Which med?

Side effects:

  • Hyperkalemia
  • Renal impairment
  • Hypersensitivity rxns (anaphylaxis, angioedema)
A

Direct Renin Inhibitors

(Aliskiren)

(Tekturna)

43
Q

Which med?

  • Avoid combining w/ ACE-I or ARB in the setting of Kidney Impairment
  • Can combine w/ thiazides, but NOT two RAAS meds
A

Direct Renin Inhibitors

(Aliskiren)

(Tekturna)

44
Q

2 Contraindications of Direct Renin Inhibitors

A
  • Combining w/ ACE-I or ARB
  • Pregnancy
45
Q

Ends in “lol”

A

Beta Blockers

46
Q

What are the 2 types of Beta Blockers

A
  • Cardioselective (Beta 1 receptors)
  • Non-Cardioselective (Beta 1 and Beta 2 receptors)
47
Q

MOA:

  • blocks the activity of catecholamines at Beta adrenoreceptors (which leads to decreased CO, decreased PVR, and decreased renin activity)
A

Beta Blockers

(Propranolol)

48
Q

Which type of Beta Blocker?

  • Atenolol (Tenormin)
  • Metoprolol (Lopressor, Toprol XL)
  • Nabivolol (Bystolic)
A

Cardioselective

49
Q

Which Beta Blocker?

  • Propanolol (Inderal)
  • Nadolol (Corgard)
  • Combo alpha and beta blockers
    • Labetolol (Trandate)
    • Carvedilol (Coreg)
A

Non-Cardioselective

50
Q

Which med?

  • CAUTION w/ asthma, COPD, DM, depression, but not for unstable HF…
  • Avoid abrupt cessation
  • Reduced mortality after MI
A

Beta Blockers

51
Q

Which med?

Side effects:

  • exercise intolerance
  • fatigue
  • bradycardia
  • sexual dysfunction (ED)
  • depression
  • exacerbate reactive airway disease
  • exacerbate peripheral vascular disease
A

Beta Blockers

52
Q

4 contraindications for Beta Blockers

A
  • AV block
  • Cardiogenic shock
  • HF
  • Hypotension

Foundations 2 exam 2 (13 decks)

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