HTN - Kaakeh Flashcards
1
Q
List the risk factors for HTN: \_\_\_\_ Na+ intake \_\_\_\_\_\_ ethnicity \_\_\_\_\_\_\_ \_\_\_\_\_ K+ intake excess \_\_\_\_\_\_ intake \_\_\_\_\_\_\_\_\_ (FH)
A
HIGH Na+; African American; Obesity; low K+; excess alcohol; genetic predisposition
2
Q
Tobacco use - HTN or CVD risk factor?
A
CVD
3
Q
Each increment of ___/___ mmHg doubles the risk of CVD across the entire BP range starting from ___/___ mmHg
A
20/10;
from 115/75
4
Q
What are CVD risk factors?
A
- HTN
- Tobacco use
- Overweight
- Dyslipidemia
- Diabetes Mellitus
- Age
- FH
- Physical Inactivity
- Microalbuminuria or GFR < 60
5
Q
How to be classified with normal Adult BP
A
Sys < 120 AND Dias < 80
6
Q
How to be classified with Pre-HTN Adult BP
A
Sys : 120 - 139 OR Dias 80-89
7
Q
How to be classified with stage 1 HTN Adult BP
A
sys: 140 - 159 OR Dias 90-99
8
Q
How to be classified with stage 2 Adult BP
A
sys > 160 OR dias > 100
9
Q
Lowering BP helps lower the incidence of what 3 things
A
stroke; MI; HF
10
Q
what are some prescription drugs that can elevate BP
A
NSAIDs Corticosteroids Estrogens/OCs; Progesterone; Androgen Sympathomimetic Amines Erythropoietin Ketoconazole
11
Q
what are the 2 determinanys of BP
A
cardiac output & peripheral resistance
12
Q
is it primary or secondary cause of HTN?
drug induced
A
secondary
13
Q
is it primary or secondary cause of HTN? Humoral abnormality (RAAS, natriuretic hormone, insulin resistance)
A
primary
14
Q
is it primary or secondary cause of HTN?
vascular endothelial mechanisms abnormality
A
primary
15
Q
is it primary or secondary cause of HTN? neuronal mechanisms (alpha and beta) abnormality
A
primary
16
Q
is it primary or secondary cause of HTN?food substances
A
secondary
17
Q
is it primary or secondary cause of HTN?
Obstructive sleep apnea
A
secondary
18
Q
is it primary or secondary cause of HTN?
CKD
A
Secondary
19
Q
is it primary or secondary cause of HTN?
Peripheral autoregulation abnormality
A
primary
20
Q
is it primary or secondary cause of HTN?
primary aldosteronism
A
secondary
21
Q
is it primary or secondary cause of HTN?
renovascular disease
A
secondary
22
Q
is it primary or secondary cause of HTN?
Chronic steroid therapy & Cushings Syndrome
A
secondary
23
Q
is it primary or secondary cause of HTN?
Pheochromocytoma
A
secondary
24
Q
is it primary or secondary cause of HTN?
electrolyte disturbances
A
primary
25
is it primary or secondary cause of HTN?
| Coarctation of the aorta
secondary
26
is it primary or secondary cause of HTN?
| thyroid/parathyroid disease
secondary
27
what food substances can cause HTN
sodium; licorice; ethanol
28
Illicit Drugs that may elevate BP
ketamine
ectasy
cocaine
29
Possible symptoms of primary aldosteronism
HA, muscle cramps, polyuria
30
Primary Aldosteronism:
______kalemia
______natremia
metabolic _______
HYPOkalemia; HYPERnatremia; alkalosis
31
what types of patients should be tested for primary aldosteronism?
- drug resistant HTN
- mod - severe HTN
- Adrenal tumors
- HTN of FH of HTN before age 40
- if pt has HTN and has 1st degree relative with PA
32
BP = _____ x _____
CO x TPR
| TPR = total peripheral resistance
33
CO = _____ x _____
HR x SV
34
What meds can be used to control SV (stroke volume)
diuretics
35
what meds can be used to control HR (heart rate)
beta blockers; some CCBs
36
what meds can be used to control TPR (total peripheral resistance)
- ACEIs
- ARBs
- Hydralazine
- Sympatholytics
37
how to treat primary aldosteronism
surgically remove adrenal tumorl
| pretreat w/ 3 - 4 wks of spironolactone 100 mg - 400 mg PO QD
38
What is the normal range for MAP
70 - 100 mmHG
39
what value of MAP is needed to perfuse/sustain perfusion of organs
60 mmHg
40
what 5 areas of the body can be damaged by HTN
- brain
- heart
- eyes
- kidneys
- vasculature
41
what can happen to the brain if HTN is persistent
stroke; hemorrhage; TIA
42
what can happen to the heart if HTN is persistent
LVH (left ventricle hypertrophy); CHD; CHF
43
what can happen to the eyes if HTN is persistent
Retinopathy; AV nicking
44
what can happen to the kidneys if HTN is persistent
Renal failure; Proteinuria; CKD
45
how is eye damaged measured (when talk about HTN..?)
