Hypertension Flashcards

1
Q

BP

A

= CO X SVR

-Determinants of Arterial Pressure
—-Cardiac Output
SV x HR = CO
Intravascular Volume / Na+ effect

-Peripheral Resistance
—Size & Compliance of the arteries/arterioles
—Autonomic Nervous System
—RAAS

Target HTN goal <130/80

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2
Q

Diagnostic Workup

A

-H&P including accurate measurement of BP on both arms with a calibrated device (use average of 3 readings on each arm)

Labs:
-Fasting glucose, CBC, Lipid Profile, serum creatinine with GFR, serum -Sodium, Potassium & Calcium, TSH
-Urinalysis, urine excretion of albumin or albumin/creatinine ratio (+1 or greater)
-ECG

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3
Q

When to screen for secondary causes of Htn?

A

New onset or uncontrolled hypertension in adults with:
-Drug resistance (> 3 drugs)
-Abrupt onset
-Age < 30
-Excessive target end organ damage
-New onset diastolic hypertension in older adults
-Presence of unprovoked or excessive hypokalemia

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4
Q

Secondary causes of HTN

A

OSA
Primary aldosteronism
renovascular disease
drug or alcohol
renal parenchymal disease
Pheochromocytoma/ Paraganglioma
Cushings Syndrome
Hypothyroidism
Aortic Coarctation (unrepaired)
Primary Hyperparathyroidism
Congenital Adrenal Hyperplasgia
Mineral Corticoid Excess Syndromes
Acromegaly

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5
Q

Initial therapy for stage 1 htn w/out comorbid conditions

A

Thiazide diuretics
Calcium Channel Blockers
Ace inhibitors or Angiotensin Receptor Blockers

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6
Q

Stage 2 HTN or average BP of 20-10 mmHg above BP target:

A

Use 2 first line drugs of different classes

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7
Q

Diuretics-preferred initial therapy: Thiazides

A

Hydrochlorothiazide (HCTZ) 12.5-50 mg
*Chlorthalidone 12.5-50 mg
Inexpensive; long half-life; need to monitor K+ & Na+; not in renal failure

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8
Q

Diuretics-preferred initial therapy: K sparing

A

Triamterene 50-100 mg; max 300 mg/day
Amiloride 5-10 mg; max 20 mg/day
not in renal failure or hyperkalemia

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9
Q

Diuretics-preferred initial therapy: Aldosterone antagonists

A

Spironolactone 12.5-50 mg
Eplerenone ($) 25-50 mg; max 100 mg/day
HF, both increase K+

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10
Q

Diuretics: Loops

A

-Furosemide 10-40 mg; max 600 mg/day;
-Bumetanide 0.5-2 mg; max 10 mg/day
PO or IV, monitor K+
-Toresmide 5-10 mg

PO only, but better gut absorption in HF; monitor K+
-Ethacrynic Acid 25-100 mg; max 100 mg/day
PO or IV, allergy to Furosemide, monitor K+

*Higher doses to treat HF

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11
Q

Beta Blockers: Known CAD or CV event-selective

A

-Metoprolol Tartarate (Lopressor) 25-200 mg BID PO; 5-10 mg IV
-Metoprolol Succinate ER (Toprol XL) 25-400 mg PO
CAD, Post MI, Tachyarrhythmias/Ectopy
-Atenolol 50-100 mg
PO only; caution in reduced kidney function/elderly

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12
Q

Beta Blockers: Known CAD or CV event-Nonselective

A

-Propranolol 40-240 mg; max 640/day
Taper dosing to DC
-Bisoprolol 2.5-5 mg daily for HTN; 1.25 mg daily for HF; max 10 mg/day. Good for patients with lung disease.

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13
Q

BB combined alpha/beta

A

Carvedilol 3.125-25 mg BID; max 50-100 mg/day
Preferred for treatment of HFrEF

-Labetalol 200-400 mg PO BID; max 2400mg/day
Hypertensive Emergency:
20-80 mg q 10 min prn; max 300 mg/total dose; IV gtt

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14
Q

ACE Inhibitors (for patients w/ DM, CKD, Stroke/TIA)

A

-Captopril 12.5-50 mg BID or TID; max 450 mg/day
Short-acting, post MI, LV dysfunction

-Lisinopril 5-40 mg QD or BID; max 80 mg/day

-Enalapril 5-40 mg daily
LV dysfunction, HF; caution in renal failure/bilateral renal artery stenosis; may cause angioedema

DO NOT combine with ARBs!
-ACE induced cough
-Angioedema cannot go on volsartan or entresto

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15
Q

ARBS

A

-Candesartan 8-32 mg; max 32 mg/day

-Losartan 25-100 mg; max 100 mg/day

-Valsartan 80-320 mg; max 320 mg/day
HF; allergy to ACEi; caution in renal failure/bilateral renal artery stenosis

-DO NOT combine with ACE inhibitors!

