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Therapeutics 2 - Exam 5 > HTN 2 - olenik > Flashcards

HTN 2 - olenik Flashcards

1
Q

what are the first line agents for HTN?

A

thiazides
CCBs
ACEi
ARBs

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2
Q

what are the results of ALLHAT trial?

A

chlorthalidone is better than amlodipine and lisinopril-based therapy in preventing stroke, heart attack, and heart failure

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3
Q

what are the key takeaways of ALLHAT trial?

A

thiazide diuretics should be first line
for pts who cannot take diuretic –> prescribe a CCB or ACEi
patients with HTN should take 1+ drugs

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4
Q

what are the preferred combination therapy for HTN?

A

ACEi/CCB
ARB/CCB
ACEi/diuretic
ARB/diuretic

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5
Q

what is an acceptable combination therapy for HTN?

A

CCB/diuretic

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6
Q

how should HTN be treated in stable ischemic heart disease?

A

beta blockers or ACEi/ARBs
use dihydropyridine CCBs if still uncontrolled

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7
Q

what is the role of beta blockers in treatment of HTN in stable ischemic heart disease?

A

reduce CV events and anginal symptoms

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8
Q

what is the goal BP in stable ischemic heart disease?

A

under 130/80

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9
Q

what is the treatment of HTN in heart failure with reduced ejection fraction (HFrEF)?

A

ARNI + evidence based beta blocker + mineralocorticoid antagonist + SGLTis
may add other agents like a loop diuretic for persistent fluid overload

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10
Q

what is an ARNI?

A

angiotensin receptor/neprilysin inhibitor

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11
Q

what are drugs to avoid in heart failure?

A

nondihydropyridine CCBs

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12
Q

what is the treatment order of HTN in heart failure with preserved ejection fracture (HFpEF)?

A
  1. SGLT2 inhibitor
  2. add other agents depending on patient-specific factors
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13
Q

how is HTN treated in CKD?

A

if CKD stage 1 or 2 with albuminuria (>300 mg/day) OR CKD stage 3, ACEi (or ARB if intolerant)
if not, use first line agents

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14
Q

what is the goal BP in CKD?

A

under 130/80

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15
Q

how is HTN treated in post kidney transplantation?

A

dihydropyridine CCBs to improve GFR and kidney survival

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16
Q

how is HTN treated in cerebrovascular disease for secondary stroke prevention?

A

ACEi/ARBs
thiazide
both if BP is over 140/90

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17
Q

what is the goal BP in cerebrovascular disease?

A

under 140/90

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18
Q

how is HTN treated in DM?

A

any first-line agent unless there is albuminuria, then ACEi/ARBs

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19
Q

how is albuminuria classified?

A

over 300mg/day or over 300mg/g albumin to creatinine ratio

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20
Q

what is the preferred anti-HTN agents in pregnancy?

A

methyldopa
nifedipine
labetolol

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21
Q

what HTN meds are CI in pregnancy?

A

ACEi
ARBs
direct renin inhibitors

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22
Q

how is HTN treated in black adults without HF or CKD (including those with DM)?

A

thiazide or CCB (better at lowering BP and reducing CV events)

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23
Q

how is HTN treated in atrial fibrillation?

A

ARB to prevent recurrence

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24
Q

how is HTN treated in aortic disease?

A

BB to help improve survival

25
Q

what HTN drugs are thiazides?

A

chlorothalidone
hydrochlorothalidone
indapamide
metolazone

26
Q

what classes of diuretics are used in HTN?

A

thiazide
loop
aldosterone antagonists
potassium-sparing

27
Q

what loop diuretics are used in HTN?

A

furosemide
torsemide
bumetanide

28
Q

what aldosterone antagonists are used in HTN?

A

spironolactone
eplerenone

29
Q

what potassium-sparing diuretics are used in HTN?

A

amiloride
triamterene

30
Q

what happens after initially introducing diuretics?