with KW values ( KW 1 - 4; KW 4 = most damage)
46
Initial add on treatment for someone that has CKD (regardless of race or DM)
ACEI or ARB
47
5 different NON-PHARM life modifications that can be done to help control BP
- weight reduction
- DASH eating plan
- Dietary Na reduction
- Aerobic physical activity
- Moderation of alcohol consumption
48
DASH diet: what is there Na restriction recommendation?
2300 mg/day
49
what is the DASH LOWER Na+ restriction recommendation?
1500 mg/day
50
what groups of patients should be using the LOWER Na+ restriction value?
```
if pt is over 51 YO
has diagnosed HTN
has DM
has CKD
or
is African American
```
51
per JNC 8 -
| what is the preferred thiazide
Chlorthalidone (longer 1/2 life and more potent)
HCTZ (cheap af tho)
52
per JNC 8 -
| what is the preferred ACEI
enalapril (BID)
| Lisinopril (QD)
53
Special Indications for HTN:
| If a pt has CAD (coronary artery disease) what is their standard pharmacotherapy
Beta blocker then add ACEI or ARB
THEN CCB
THEN Thiazide
54
Special Indications for HTN:
| standard pharmacotherapy for post MI pts
Beta blocker then add ACEI or ARB
55
Special Indications for HTN:
| standard pharmacotherapy for pt who has HF w/ reduced ejection fraction
Diuretic w/ ACE or ARB
THEN beta blocker
THEN aldosterone antagonist
56
Special Indications for HTN:
| Recurrent stroke prevention pt - what is their standard pharmacotherapy
Thiazide or Thiazide w/ ACEI
57
If a pt is in stage 1 HTN (and no compelling indications)
| how should drug therapy be initiated?
Monotherapy of the 4 first line agents
OR
2 drug combo of ACEI (or) ARB with CCB (or) thiazide
58
If a pt is in stage 2 HTN (and no compelling indications)
| how should drug therapy be initiated?
Two drug combo:
ACEi or ARB with CCB
OR
ACEi or ARB with thiazide
59
JNC8 Treatment Strategies aka wtf to do:
| If goal BP not met after 1 month of treatment.....
- increase dose of initial drug (maximize if tolerated)
or
- add 2nd drug - CAN add 2nd drug before achieving max dose of initial drug (watch for ADEs)
60
JNC8 Treatment Strategies aka wtf to do:
| May consider start w/ 2 drugs at the same time if.....
if SBP > 160 and/or DBP > 100
OR
if SBP > 20 and/or DBP > 10 ABOVE goal
61
JNC8 Treatment Strategies aka wtf to do:
| If goal BP not met w/ 2 meds....
add/titrate 3rd medication
| *DO NOT use ACEI and ARB together tho - possible kidney failure
62
JNC8 Treatment Strategies aka wtf to do:
| when to start using other classes of drugs (aka when to use drugs other than the 4 first line agents)
- Goal BP NOT met with 3 meds
| - Contraindication ot thiazide, ACEi/ARB, or CCB
63
what drug classes are known to be 2nd line therapy
- Loops/K+ sparing diuretics
- Beta-blockers
- Vasodilators (hydralazine)
- alpha blockers
- Direct renin inhbitors
64
4 classes of diuretics
- loops
- thiazides
- K+ sparing
- Aldosterone antagonists
65
What drugs are apart of the thiazide diuretic class?
- chlorthalidone
- HCTZ
- indapamide
- metolazone
66
What drugs are apart of the loop diuretic class?
bumetanide; furosemide; torsemide
67
What drugs are apart of the K+ sparing diuretic class?
amiloride; triamterene
68
What drugs are apart of the aldosterone antagonist diuretic class?
eplerenone; spironolactone
69
which diuretic can cause DM?
thiazides
70
which diuretic can help with osteoporosis?
thiazides - because they cause hypercalcemia/slow demineralization in osteoporosis
71
what are the clinical indications for diuretics
- HTN
- Edema
- CHF
- kidney disease
- Hepatic cirrhosis
- Hypercalcemia
- diabetes insipidus
72
which diuretic can cause a flare of gout?
thiazide
73
______ diuretics are more effective than ______ diuretics unless CrCl < 30 mL/min
thiazide; loop
74
T or F: Thiazides have a contraindication for sulfa allergy
True!