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16
Q

Ca Channel Blockers (good choice in African Americans) good for angina: Dihydropyridines:

A

Nifedipine (long-acting ONLY) 30-90 mg ER; max 120 mg/day

17
Q

Ca Channel Blockers (good choice in African Americans) good for angina: Non-Dihydropyridines:

A

-Diltiazem 30-90 mg QID; max 320 mg/day

-Diltiazem CD 120-480 mg; max 480 mg/day
Short & Long-Acting preparations; IV for Afib

-Verapamil IR 80-120 mg TID; max 480 mg/day
Multiple forms; IV for Afib

-Amlodipine 5-10 mg; max 10 mg/day
Long-acting; does not effect heart rate

*CCBs are constipating & may promote LE edema

18
Q

Alpha Antagonists (selective)

A

-Doxazosin(Cardura) 1-4 mg; max 16 mg/day

-Terazosin(Hytrin) 1-5 mg PO q HS; max 20 mg/day

-Prazosin(Minipress) 1-15 mg BID or TID
prostatism

19
Q

Alpha Antagonists (non-selective)

A

Phenoxybenzamine 10-40 mg BID or TID
pheochromocytoma

20
Q

SYMPATHOLYTICS (Central):

A

-Clonidine 0.1-0.3 mg PO BID; max 2.4 mg/day
Increase 0.1 mg/week; taper at DC

-Clonidine transdermal 0.1 mg/24 h patch; max 0.6 mg/24 h
May increase dose every 1-2 weeks

-Methyldopa, Reserpine, Guanfacine

TAPER- do not withdraw quickly!

21
Q

Direct Vasodilators

A

-Hydralazine 10-50 mg PO QID; max 300 mg/day
short-acting, DO NOT use in severe CAD; renal dosing
Hypertensive Emergency: 10-20 mg IM-IV q 2-4 h prn

-Minoxidil 5-40 mg; max 100 mg/day-Severe Hypertension

22
Q

Dangerous signs/symptoms

A

Headache
Vision Changes
Nosebleeds
Nausea/Vomiting
Confusion or Mental Status Changes
Chest pain

23
Q

Hypertensive Emergency: IV medications

A

-Nicardipine 5 mg/h IV; inc 2.5 mg/h q 5-15 min; max 15 mg/h
-Clevidipine 1-2 mg/h; double q 5-10 min; max 32 mg/h; max 72 h
-Nitroprusside 0.3-0.5 mcg/kg/min IV; max 10 mcg/kg/min
-Nitroglycerin 5 mcg/min IV; inc 5 mcg/kg q 3-5 min; max 20 mcg/kg
-Hydralazine 10 mg IV; max initial dose 20 mg; repeat q 4-6 h prn
-Esmolol initial bolus 500-1000 mcg; 50 mcg/kg/min IV; max 200 mg/kg/min
-Labetolol 0.3-1 mg/kg dose (max 20 mg) q 10 min; max 300 mg
-Phentolamine 5 mg IV bolus; additional boluses q 10 min prn
-Fenoldopam 0.1-0.3 mcg/kg/min; max 1.6 mcg/kg/min
-Enalaprilat initial bolus 1.25 mg IV; max 5 mg IV q 6 h

24
Q

Stages of HTN

A

-Normal: SBP <120 and DBP 80 mmHg
-Elevated: SBP120-129 and DBP <80 mmHg
-Hypertension Stage I: SBP 130-139 or DBP 80-89 mmHg
-Hypertension Stage II: SBP > 140 or DBP >90 mmHg
-Hypertensive Urgency: SBP >180 and/or DBP >120
-Hypertensive Emergency: SBP > 180 mm Hg and/or DBP >120 mmHg + target organ damage