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AC-AGNP I > HTN and Lipidemia > Flashcards

HTN and Lipidemia Flashcards

1
Q

What is the definition of HTN

A

SBP is 140 mmHg or higher and/or DBP is 90 mm Hg or higher

following repeated examination (2-3 office visits 1-4 week intervals, out of office BP measurements preferred)

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2
Q

When can HTN be diagnosed at a single office visit

A

if BP is 180/110 mm Hg or higher and evidence of CVD

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3
Q

idiopathic form of HTN, genetic predisposition, environmental factors

A

primary HTN

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4
Q

form of HTN with identifiable cause - suspect in patients who are below 30 years of age, resistant HTN and/or malignant HTN

A

secondary HTN

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5
Q

malignant HTN

A

hypertensive emergency characterized by presence of severe BP elevation (usually >200/120 mm Hg) and advanced retinopathy, defined as bilateral presence of flame‐shaped hemorrhages, cotton wool spots, or papilledema.

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6
Q

common causes of secondary HTN

A

renovascular disease, OSA, hypothyroidism/hyperthyroidism, cushing syndrome, primary aldosteroism, pheochromocytoma (adrenal tumor), coarctation of aorta, drug or alcohol induced

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7
Q

screening for secondary HTN

A

drug resistant HTN? new onset of hTN? adding more hypertensives to previously controlled? below 30 years of age? malignant Htn? disproportionate target organ damage for degree of HTN (retinopathy, stroke, LVH, pulmonary edema, etc)? onset of diastolic HTN in older adults? unprovoked or excessive hypokalemia

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8
Q

common medication/substances that can cause secondary HTN

A

alcohol, amphetamines, antidepressants (MAOIs, TCA, SNRI) caffeine, NSAIDS, atypical antipsychotics (clozapine, olanzapine), st johns wort, decongestants, immunosuppressants (cyclosporine), oral contraceptives, cocaine, bath salts, corticosteroids, nicotine replacement therapy, withdrawal (beta blocker withdrawal, etc)

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9
Q

First 4 classes of drugs for HTN treatment (no compelling indications, no sign of organ issues)

A

ACE inhibitors, ARBs, DHP-CCBs, thiazide direutics

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10
Q

Step 1 of treatment of essential HTN

A

ACE/ARB and a CCB

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11
Q

Step 2 treatment of essential HTN

A

increase dose of ACE and CCB

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12
Q

Step 3 treatment of essential HTN

A

ACE/ ARB, CCB at increased dosages and add thiazide

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13
Q

Step 4 treatment of essential HTN

A

ACE/ARB, CCB, thiazide, add spironolactone or other agents depending on comorbities

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14
Q

blood pressure goals

A

< 130 / 80 mmHg (except for elderly patients) – control within 3 month of pharmacological intervention

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15
Q

What meds to start for HTN in patients with heart failure

A

ACE/ARB, spirnolactone, and beta blocker

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16
Q

What meds to start for HTN in patients with MI/CAD

A

ACE/ARB, beta blocker (add CCB for angina)what

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17
Q

what meds to start for HTN in patients with DM

A

ACE/ARB for first line reduce albuminuria (renal protector)

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18
Q

What meds to start for HTN for patients with CKD

A

ACE/ARB reduce albuminuria

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19
Q

Considerations for ethnicity in treating HTN

A

black populations need to be started on two agents right away given resistance to HTN treatment; thiazide and CCB (or CCB and ARBs but consider angioedema)

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20
Q

first choices for HTN treatment in pregnant patients

A

CCB (nifedipine)
beta blockers (in first trimester)

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21
Q

ACE inhibitors (prils) - MOA

A

prevent conversion of angiotensin I to II (which stimulates aldosterone and increases Na and water absorption and vasoconstriction ) – decreased Na/H2o retention and decreased peripheral resistance

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22
Q

ACE inhibitor& ARBs - side effects

A

dry cough - more so with ACE (1-2 weeks after initaiton - can switch to ARBs)
monitor for hypokalemia (especially on potassium sparing diuretics, RAS)
risk of ARF in patients with RAS
do not use WITH arbs/direct renin inhibitors
contraindicated in patients with history of angioedema with ACEI
avoid in pregnancy

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23
Q

ARBs (sartans) - MOA

A

directly inhibit angiotensin II

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24
Q

calcium channel blockers

A

inhibit L type calcium channel in cells

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25
Q

CCB: Dihydropyridines (-dipines)

A

potent vasodilator, do not affect cardiac contractility

pedal edema common side effect

avoid in heart failure /reduced EF as it causes refractory tachycardia (except for amolodipine and felodipine)

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26
Q

Which DHP -CCB can be used in HF patients

A

amlodopine and felodipine

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27
Q

Nondihydropyridines CCB (diltiazem, verapimil)

A

directly affect cardiac muscle

reduce proteinuria

constipation common side effect

causes bradycardia, reduces CO

28
Q

nondihydropyridines CCB (diltiazem, verapamil) are contraindicated in which patients

A

not used in heart failure / low EF/ sick sinus syndrome and heart blocks

29
Q

Thiazide diuretics (Chlorathidone **, HCTZ, indapamide, metolazone)

A

decrease water and sodium reabsorption

monitor for hyponatremia and hypokalemia

use with caution in gout

30
Q

why use thiazide with ACE inhibitors

A

ACE inhibitors retain potassium so counteracts hypokalemia affect of thiazide

31
Q

aldosterone antagonists (spironolactone)

A

preferred agents in primary aldoesteronism

add ons for stage IV HTN, and HF

monitor for hyperkalemia

gynecomastia and impotence***

32
Q

beta blockers - indications, MOA, SEs

A

reserved for post MI/CHF/AF/pregnancy

reduce heart and contractility

not first line for HTN

SEs - fatigue, bradycardia, increase glucose (can mask hypoglycemic awareness)