75
ADE's of thiazides?
hypokalemia/hypomagnesemia
hypercalcemia/hyperuricemia
hyperglycemia/hyperlipidemia
sexual dysfunction
76
what are the contraindications for thiazides?
sulfa allergy
| Anuria (aka hella renal dysfunction - do not use if CrCl < 30 mL/min)
77
Loop diuretics - sulfa allergy - yes or no?
yes - sulfa allergy is an issue
78
ADEs of Loop Diuretics
- hypokalemia/hypomagnesemia/hypocalcemia
- hyperuricemia
- ototoxicity
79
what are the K+ sparing diuretics
Amiloride; triamterene
80
who are K+ sparing diuretics used for?
pts that have had diuretic induced hypokalemia
81
K+ sparing diuretics should be avoided in what types of pts?
CKD or diabetic pts
82
What diuretics are aldosterone antagonists
spironolactone; eplerenone
83
Due to increased risk of hyperkalemia, _________ is contraindicated in CrCl < 50 ml/min and pts with T2DM and proteinuria
eplerenone
84
diuretic drug interactions
- NSAIDs
- Digitalis toxicity
- Lithium toxicity
- Corticosteroids
85
What are the diuretic monitoring parameters?
- BP
- BUN/SCr
- Serum electrolytes
- Cholesterol/triglycerides
- skin rash
- uric acid
86
Indications for ACEIs
- HTN
- Left ventricular systolic dysfunction
- MI
- diabetic nephropathy
87
Indications for ARBs
HTN
CHF
Progressive renal impairment (diabetes)
88
Contraindications for Angiotensin Inhbitors (ACEI/ARBs/Renin inhibitor)
- Pregnancy/Nursing mothers
- Hx of angioedema
- Bilateral renal artery stenosis
- Pre-existing kidney dysfunction
- Hyperkalemia
89
for ACE inhibitors: monitoring serum _____ & ____ within _____ of initiation of dose increase
K+; SCr; 4 weeks
90
Reduce the starting dose for ACE inhibitors/ARBs by ______% if the patients have a _________ risk
50%; hypotension;
91
What types of patients may need a 50% decrease in their starting dose for their ACEI/ARB
- pts also taking a diuretic
- Volume depletion
- Elderly patients
(everyone who has hypotension risk)
92
what types of patients are at a higher risk of hyperkalemia when starting an ACEI/ARB
CKD patients
or
pts on other K+ sparing medications (K+ sparing diuretics/aldosterone antagonists)
93
what are the compelling indications for Angiotension Inhibitors (ACEIs/ARBs)
DM - type 1 w/ proteinuria
HF
Post MI w/ Systolic Dysfucntion
94
when is it appropriate to have someone on both an ARB and ACEI
if the pt has severe forms of nephrotic syndrome
95
Indications for CCBs
- HTN
- Angina
- Arrhytmias
- (other: bipolar; HA; pulmonary HTN; diabetes)
96
Contraindications for CCBs
Preexisting bradycardia
Conduction defects
HF due to systolic dysfunction
97
______ is a contraindication to non-DHPs
Heart block
98
what are CCB Drug interactions
non-DHPs and BETA blockers (low HR!!)
Increase CCB effect: Grapefruit juice; Cimetidine; ranitidine
Decrease CCB effect: Rifampin; Phenobarbital
99
what drugs will increase CCB effect
grapefruit juice, cimetidine, ranititinde
100
what drugs will decrease CCB effect
rifampin; phenobarbital
101
monitoring for CCBs
BP
HR
Edema
Constipation
102
potentially favorable effects of Beta Blockers...
- shown to reduce mortality in pts w/ HF
- useful in the tx of atrial tachyarrhytmias/fibrilation
- migraines
- thyrotoxicosis (short term)
- essential tremor
- perioperative HTN
103
Potentially unfavorable effects of Beta Blockers
- Asthma/Reactive airway disease
- Renal insufficiency
- Diabetes
- HF exacerbation
- 2nd/3rd Degree heart block
104
frequent side effects of direct arterial vasodilators are ________
fluid retention; reflex tachycardia
105
Contraindication for Direct Arterial Vasodilator
Dissecting aortic aneurysm (bc reflex tachycardia issue with direct vasodilators...)
106
Which drug can have SLE side effects
Hydralazine (lupus like side effects - rash)
107
which drugs are preferred for pregnant women (bc safety of fetus)
Methyldopa
BBs
Vasodilators
