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Pharm-HTN/CHF > HTN Day 1 > Flashcards

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
Q

What is the treatment approach 2nd option

A

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

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26
Q

What is the treatment approach 3rd option

A

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.

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27
Q

What drugs are part of the the thiazide diuretics

A

HCTZ, chlorthalidone, metolzone (most potent diuretic)

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28
Q

what is the MOA for Thiazide diuretics

A

Inhibits sodium reabsorption in the distal tubule.

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29
Q

what are the adverse effects of Thiazide diuretics

A

Orthostatic hypotensionElectrolyte abnormalities: ↓ K, ↓ Na, ↑ Ca, ↑ uric acid, ↑ glucose

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30
Q

What are the allergy precautions with thiazide diuretics

A

Caution in sulfa allergic patients
Ineffective in patients with severe renal disease
Avoid in patients taking lithium– may increase serum lithium concentrations

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31
Q

What are the loop diuretics

A

Furosemide (Lasix™)
Bumetanide (Bumex™)
Torsemide (Demadex )

32
Q

what is the MOA for loop diuretics

A

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
Q

What are loop diuretics used in therapy of

A

CHF
Edema both pulm and peripheral
HTN

34
Q

what are the adverse effects of loop diuretics

A

Electrolytes abnormalities: ↓ K, ↓Na, ↓ Ca, ↓ Mg, ↑ uric acid
Increase in SCr
Dehydration
Ototoxicity

35
Q

What are the precautions with loop diuretics

A

sulfa allergies

nephrotoxicity

36
Q

What drugs are aldosterone receptor blockers:

A

spironolactone

eplerenone

37
Q

what is the MOA for aldosterone receptor blockers:

A

Competes with aldosterone, prevents sodium reabsorption and potassium excretion

38
Q

what are potassium sparing drugs

A

Triamterene

Amiloride

39
Q

what is the MOA for potassium sparing drugs

A

blocks sodium reabsorption and potassium excretion, effect independent of aldosterone

40
Q

What potassium sparing drugs is used for class IV heart failure

A

spironolactone

41
Q

what are the adverse effects with potassium sparing diuretics

A

hyperkalemia ( need to watch with patients who have renal failure)

42
Q

what are the adverse effects of spironolactone?

A

gynecomastia

menstrual irregularities

43
Q

what are the benefits of eplerenone

A

more selective
less side effects
more expensive

44
Q

What do you need to educate your patients about using potassium sparing diuretics?

A

people who are using salt substitutes have potassium in them which can cause hyperkalemia affecting the heart

45
Q

What drugs are part of the ACE inhibitors

A 
anything that ends in -pril
Captopril
Enalapril
Lisinopril
Ramipril
46
Q

what is the MOA for ACE-I

A

inhibits ACE to block the production of AT II

Inhibits the breakdown of bradykinin

47
Q

What are the benefits of ACE-I and

Disadvantages

A

lowers BP
Dilate the efferent arteriole of kidney
Inflammatory mediator

48
Q

What are ACE-I used for?

A

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
Q

What do you need to monitor with ACE-I?

A

Serum K+ & SCr within 4 weeks of initiation or dose increase. You will likely see a benign increase in Scr (<30% from baseline)

50
Q

what are the adverse effects with ACE-I

A

Cough due to increased bradykinin
Angioedemia
Hyperkalemia: esp in patients with DM or CKD
Neutropenia, agranulocytosis, proteinuria, glomerulonephritis, acute renal failure

51
Q

what are the contraindications with ACE-I?

A

pregnancy-childbearing age
angioedema
renal artery stenosis

52
Q

what are the drug interactions with ACE-I?

A

potassium supplements
Potassium sparing diuretics
NSAIDs

53
Q

how often is captpril dosed?

A

dosed 2-3 times daily

54
Q

Which of the ACE-I is a prodrug and only available IV?

A

Enalapril

55
Q

Which is the most commonly used ACE-I and what are the doses?

A

Lisinopril

10-40mg daily

56
Q

What decreases the absorption of captopril and by how much

A

when given with food and by 30-40%

57
Q

what drugs are part of the ARB drug class?

A 
anything that ends in -sartan
candesartan
eprosartan
irbesartan
losartan
valsartan
58
Q

what is the MOA for ARB

A

Inhibits angiotensin II at its receptor sites

Does NOT inhibit the breakdown of bradykinin

59
Q

What is ARB used for therapy in?

A

One of the first line drug classes in HTN
First line option for CKD
Used in CHF

60
Q

what do you need to monitor with ARB?

A

potassium

angioedema

61
Q

what are the adverse effects of ARB’s?

A 
Hypotension/orthostatic hypotension
Angioedema 
Hyperkalemia
Dizziness
Cough
62
Q

What are ARB’s contraindicated with?

A

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
Q

what are the drug interactions for ARBs?

A

potassium supplements
potassium sparing diuretics
NSAID

64
Q

what drug is a renin inhibitor

A

Aliskiren

65
Q

What is aliskiren contraindicated with?

A

ACE or ARB because it causes kidney damage

66
Q

What drugs are part of the beta blocker drug class

A

atenolol- dosed once a day
Metoprolol succinate- dosed once a day
metoprolol tartrate- dosed twice a day

67
Q

Beta blockers Reserved for patients that have significant history of what?

A 
cardiac history
Heart failure
Post MI
High coronary artery disease
CKD
68
Q

what is the MOA for beta blockers?

A

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
Q

What are the 4 categories of beta blockers

A

Cardioselectivity
Mixed α and β blockers

70
Q

what drugs are part of the Cardioselective category?

A 
AMEBBA
Atenolol
metoprolol
esmolol
bisoprolol
betaxaolol
acebutolol
71
Q

what drugs are part of the Mixed α and β blockers category?

A

Carvedilol

labetalol

72
Q

what drugs are part of the ISA category?

A 
CAPP
Carteolol- take with food
Acebutolol
Penbutolol
Pindolol
73
Q

what drugs are part of the non specific category?

A

Nadolol
propanolol-migrane tx
Timolol

74
Q

What beta blockers are used for heart failure?

A

Bisoprolol
Carvedilol
metoprolol succinate

75
Q

what are common adverse effects of beta blockers

A

“beta blocker blues”
Tire, fatigued, depressed, tight chest due to change in heart beat
Sexual dysfunction, rebound HTN

76
Q

what are relative contraindications of beta blockers?

A 
Asthma & COPD
Diabetes (masks hypoglycemia)
Severe peripheral vascular dz
heart block
severe acute heart failure
Pregnancy
77
Q

what class does sotalol belong too

A

class III anti-arrhythmic (beta-blockers)

Pharm-HTN/CHF (4 decks)

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