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Clinical Therapeutics > HTN-Thumar > Flashcards

HTN-Thumar Flashcards

1
Q

What does the JNC8 focus on more than 7 did?

A

BP control rather than use of particular agents for compelling indications

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2
Q

What has specific initial treatment recommendations?

A

CKD and race

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3
Q

What is no longer used as first-line agents?

A

Beta blockers

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4
Q

Which drugs did the ALLHAT trial compare?

A

Chlorthalidone vs Amlodipine vs Lisinopril

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5
Q

What did the ALLHAT trial say about those 3 drugs?

A

There is no clear difference between single agents regarding fatal CAD and nonfatal MI

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6
Q

Which drug out of the 3 from ALLHAT trial MAY be preferable?

A

Chlorthalidone

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7
Q

What is recommended for CKD (+/- diabetes, regardless of race)

A

ACEI or ARB

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8
Q

What is recommended for the black population?

A

Thiazide or CCB

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9
Q

What is recommended for the general population?

A

Thiazide or CCB or ACEI or ARB

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10
Q

What is the definition of CKD?

A

Abnormalities of kidney structure or function, present for >3mos, with implications for health

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11
Q

What is CKD based on?

A

Cause, GFR category, and albuminuria category

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12
Q

What does Stage1-2 CKD consist of?

A

GFR >60ml/min for >3mos plus one or more markers of kidney damage (albuminuria)

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13
Q

What is an example of a marker for kidney damage?

A

Albuminuria

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14
Q

What does stages 3-5 of CKD consist of?

A

GFR<60ml/min for >3mos

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15
Q

What is the A1 category for albuminuria?

A

Normal to mildly increased

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16
Q

What is the range for A1 albuminuria?

A

<30mg/m

<3 mg/molecules

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17
Q

What is the A2 category for albuminuria?

A

Moderately increased

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18
Q

What is the range for A2 albuminuria?

A

30-300mg/m

3-30 mg/mmol

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19
Q

What is the category A3 for albuminuria?

A

Severely increased

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20
Q

What is the range for A3 albuminuria?

A

> 300mg/g

>30mg/mmol

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21
Q

G1 (GFR)

A

Normal or high

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22
Q

G1 range

A

> 90

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23
Q

G2

A

Mildly decreased

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24
Q

G2 range

A

60-89

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25
Q

G3a

A

Mildly to moderately decreased

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26
Q

G3a range

A

45-59

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27
Q

G3b

A

Moderately to severely decreased

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28
Q

G3b range

A

30-44

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29
Q

G4

A

Severely decreased

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30
Q

G4 range

A

15-29

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31
Q

G5

A

Kidney failure

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32
Q

G5 range

A

<15

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33
Q

What is a common lab to order for albuminuria?

A

Albumin-creatintine ratio “ACR” or microalbumin/urine creatinine ratio

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34
Q

What is a normal ACR?

A

<30mg/g

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35
Q

What is “albuminuria”

36
Q

Moderately increased ACR is what

37
Q

Severely increased ACR is what

38
Q

Who has high-volume HTN?

A

Black population

39
Q

Low plasma renin activity and increased sodium/fluid loading

A

Black population-HTN

40
Q

The black population with HTN is particularly responsive to what?

A

Sodium restriction and dieresis

41
Q

Thiazide diuretics and CCBs have better efficacy for the black population as what?

A

Monotherapy

42
Q

What is most effective in improving cerebrovascular, heat failure, and combined CV outcomes?

A

Thiazide diuretics and CCBs in black population

43
Q

You can consider starting with dual therapy is the BP is how much over goal?

A

> 20/10mmHg above goal at diagnosis

44
Q

What are the options if the BP goal is not reached within one month of initiating treatment?

A

Increase/maximize dose or initial drug OR

Add second agent from different class

45
Q

What combination therapies should be considered first?

A

ACEI+CCB over ACEI+thiazide

46
Q

Which two classes should NOT be used in combo?

A

ACEI and ARB

47
Q

If goal cant be reached using third drug:

A

Ensure dose optimization and proper BP measurement, consider aldosterone-antagonist, BB, alpha-blocker, etc, refer to specialist

48
Q

If the goal cant be reached with 3 drugs, what type of HTN could it be?

A

Secondary or resistant

49
Q

What is one of the biggest barriers to HTN management?

