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HTN Day 1 Flashcards

1
Q

What are the risk factors for HTN

A 
Cigarette smoking
Obesity (BMI>30)
Sedentary life style
Dyslipidemia
DM
Renal Dysfunction
Age: men>55, women>65
Fam Hx
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2
Q

Essential HTN makes up what percent of HTN cases

A

90%

Hereditary component

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3
Q

Secondary HTN makes up what percent of HTN cases and what are the common causes?

A

<10% of cases
Chronic Kidney Disease
Renovascular disease

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4
Q

Systolic BP

A

number that represents cardiac contraction

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5
Q

Diastolic BP (DBP):

A

Number that represents nadir (lowest point)…filling of the heart

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6
Q

Cardiac Output:

A

Amount of blood pumped out by the ventricles (represent the SBP)

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7
Q

Total Peripheral Resistance (TPR):

A

Sum of peripheral resistance in peripheral vasculature (represents DBP)

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8
Q

BP=

A

CO X TPR

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9
Q

What are the mechanisms of pathogenesis for HTN

A

Increased peripheral resistance

Increases CO

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10
Q

How does Increased peripheral resistance contribute to HTN

A

functional vascular constriction/vascular hypertrophy:

  • Over activity of sympathetic nervous system
  • Genetic component
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11
Q

How does Cardiac output cause HTN

A

Increased preload via:
Increased fluid volume
Excess sodium intake
Renal sodium retention

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12
Q

how does venous constriction cause increase cardiac output with HTN

A

excess RAAS stimulation

Sympathetic nervous system over activity

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13
Q

JNC8 BP goal:Patients ≥60 years old goal?

A

<150/90

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14
Q

JNC8 BP goal:Patients <60 years old goal?

A

<140/90

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15
Q

JNC8 BP goal:Patients with DM and CKD?

A

<140/90

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16
Q

Patient with DM according to ADA BP goal?

A

<140/80

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17
Q

Majority of patients will require how many medications to reach goal?

A

at least two

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18
Q

What are non-pharmacological therapy to treat HTN

A 
smoking cessation
weight loss
DASH diet
sodium reduction
Increase physical activity
limit alcohol intake to no more than 1-2/day
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19
Q

What is the most effective non pharmacological treatment to reduce blood pressure

A

weight loss

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20
Q

What are the 1st line options for HTN treatment

A

Thiazides, CCB’s, ACE-I, ARB’s

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21
Q

What would be best choice for a black patient

A

Thiazides or CCB

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22
Q

What would be the best treatment for DM or chronic kidney disease

A

ACE or ARB

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23
Q

What would be the best treatment option for a patient with cardiac history

A

beta-blocker

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24
Q

What is the treatment approach 1st option

A

Start with 1 drug and max the dose and then add on a 2nd agent if still not at goal, and then add on a 3rd agent once the 2nd drug is maxed out if pt. still not at goa

