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PHAR 152 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

How long does it take take for a BP drug to have full effect?

A

1 month

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2
Q

By how much to most BP drugs lower BP?

A

-10/-5

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3
Q

When is HTN treatment resistant?

A

When using 3 anti hypertensives in combination
One of the drugs is a diuretic and
Non-adherence is ruled out

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4
Q

What drugs can elevate BP?

A

NSAIDs - lower renal perfusion
Steroids - mineralocorticoid effect
Decongestants/certain anti-depressants/stimulants - SNS activity
Alcohol - impairs ADH + other mechanisms

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5
Q

When are BB used in HTN?

A

Uncomplicated HTN if <60yo
Complicated pts + HTN (extremely protective for other conditions)

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6
Q

When are vasodilators used in HTN?

A

DHP CCB - arterial vasodilator - extremely useful
Alpha-blockers - less effective (used for BPH)
Smooth muscle relaxant

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7
Q

What are the first line therapies for HTN?

A

Thiazide diuretics, CCB, ACE, ARB

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8
Q

What meds should be avoided in elderly?

A

Combos. Especially ACE, diuretics, central agents

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9
Q

What combos should be avoided?

A

ACE + ARB - reduces renal function too much
BB + non-DHP CCB - reduces HR too much

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10
Q

What do we do for treatment resistant HTN?

A

Add on therapy of:
Spironolactone (DOC)
Alpha-2 agonists
Hydralazine/minoxidil + BB (plus diuretic)

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11
Q

What is isolated systolic hypertension (ISH)?

A

High SBP yet normal DBP
Classified if different between SBP-DBP is greater then 98

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12
Q

How is ISH treated?

A

Any of the following: TZD, ARB, DHP CCB
Dual combo of two of above
Triple combo (all three)

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13
Q

What are indications of complicated HTN?

A

Diabetes w/so nephropathy
Kidney disease
CHD
Heart failure
LVH
Stroke or TIA

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14
Q

What is the target BP for complicated HTN in diabetes ?

A

<130/80

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15
Q

Treatment for complicated HTN in diabetes without risk factors?

A

1 of the following: ACE, ARB, DHP- CCB, or TZD
ACE and DHP-CCB preferred
2nd line add on: TZD OR a CCB

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16
Q

What are the risk factors for complicated HTN in diabetes?

A

Microalbuminuria
Renal disease
CVD or other CV factors

17
Q

Treatment for patients with diabetes and HTN with risk factors

A

Initial therapy: ACE or ARB
For second line: ACE + DHP-CCB

18
Q

What is the target BP for CKD patients with HTN?

A

<120/NA

19
Q

What is the treatment for CKD patients with HTN?

A

ACE or ARB at highest approved or maximally tolerated dose (+/- diuretic)

20
Q

What is the target BP for HTN with artery disease?

A

<120/80

21
Q

What are the treatments for patients with HTN and artery disease?

A

1st line: ACE or ARB; BB or CCB in those with stable angina
2nd line add-on: THZ or DHP CCB(preferred)

22
Q

How does hypokalemia happen?

A

Results from diuretic tx
Common TZD AE - start with low dose

23
Q

Treatment options for hypokalemia

A
  1. Reduce Na+ intake and increase K+ intake
  2. Lower diuretic dose
  3. Add K+ sparing agent (BB, ACE/ARB, K-diuretic)
  4. Add K+ supplement
  5. D/c diuretic if seriously low
24
Q

What drugs can increase K+ and lead to hyperkalemia?

A

RAAS drugs
NSAIDs
Vitamins/supplements
K+ sparing diuretics
TMP/SMX
For treatment we could remove the drug unless it is providing other major benefit

25
Q

What needs to be avoided in HTN during pregnancy?

A

ACE and ARB

26
Q

What is the treatment for HTN during pregnancy?

A

1st line: labetalol, methyldopa, long-acting oral nifedipine, other BB
2nd line: clonidone, hydralazine, TZD

27
Q

What is required for HTN or be diagnosed?

A
  1. Must be high as rest
  2. Unrelenting / consistent
  3. CANNOT be diagnosed in pharmacy
28
Q

What is primary HTN?

A

Metabolic syndrome - caused by at lest 3 of:
- insulin resistance / increased blood sugar
- low HDL
- obesity
- high TGs
- high BP

29
Q

What is secondary HTN?

A

HTN caused by dysfunction of 1 system (RAAS, renal dysfunction, increased SNS activity)

30
Q

What is treatment resistance?

A

Lack of control despite a combination of 3 anti hypertensive medications (including diuretic)

PHAR 152 (10 decks)

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