HTN 3 Flashcards
- “Last resort” medication
- Clonidine (Catapres)
- Methyldopa
Central Alpha Agonists
MOA:
Stimulate Alpha 2 adrenergic receptors in the brain which reduces CNS sympathetic outflow
Central Alpha Agonists
Which med is okay in pregnancy?
Central Alpha Agonist : Methyldopa
How do you prevent rebound HTN when using Central Alpha Agonists?
Avoid abrupt cessation
Which med?
Side effects:
- Anticholinergic side effects
- Bradycardia
- Orthostatic hypotension
- Dizziness
- Rebound HTN
Central Alpha Agonists
What are the 3 side effects of Central Alpha Agonist : Methyldopa
- Hepatitis
- Hemolytic anemia
- Fever
1 contraindication of Central Alpha Agonists
Methyldopa in liver disease
End in “zosin”
Alpha Blockers
Which med?
- Not utilized frequently
- Doxazosin (Cardura)
- Terazosin (Hytrin)
- Prazosin (Minipress)
Alpha Blockers
MOA:
- Targets Alpha 1 receptors on vascular smooth muscle, causing a decrease in peripheral vascular resistance (PVR)
- –> thus decreasing BP
Alpha Blockers
(Zosin)
Which med?
- Use in mild - moderate HTN
- Not for monotherapy
- ALLHAT trial showed increased risk of HF w/ _____
- Compelling indication for BPH (which means this med is helpful for both BPH and HTN)
Alpha Blockers
- doxazosin
Which med?
Side effects:
- Orthostatic Hypotension (severe w/ 1st use)
- Reflex tachycardia
- Dizziness
Alpha Blockers
(zosin)
What tx should you always start a patient on w/ HTN?
Lifestyle interventions
After implementing lifestyle changes, when should you FU w/ pt?
3 to 6 months
After initiating pharmacologic therapy, how soon should you reassess pt?
1 month
(monitor labs if necessary depending on meds given)
If the patient is not at their goal BP after starting a medication at the 1 month FU, what should you do?
- Increase dose
or
- add 2nd medication
If the patient is not at their goal BP after being placed on 3 medications, what should you do?
Consider consulting a HTN specialist
- Once the patient’s BP is controlled, how often should FU appointments be?
- What 2 things should you monitor?
- Every 3 to 6 months
- Serum K and creatinine once or twice annually **(electrolytes)**
Which guidelines?
- 1st: Diuretic
- Follow compelling indications
JNC 7
Which guidelines?
- 1st: Thiazides / ACE-I / ARB / CCB
- African Americans: Thiazides / CCB
- ***CKD patients: ACE or ARB***
JNC 8
Which guidelines?
- 1st: TZD (Thiazolidinediones) / CCB / ACE-I / ARB
AHA/ACC 2017
Which 2 meds would you give patients w/ CKD?
- ACE-I
- ARB
Which 2 meds would you give for recurrent stroke prevention patients?
- Diuretics
- ACE-I
Heart failure patients can receive all meds except for which one?
- CCB
Which 2 meds should you not give post-MI patients?
- ARB
- CCB
Which 2 meds should you not give patients w/ high risk of coronary disease?
- ARB
- Aldo ANT
DM patients can receive all but which med?
Aldo ANT
What is the goal BP of patients w/ stable ischemic heart disease?
< 130/80
Which meds to give for patients w/ stable ischemic heart disease?
- Beta Blockers
- ACE-I
- ARBs
If a patient w/ stable ischemic heart disease BP goal is not met and they have angina what should you do?
add CCB (dihydropyridine)
If a patient w/ stable ischemic heart disease BP goal is not met, without angina, what should you do?
add CCB (dihydropyridine)
or
Thiazide
or
Minerlocorticoid receptor antagonist (spironolactone)
- What is the BP goal of a patient w/ HF w/ reduced ejection fraction?
- What med should you NOT give this pt?
- < 130/80
- CCB - nondihydropyridine
What is the goal BP of a patient w/ CKD (chronic kidney disease)?
< 130/80
- What tx for patient w/ CKD, w/o albuminuria?
- What tx for patient w/ CKD, w/ albuminuria?
- Use the usual 1st line med
- ACE-I or if they can’t tolerate that, give ARB
- What is the BP goal of pt w/ DM?
- Which classes of drugs are most useful in these patients?
- DM patient w/ albuminuria, what should you give?
- < 130/80
- ALL classes are useful in DM patients
- ACE-I or ARB
- What 3 medications are given to pregnant women w/ HTN?
- ***What 3 meds are NOT given to pregnant women??******
- Methyldopa, Nifedipine, Labetalol
- ***DO NOT GIVE: ACE-I, ARB, or DRI***
Prognosis for HTN patients is poor in which 5 diseases?
- Cardiovascular Disease
- Cerebrovascular Disease
- Kidney Disease
- Retinopathy
- Vascular Disease
- In patients w/ HTN and Cardiovascular Disease, prognosis is poor if the patient has Left Ventricular Hypertrophy.
- As well as:
Women over ___ years old
Men over ____ years old
Women >65
Men >55
Carotid wall thickening or plaque is associated with which disease as an indicator of poor prognosis in patients w/ HTN?
Cerebrovascular disease
Low eGFR and Microalbuminuria are associated with which disease as an indicator of poor prognosis in patients w/ HTN?
Kidney Disease
ABI (ankle brachial index) <9 is associated with which disease as an indicator of poor prognosis in patients w/ HTN?
Vascular Disease
- Failure to achieve BP goal in patient adhering to full dose tx of 3 drug regimen (thiazide diuretic)
- Achieving BP goal, but requires 4+ antihypertensives
Resistant HTN
- What BP measurement classifies pt has “Hypertensive Urgency?”
- What are the sxs?
- What is the etiology?
- SBP > or equal to 180
- Asymptomatic
- Etiology: non-compliant w/ meds or non-compliant w/ low Na diet
- What is the BP measurement of a patient w/ a “Hypertensive Emergency?”
- What is it associated with?
- DBP > or equal to 120
- Acute End-Organ Damage
- How do you tx Hypertensive Urgency?
(Overall Goal)
- Which drug is contraindicated?
- Gradual reduction to safe levels (<160/100)
- If too rapid, can lead to:
- cerebral ischemia
- myocardial ischemia
- MI
- Sublingual Nifedipine
When would it be appropriate to send a patient w/ Hypertensive Urgency to the ED?
New occurence of HTN
What is the tx for pt w/ Hypertensive Emergency?
Hospitalized (ICU)
