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MJ- Foundations 2 Exam 2 > HTN 3 > Flashcards

HTN 3 Flashcards

1
Q
  • “Last resort” medication
  • Clonidine (Catapres)
  • Methyldopa
A

Central Alpha Agonists

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2
Q

MOA:

Stimulate Alpha 2 adrenergic receptors in the brain which reduces CNS sympathetic outflow

A

Central Alpha Agonists

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3
Q

Which med is okay in pregnancy?

A

Central Alpha Agonist : Methyldopa

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4
Q

How do you prevent rebound HTN when using Central Alpha Agonists?

A

Avoid abrupt cessation

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5
Q

Which med?

Side effects:

  • Anticholinergic side effects
  • Bradycardia
  • Orthostatic hypotension
  • Dizziness
  • Rebound HTN
A

Central Alpha Agonists

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6
Q

What are the 3 side effects of Central Alpha Agonist : Methyldopa

A
  • Hepatitis
  • Hemolytic anemia
  • Fever
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7
Q

1 contraindication of Central Alpha Agonists

A

Methyldopa in liver disease

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8
Q

End in “zosin”

A

Alpha Blockers

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9
Q

Which med?

  • Not utilized frequently
  • Doxazosin (Cardura)
  • Terazosin (Hytrin)
  • Prazosin (Minipress)
A

Alpha Blockers

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10
Q

MOA:

  • Targets Alpha 1 receptors on vascular smooth muscle, causing a decrease in peripheral vascular resistance (PVR)
  • –> thus decreasing BP
A

Alpha Blockers

(Zosin)

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11
Q

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)
A

Alpha Blockers

  • doxazosin
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12
Q

Which med?

Side effects:

  • Orthostatic Hypotension (severe w/ 1st use)
  • Reflex tachycardia
  • Dizziness
A

Alpha Blockers

(zosin)

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13
Q

What tx should you always start a patient on w/ HTN?

A

Lifestyle interventions

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14
Q

After implementing lifestyle changes, when should you FU w/ pt?

A

3 to 6 months

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15
Q

After initiating pharmacologic therapy, how soon should you reassess pt?

A

1 month

(monitor labs if necessary depending on meds given)

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16
Q

If the patient is not at their goal BP after starting a medication at the 1 month FU, what should you do?

A
  • Increase dose

or

  • add 2nd medication
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17
Q

If the patient is not at their goal BP after being placed on 3 medications, what should you do?

A

Consider consulting a HTN specialist

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18
Q
  • Once the patient’s BP is controlled, how often should FU appointments be?
  • What 2 things should you monitor?
A
  • Every 3 to 6 months
  • Serum K and creatinine once or twice annually **(electrolytes)**
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19
Q

Which guidelines?

  • 1st: Diuretic
  • Follow compelling indications
A

JNC 7

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20
Q

Which guidelines?

  • 1st: Thiazides / ACE-I / ARB / CCB
  • African Americans: Thiazides / CCB
  • ***CKD patients: ACE or ARB***
A

JNC 8

21
Q

Which guidelines?

  • 1st: TZD (Thiazolidinediones) / CCB / ACE-I / ARB
A

AHA/ACC 2017

22
Q

Which 2 meds would you give patients w/ CKD?

A
  • ACE-I
  • ARB
23
Q

Which 2 meds would you give for recurrent stroke prevention patients?

A
  • Diuretics
  • ACE-I
24
Q

Heart failure patients can receive all meds except for which one?

A
  • CCB
25
Q

Which 2 meds should you not give post-MI patients?

A
  • ARB
  • CCB
26
Q

Which 2 meds should you not give patients w/ high risk of coronary disease?

A
  • ARB
  • Aldo ANT
27
Q

DM patients can receive all but which med?

A

Aldo ANT

28
Q

What is the goal BP of patients w/ stable ischemic heart disease?

A

< 130/80

29
Q

Which meds to give for patients w/ stable ischemic heart disease?

A
  • Beta Blockers
  • ACE-I
  • ARBs
30
Q

If a patient w/ stable ischemic heart disease BP goal is not met and they have angina what should you do?

A

add CCB (dihydropyridine)

31
Q

If a patient w/ stable ischemic heart disease BP goal is not met, without angina, what should you do?

A

add CCB (dihydropyridine)

or

Thiazide

or

Minerlocorticoid receptor antagonist (spironolactone)

32
Q
  • What is the BP goal of a patient w/ HF w/ reduced ejection fraction?
  • What med should you NOT give this pt?
A
  • < 130/80
  • CCB - nondihydropyridine
33
Q

What is the goal BP of a patient w/ CKD (chronic kidney disease)?

A

< 130/80

34
Q
  • What tx for patient w/ CKD, w/o albuminuria?
  • What tx for patient w/ CKD, w/ albuminuria?
A
  • Use the usual 1st line med
  • ACE-I or if they can’t tolerate that, give ARB
35
Q
  • 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?
A
  • < 130/80
  • ALL classes are useful in DM patients
  • ACE-I or ARB
36
Q
  • What 3 medications are given to pregnant women w/ HTN?
  • ***What 3 meds are NOT given to pregnant women??******
A
  • Methyldopa, Nifedipine, Labetalol
  • ***DO NOT GIVE: ACE-I, ARB, or DRI***
37
Q

Prognosis for HTN patients is poor in which 5 diseases?

A
  1. Cardiovascular Disease
  2. Cerebrovascular Disease
  3. Kidney Disease
  4. Retinopathy
  5. Vascular Disease
38
Q
  • 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

A

Women >65

Men >55

39
Q

Carotid wall thickening or plaque is associated with which disease as an indicator of poor prognosis in patients w/ HTN?

A

Cerebrovascular disease

40
Q

Low eGFR and Microalbuminuria are associated with which disease as an indicator of poor prognosis in patients w/ HTN?

A

Kidney Disease

41
Q

ABI (ankle brachial index) <9 is associated with which disease as an indicator of poor prognosis in patients w/ HTN?

A

Vascular Disease

42
Q
  • 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
A

Resistant HTN

43
Q
  • What BP measurement classifies pt has “Hypertensive Urgency?”
  • What are the sxs?
  • What is the etiology?
A
  • SBP > or equal to 180
  • Asymptomatic
  • Etiology: non-compliant w/ meds or non-compliant w/ low Na diet
44
Q
  • What is the BP measurement of a patient w/ a “Hypertensive Emergency?”
  • What is it associated with?
A
  • DBP > or equal to 120
  • Acute End-Organ Damage
45
Q
  • How do you tx Hypertensive Urgency?

(Overall Goal)

  • Which drug is contraindicated?
A
  • Gradual reduction to safe levels (<160/100)
  • If too rapid, can lead to:
    • cerebral ischemia
    • myocardial ischemia
    • MI
  • Sublingual Nifedipine
46
Q

When would it be appropriate to send a patient w/ Hypertensive Urgency to the ED?

A

New occurence of HTN

47
Q

What is the tx for pt w/ Hypertensive Emergency?

A

Hospitalized (ICU)

48
Q
A

MJ- Foundations 2 Exam 2 (18 decks)

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