A

Compliance

50
Q

What is favorable treatment for the elderly?

A

Low-dose thiazide diuretics

51
Q

What should be considered when treating the elderly for HTN?

A

Fall risk, hypoperfusion if BP is too low

52
Q

What is the age cutoff for HTN treatment?

53
Q

What is the HYVET trial?

A

Assessed BP treatment in >80YO

54
Q

What drugs were associated with a trend towards reduced rates of fatal/nonfatal stroke for the elderly?

A

Diuretic+/- ACEI

55
Q

What is the take home point from the HYVET trial?

A

Its better to treat than to not treat elevated BP in the elderly

56
Q

What is first line HTN treatment for pregnancy?

A

Methyldopa, Labetalol

57
Q

What is second line treatment for HTN in pregnancy?

A

Nifedipine, Verapamil

58
Q

What is the BP goal for pregnancy?

59
Q

How can we improve pts adherence to HTN meds?

A

Use charts or pill boxes, link med use with daily activities, provide support, simplify medication regimens

60
Q

Chronotherapeutics is what?

A

Considering to administer one BP med at night

61
Q

What are some pros to chronotherapy?

A

better 24 hour control, possibly less dizziness, nighttime elevated BP correlates more with CV risk than daytime

62
Q

What is the exception to administering HTN meds at night?

A

Diuretics-dont prescribe at night

63
Q

How much can weight reduction lower BP?

A

5-20mmHg/10kg

64
Q

How much can adopting the DASH eating plan lower BP?

65
Q

How much can lowering dietary sodium decrease BP?

66
Q

How much can physical activity decrease BP?

67
Q

How much can lowering alcohol consumption decrease BP?

68
Q

“Blood pressure that remains above goal in spite of the concurrent use of 3 antihypertensive agents of different classes”

A

Resistant HTN

69
Q

What is the classic triad of meds for resistant HTN?

A

Diuretics, ACEI or ARB, CCB

70
Q

What are some risks for resistant HTN?

A

Incresing age, high baseline BP, excessive dietary salt, CKD, diabetes, LVH, African-American, female, residence in southeast US

71
Q

What is a common secondary cause of resistant HTN?

A

Pseudoresistance

72
Q

Pseudoresistance can be due to several situations:

A

Faulty BP monitoring, white coat HTN, NON-ADHERENCE (most common cause)

73
Q

What % of pts stop their BP meds within the first year of treatment

74
Q

What are common secondary causes of HTN?

A

Obstructive sleep apnea, primary aldoesteronism, advanced CKD, renal artery stenosis, volume overload, excess alcohol, obesity meds

75
Q

What are some uncommon causes of secondary HTN?

A

Pheochromocytoma, Cushing’s, hyperparathyroidism, intracranial tumor

76
Q

What types of drugs can cause secondary HTN?

A

NSAIDs, COX-2inhibitors, stimulants, cocaine, sympathomimetics (decongestants, diet pills), OCPs, cyclosporine, tacrolimus, steroids, erythropoietin, natural licorice, herbals

77
Q

What are the medication options for resistance HTN?

A

Based on expert consensus and/or clinical experience

78
Q

What should be considered when treating resistant HTN?

A

Utilizing different drug mechanisms; optimizing management of co-morbidities; proper 24hr BP control

79
Q

Which potassium-sparing diuretics can be used for resistant HTN?

A

Spironolactone

80
Q

What are some pros to use Spironolactone for resistant HTN?

A

Can decreased SBP 5-20, DBP 5-10, improves LV size with addition to a 3 drug regimen

81
Q

What is the dosing for potassium-sparing diuretics for resistant HTN?

A

Spironolactone 12.5-50mg daily
Eplerenone 50mg BID
Amiloride 2.5-10mg daily

82
Q

BB should already be part of the resistant HTN regiment for pts that also have what?

A

CHF or CVD (angina, prior MI_

83
Q

When should BBs be considered for resistant HTN treatment?

A

If resting HR is >80bpm

Consider Carvedilol, Labetalol

84
Q

Alpha-blockers can be considered for resistant HTN when pts have

A

Low HR and or BPH

85
Q

Which other drugs can be used (but often are not due to adverse effects)

A

Clonidine, Hydralazine

Clinical Therapeutics (8 decks)

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