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25
What is the treatment approach 2nd option
Start with 1 drug and if not at goal add a 2nd drug prior to maxing out the dose on the first. Then max the dose on both drugs and if not at goal add a 3rd agent
26
What is the treatment approach 3rd option
Start with 2 drugs from the beginning if the SBP >160 and/or the DBP >100. Max out the drug doses and add on a 3rd agent if needed.
27
What drugs are part of the the thiazide diuretics
HCTZ, chlorthalidone, metolzone (most potent diuretic)
28
what is the MOA for Thiazide diuretics
Inhibits sodium reabsorption in the distal tubule.
29
what are the adverse effects of Thiazide diuretics
Orthostatic hypotensionElectrolyte abnormalities: ↓ K, ↓ Na, ↑ Ca, ↑ uric acid, ↑ glucose Photosensitivity (use SPF 30) Increased urination
30
What are the allergy precautions with thiazide diuretics
Caution in sulfa allergic patients Ineffective in patients with severe renal disease Avoid in patients taking lithium– may increase serum lithium concentrations
31
What are the loop diuretics
Furosemide (Lasix™) Bumetanide (Bumex™) Torsemide (Demadex)
32
what is the MOA for loop diuretics
Inhibits active transport of sodium, chloride and potassium in thick ascending limb of Loop of Henle, causing excretion of these ions Collecting duct excretes more water in response
33
What are loop diuretics used in therapy of
CHF Edema both pulm and peripheral HTN
34
what are the adverse effects of loop diuretics
Electrolytes abnormalities: ↓ K, ↓Na, ↓ Ca, ↓ Mg, ↑ uric acid Increase in SCr Dehydration Ototoxicity
35
What are the precautions with loop diuretics
sulfa allergies | nephrotoxicity
36
What drugs are aldosterone receptor blockers:
spironolactone | eplerenone
37
what is the MOA for aldosterone receptor blockers:
Competes with aldosterone, prevents sodium reabsorption and potassium excretion
38
what are potassium sparing drugs
Triamterene | Amiloride
39
what is the MOA for potassium sparing drugs
blocks sodium reabsorption and potassium excretion, effect independent of aldosterone
40
What potassium sparing drugs is used for class IV heart failure
spironolactone
41
what are the adverse effects with potassium sparing diuretics
hyperkalemia ( need to watch with patients who have renal failure)
42
what are the adverse effects of spironolactone?
gynecomastia | menstrual irregularities
43
what are the benefits of eplerenone
more selective less side effects more expensive
44
What do you need to educate your patients about using potassium sparing diuretics?
people who are using salt substitutes have potassium in them which can cause hyperkalemia affecting the heart
45
What drugs are part of the ACE inhibitors
``` anything that ends in -pril Captopril Enalapril Lisinopril Ramipril ```
46
what is the MOA for ACE-I
inhibits ACE to block the production of AT II | Inhibits the breakdown of bradykinin
47
What are the benefits of ACE-I and | Disadvantages
lowers BP Dilate the efferent arteriole of kidney Inflammatory mediator
48
What are ACE-I used for?
One of the first line drug classes in HTN First line option for CKD (chronic kidney disease) Used in CHF In practice use for DM
49
What do you need to monitor with ACE-I?
Serum K+ & SCr within 4 weeks of initiation or dose increase. You will likely see a benign increase in Scr (<30% from baseline)
50
what are the adverse effects with ACE-I
Cough due to increased bradykinin Angioedemia Hyperkalemia: esp in patients with DM or CKD Neutropenia, agranulocytosis, proteinuria, glomerulonephritis, acute renal failure
51
what are the contraindications with ACE-I?
pregnancy-childbearing age angioedema renal artery stenosis
52
what are the drug interactions with ACE-I?
potassium supplements Potassium sparing diuretics NSAIDs
53
how often is captpril dosed?
dosed 2-3 times daily
54
Which of the ACE-I is a prodrug and only available IV?
Enalapril
55
Which is the most commonly used ACE-I and what are the doses?
Lisinopril | 10-40mg daily
56
What decreases the absorption of captopril and by how much
when given with food and by 30-40%
57
what drugs are part of the ARB drug class?
``` anything that ends in -sartan candesartan eprosartan irbesartan losartan valsartan ```
58
what is the MOA for ARB
Inhibits angiotensin II at its receptor sites | Does NOT inhibit the breakdown of bradykinin
59
What is ARB used for therapy in?
One of the first line drug classes in HTN First line option for CKD Used in CHF
60
what do you need to monitor with ARB?
potassium | angioedema
61
what are the adverse effects of ARB's?
``` Hypotension/orthostatic hypotension Angioedema Hyperkalemia Dizziness Cough ```
62
What are ARB's contraindicated with?
Pregnancy Caution in pt's with renal artery stenosis ARB's can be used in patients who have angioedema with an ACE but use caution
63
what are the drug interactions for ARBs?
potassium supplements potassium sparing diuretics NSAID
64
what drug is a renin inhibitor
Aliskiren
65
What is aliskiren contraindicated with?
ACE or ARB because it causes kidney damage
66
What drugs are part of the beta blocker drug class
atenolol- dosed once a day Metoprolol succinate- dosed once a day metoprolol tartrate- dosed twice a day
67
Beta blockers Reserved for patients that have significant history of what?
``` cardiac history Heart failure Post MI High coronary artery disease CKD ```
68
what is the MOA for beta blockers?
Beta-1 receptors; located in heart and beta-2 receptors are located in the lungs Beta-blockers block beta-1 receptors thus decreasing the effects of epinephrine, and nor-epinephrine which therefore decrease BP and HR
69
What are the 4 categories of beta blockers
Cardioselectivity Mixed α and β blockers ISA (intrinsic sympathomimetic activity) Non-specific
70
what drugs are part of the Cardioselective category?
``` AMEBBA Atenolol metoprolol esmolol bisoprolol betaxaolol acebutolol ```
71
what drugs are part of the Mixed α and β blockers category?
Carvedilol | labetalol
72
what drugs are part of the ISA category?
``` CAPP Carteolol- take with food Acebutolol Penbutolol Pindolol ```
73
what drugs are part of the non specific category?
Nadolol propanolol-migrane tx Timolol
74
What beta blockers are used for heart failure?
Bisoprolol Carvedilol metoprolol succinate
75
what are common adverse effects of beta blockers
"beta blocker blues" Tire, fatigued, depressed, tight chest due to change in heart beat Sexual dysfunction, rebound HTN
76
what are relative contraindications of beta blockers?
``` Asthma & COPD Diabetes (masks hypoglycemia) Severe peripheral vascular dz heart block severe acute heart failure Pregnancy ```
77
what class does sotalol belong too
class III anti-arrhythmic (beta-blockers)

Pharm-HTN/CHF (4 decks)

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