33
Q

cardioselective B blockers (only work on beta 1)

A

beta 1 - those with asthma/COPD

atenolol, betaxolol, bisoprolol, metoprolol

34
Q

combined alpha and beta blockers

A

carvedilol and labetolol (often used in ICU settings) - very hypertensive patients

35
Q

Non cardioselective beta blockers

A

nadolol, propranolol

36
Q

beta blockers for HF

A

metoprolol, labetolol, bisoprolol

37
Q

direct renin inhibitors (aliskiren)

A

SEs - RAS, hyperkalemia

avoid in pregnancy

do not use in combination with ACEI or ARBs

38
Q

Vasodilators (-zosin)

A

add ons for BPH with HTN

specifically for orthostasis so prescribed overnight

39
Q

hydralazine (vasodilator)

A

stimulates nO production in endothelial cells

SEs- fluid retention, reflex tachycardia (not good for patients with cardiac issues/HF)

40
Q

minoxidil (vasodilator)

A

SEs- reflex tachycardia, fluid retention

**used with resistant HTN, use with diuretic and beta blocker

41
Q

Clonidine

A

last line treatment for HTN
resistant HTN
CNS side effects - need to wean to avoid HTN crisism

42
Q

methyldopa

A

for pregnant patients

43
Q

Loop direutics (-mides) when preferred?

A

symptomatic CHF
replaces thiazide
moderated to severe CKD with GFR of less than 30

44
Q

Pharmacological approach to refractory HTN

A

HTN maintained on 4 meds; rule out reasons for secondary HTN

maximize direuetic therapy –>
add mineralcorticosteroid receptor antagonist (i.e. spirnolactone)

add other agents with different mechanisms of action (SVR, preload, contractility/HR with beta blocker or CCB, etc)

use loop diuretics with CKD or patients on minoxidil

45
Q

HTN emergency vs HTN urgency

A

elevated HTn (SBP >180, DBP >120) with signs of TOD

urgency - severe elevation in bP without acute TOD

46
Q

Reduction of HBP in aortic dissection

A

rapid reduction in BP to SBP <120 mm Hg within 20 minutes; beta blockade first –> esmolol, labetalol

47
Q

Reduction of HBP in acute pulmonary edema

A

clevidipine, nitro, nitroprusside –> BETA BLOCKERS CONTRINDICATED!!; diuretics

48
Q

Reduction of HBP in ACS

A

esmolol, labetalol, nicardipine, nitro

49
Q

Reduction of. HBP in acute renal failure

A

acute hypertensive hephrosclerosis

proteinura, hematura, elevated creat

clevidipine, fenoldopam, nicardipine

50
Q

Reduction of HBP in eclampsia

A

rapid lowering of SBP <140 in 1st hour

hydralazine, labetalol, nicardipine

CONTRAINDICATED - ACE/ARB/ Renin I/ SNP

51
Q

Reduction of HBP in acute ICH (less than 6 hours from onset)

A

reasonable to streat SBP > 220 with continous IV infusion with close BP monitoring

Keep SBP < 150

labetalol, nicardipine, clevidipine

52
Q

Management of HBP in acute ischemic stroke

A

bp is NOT lowered unless it is >185/100 in candidiates for reperfusion tx or 220/120 for those who are not candidates

labetalol, nicardipine, clevidipine

53
Q

Management of HBP in phemochromocytoma

A

rapid lowering of SBP <140 1st hour

clevidipine, nicardipine, phentolamine

54
Q

management of HBP due to ingestion of cocaine, amphetamines, tyramine with MAOIs

A

phentolamine, nitroprusside

beta blockers contraindicated due to unopposed alphra-adrenergic vasoconstriction

55
Q

Management of HBP due to severe autonomic dysfunction (guillian barre, acute spinal cord injury)

A

nitroprusside, phentolamine

Beta blockers contraindicated

56
Q

Management of HBP due to HTN agent withdrawal

A

happens usually with beta blockers and clonidine

treatment includes reinstating agent, short acting IV initially

57
Q

who goes straight to high intensity statin regimen

A

hx of heart disease, 40-75 years, LDL >190, dx DM or risk of CAD; risk greater than 7.5 % on 10 year risk

58
Q

what should someone on statins avoid

A

grapefruit juice - can decrease breakdown of statins in blood and lead to higher side effects

59
Q

initial labs before statin therapy

A

lipid panel, lft’s, bmp ; lipid panel every 6 weeks after therapy and adjusting dosage and then every 4 months

60
Q

what HTN medication for those with renal disease/kidney dysfunction

A

ACE/ARB

61
Q

lovaza (omega 3 fatty acid) - dose? when to take? indication? caution?

A

4 g daily or BID with meals
for severe (OTC fish oils
hypertriglyceridemia
caution in those with fish or shellfish allergy, heptic impairment, bleeding risk

62
Q

fibrates (gemfibrozil, fenofibrate, clofibrate) - indications?

A

hypertriglyceridemia, hyper cholesteremia, mixed disylipidemia

63
Q

what drug should be added to statin therapy for high risk patients before considering a pck 9 inhibitor

A

ezetimbie

64
Q

when should a lipid panel be repeated after initiating therapy? how often are the panels repeated until levels are controlled? when control is achieved, how often do you repeat lipid panel

A

4-6 weeks repeat
every 3-4 months
every 6-12 months after control achieved

65
Q

PCSK9 inhibitors

A

alirocumab, evolocumab

66
Q
A

AC-AGNP I (1 decks)

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