HTN 2 Flashcards
Under what circumstances/which patients should you initiate anti-hypertensives?
- 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%
What is the goal BP of a patient on anti HTN meds?
< 130 / 80
What is the goal BP for a patient with “low risk Stage 1 HTN” who does not qualify for medications?
< 140 / 90
Patients over age 60 yrs w/ isolated systolic HTN, what BP value do you need to be careful with?
Why?
- CAUTION, do not lower DBP <55 to 60 mmHg
- Low DBP is assocated w/ increassed risk of MI and stroke
3 treatment options for HTN
-
Patient Education
- 20% unaware of dx
- 54% who have HTN do not have it controlled
- Lifestyle changes / “Non-Pharm”
- Pharmacologic interventions
What are 3 “Dietary Modifications” HTN patients can make?
- 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
What are 3 Non-Pharm tx options for HTN other than dietary changes?
- Weight loss (1 mmHg per 1 lb)
- Exercise (4-6 / 3 mmHg)
- Smoking cessation
8 pharmacologic tx options for HTN
“BRADACAA”
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
Which med for HTN?
- works well for most people/good starting point
- Inhibits Na reabsorption in the nephron (increasing Na and H2O excretion)
Diuretics
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
Diuretics
What are the 4 types of Diuretics?
- Thiazides
- Loop diuretics
- K sparing
- Aldosterone antagonists
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**
Thiazide Diuretics
(Hydrochlorothiazide)
(Hydrodiuril)
Contraindications of Thiazide Type Diuretics?
Hypersensitivity to sulfonamide derived drugs
Which HTN med?
-
Side Effects:
- Hypokalemia
- Hypercholesterolemia
- **SUPPLEMENT w/ potassium**
- Poor antihypertensive
- Reserved for patients w/ what 2 things??
Loop Diuretics
- Reserved for pts w/ kidney disease or fluid retention
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)
Potassium Sparing Diuretics
(Triamterene)
(Dyrenium)
What are 4-ish contraindications of Potassium Sparing Diuretics?
-
CAUTION combining w/:
- ACE-I
- ARB
- DRI (direct renin inhibitor)
- K supplements
- Hepatic disease
- Renal failure
- Hyperkalemia
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
Aldosterone Antagonists
(Spironolactone)
(Aldactone, Aldactazide)
3 Contraindications for Aldosterone Antagonists
- Renal impairment
- DM w/ proteinuria
- Hyperkalemia
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?
- Myocardial cells
- Vascular smooth muscle cells
- Leads to Vasodilation
- Effect: reduced peripheral vascular resistance
What are the 2 types of Calcium Channel Blockers?
- Non-dihydropyridines (verapamil, diltiazem)
- Dihydropyridines
Which type of CCB?
- More of a “cardiac depressant effect”
- Decrease HR
- Decrease CO
Non-dihydropyridines
(verapamil, diltiazem)
Which type of CCB?
- More selective as vasodilators
- Less cardiac depressant effect
Dihydropyridines
“dipine”
Ends in “dipine”
CCB - Dihydropyridines
(selective vasodilators)
Has an increased efficacy in blacks and elderly
CCB
Which CCB?
Side effects:
- Bradycardia
- Constipation
- Gingival hyperplasia
- Worsening HF
Non-DHP (dihydropyridine)
Which CCB?
Contraindications:
- Acute MI
- AV block
- Cardiogenic shock
- HF
- Hypotension
- SSS
- Ventricular dysfunction
- V tach
- WPW syndrome
(heart stuff….)
Non - DHP
Which CCB?
Side effects:
- Peripheral edema
- HA
- Flushing
(these do not go away, so need to change meds)
DHP
Which CCB?
Contraindications:
- Acute MI
- In urgent / emergent HTN, ____ is contraindicated.
DHP (dihydropyridines)
- Immediate release nifedipine
Ends in “pril”
ACE - Inhibitors
MOA:
- inhibits the RAAS system
- stimulates bradykinin (vasodilator effect)
ACE - Inhibitors
What do ACE inhibitors do in the RAAS system?
Stops the conversion of Antiotensin 1 to Angiotensin 2
What symptom does Bradykinin produce?
Cough
Which med?
- Helpful in pts w/ CKD, DM, HF, post MI
- ***Less effective in blacks, elderly, prodominent systolic HTN***
ACE inhibitors
Which med?
Side effects:
- Cough
- Hyperkalemia
- Angioedema
- Acute renal failure
ACE inhibitors
3 contraindications of ACE inhibitors
- ***Pregnancy***
- angioedema
- renal artery stenosis
Ends in “sartan”
ARBs (angiotensin receptor blockers)
MOA:
- inhibits the RAAS system
ARBs
Which med?
- Helpful in patients w/ CKD, DM, HF
- Not helpful in pts w/ Post-MI
ARBs
Which med?
Side Effects:
- Hyperkalemia
- Angioedema
- Acute renal failure
- (NOT cough)
ARBs
2 contraindications of ARBs
- Pregnancy
- Renal artery stenosis
MOA:
- inhibit enzyme activity of renin
- (reduces activity of Ang 1, Ang 2, and Aldosterone
Direct Renin Inhibitors
(Aliskiren)
(Tekturna)
Which med?
Side effects:
- Hyperkalemia
- Renal impairment
- Hypersensitivity rxns (anaphylaxis, angioedema)
Direct Renin Inhibitors
(Aliskiren)
(Tekturna)
Which med?
- Avoid combining w/ ACE-I or ARB in the setting of Kidney Impairment
- Can combine w/ thiazides, but NOT two RAAS meds
Direct Renin Inhibitors
(Aliskiren)
(Tekturna)
2 Contraindications of Direct Renin Inhibitors
- Combining w/ ACE-I or ARB
- Pregnancy
Ends in “lol”
Beta Blockers
What are the 2 types of Beta Blockers
- Cardioselective (Beta 1 receptors)
- Non-Cardioselective (Beta 1 and Beta 2 receptors)
MOA:
- blocks the activity of catecholamines at Beta adrenoreceptors (which leads to decreased CO, decreased PVR, and decreased renin activity)
Beta Blockers
(Propranolol)
Which type of Beta Blocker?
- Atenolol (Tenormin)
- Metoprolol (Lopressor, Toprol XL)
- Nabivolol (Bystolic)
Cardioselective
Which Beta Blocker?
- Propanolol (Inderal)
- Nadolol (Corgard)
- Combo alpha and beta blockers
- Labetolol (Trandate)
- Carvedilol (Coreg)
Non-Cardioselective
Which med?
- CAUTION w/ asthma, COPD, DM, depression, but not for unstable HF…
- Avoid abrupt cessation
- Reduced mortality after MI
Beta Blockers
Which med?
Side effects:
- exercise intolerance
- fatigue
- bradycardia
- sexual dysfunction (ED)
- depression
- exacerbate reactive airway disease
- exacerbate peripheral vascular disease
Beta Blockers
4 contraindications for Beta Blockers
- AV block
- Cardiogenic shock
- HF
- Hypotension