A

diuresis –> reduced stroke
volume –> increased PVR

31
Q

what happens long-term after introducing diuretics?

A

stroke volume returns to normal and decreases the PVR to go below pre-treatment levels

32
Q

what is the most potent thiazide diuretic?

A

chlorothalidone

33
Q

what are the clinical pearls of thiazides?

A

more effective than loops with CrCl over 30 mL/min
dose in the morning to avoid nocturnal diuresis

34
Q

how often should thiazides be taken?

A

once a day

35
Q

what are the SE of thiazides?

A

low K
low Mg
high Ca
hyperuricemia
hyperglycemia
hyperlipidemia
sexual dysfunction
increase in TG/cholesterol

36
Q

what drug-drug interaction is important to note in thiazides?

A

lithium –> causes toxicity with concurrent use

37
Q

what is the CI of thiazides?

A

sulfa allergy
anuria

38
Q

what is the indication of loop diuretics?

A

heart failure
not first line for HTN but more effective than thiazides when CrCl is under 30 mL/min

39
Q

what are the clinical pearls of loop diuretics?

A

dose in the morning/afternoon to avoid nocturnal diuresis
high-ceiling dose response curve (may need higher doses in severely reduced renal function or fluid overload –> switching to another loop or from oral to IV can help)

40
Q

how often should loop diuretics be taken?

A

1-2x daily
QD for torsemide

41
Q

what is SE of loop diuretics?

A

low K
low Mg
low Ca
hyperuricemia
ototoxicity

42
Q

what is CI of loop diuretics?

A

sulfa allergy

43
Q

what is the preferred add-on agent in resistant HTN?

A

spironolactone

44
Q

what are the clinical pearls of aldosterone antagonists?

A

dose in the morning/afternoon to avoid nocturnal diuresis
don’t use if potassium is greater than 5 mEq/L

45
Q

what should be done if the pt develops gynecomastia?

A

switch from spironolactone to eplerenone

46
Q

what is another name for aldosterone antagonists?

A

mineralocorticoid receptor antagonists

47
Q

how often should aldosterone antagonists be dosed?

A

1-2x per day

48
Q

under what conditions should an aldosterone antagonist be held or reduced?

A

if potassium is greater than 5/5 mEq/L or SCr increases by over 25%

49
Q

what is SE of aldosterone antagonists?

A

high K
hyponatremia
gynecomastia (spironolactone 10%)

50
Q

what are the drug-drug interactions of aldosterone antagonists?

A

ACEi
ARBs
renin inhibitors
NSAIDs
increase risk of hyperkalemia

51
Q

what are CIs of aldosterone antagonists?

A

concomitant use of potassium sparing diuretics

52
Q

what are the CIs of eplerenone?

A

impaired renal function
T2DM with proteinuria

53
Q

what are the lab values for impaired renal function?

A

CrCl under 50 mL or
SCr greater than 2 for men or over 1.8 for women

54
Q

what is the purpose of potassium-sparing diuretics in HTN?

A

used in combination with thiazides to minimize hypokalemia (minimal BP effects)

55
Q

what are the clinical pearls of potassium-sparing diuretics?

A

use with caution in patients with DM or CKD (GFR under 45)
dose in morning to avoid nocturnal diuresis

56
Q

how often should potassium-sparing diuretics be taken?

A

1-2x daily

57
Q

what is SE of potassium-sparing diuretics?

A

high K
increased uric acid
hyperglucemia

58
Q

what are the monitoring parameters of diuretics

A

electrolytes and renal function
at baseline
1-2 weeks after initiation
3-4 months after initiation (loop/aldosterone only)
every 5-12 months

59
Q

what are the clinical pearls of diuretics?

A

nocturnal diuresis
thiazides are first-line for most HTN pts
spironolactone is first-line for resistant HTN
potassium-sparing is not monotherapy
pts with sulfa allergy cannot take
check CrCl when choosing class
monitor potassium and other electrolytes

Therapeutics 2 - Exam 5 (14 decks)

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