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CDM 1 Exam 1 > Hypertension 3 - Compelling indication and Special pop > Flashcards

Hypertension 3 - Compelling indication and Special pop Flashcards

1
Q

Difference between Hypertensive Urgency vs Emergency?

A

Both have SBP > 180 or DBP > 120

Difference is if have Target Organ damage or not, if someone has symptoms or not.

Symtoms + Damage = emergency

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2
Q

What to do if Hypertensive Urgency

A

Make sure taking BP correctly, recheck
Make sure they take meds
Want to lower BP gradually

only do this if having no symptoms

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3
Q

What to do if Hypertensive Emergency?

A

Hospital or doctor

Lower BP in min/hrs

Have symptoms in this situation. vision issues

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4
Q

What is Resistant Hypertension

A

Above goal and >3 meds

At goal and >4 meds

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5
Q

Reasons for Resistant Hypertension

A

Med adherence
White coat HTN
Poor BP measuring technique

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6
Q

Resistant Hypertension Treatment

A

Remove contributing life factors (Diet, Exercise, etc)

  1. Discontinue or decrease interfering substances
  2. Optimize current regimen
  3. Consider adding other medications
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7
Q

What should be discontinued in Resistant HTN? (can be interfering)

A 
NSAIDs
Sympathomimetics (amphetamines / decongestants)
Stimulants
Oral contraceptives
Licorice
Ephedra
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8
Q

How to optimize current regimen for Resistant HTN?

A

Maximize current med dosing
Maximize diuretic therapy

Consider chlorthalidone over HCTZ for better BP lowering response or loop diuretic if severe renal impairment

Consider blister packing, med delivery, combo BP meds to reduce pill burden / improve adherence

Recommend patient take one or more BP meds at bedtime

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9
Q

What drugs can you add for Resistant HTN?

A

Aldosterone antagonist (spironolactone)

Evidence supports adding spironolactone over other med options to improve BP

Other agent options: Beta blocker, a centrally acting agent (clonidine), an alpha blocker, or hydralazine or minoxidil

Consider HTN Specialist referral

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10
Q

What is White Coat Hypertension?

A

When a person has elevated blood pressure readings in clinic but have normal readings outside of clinic

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11
Q

How to reduce White Coat Hypertension?

A

24hr BP monitoring (Gold Standard)

Monitor BP at home

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12
Q

Anti-HTN in Black patients initial treatment?

A

Thiazide-type diuretic or CCB

Most patients require 2 of more meds
Add ACEi or ARB as add-on w/ compelling indication

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13
Q

BP in Elderly people

A

Often have Isolated Systolic Hypertension (ISH)

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14
Q

What medications are effective in elderly with ISH?

A

Dihydropyridine CCBs (Amlodipine, Nifedipine)

Generally used first, tolerated best

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15
Q

Challenges of Treating elderly people?

A

Poly-pharmacy
Frailty
Cognitive impairment
Variable life expectancy

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16
Q

Which BP side effects are elderly at higher risk?

A

Orthostatic hypotension
Risk of syncope/falls
Volume depletion
Electrolyte problems

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17
Q

BP goal in elderly people?

A

Goal = <130/80 IF tolerated well

Modify goal to <140/90 or <150/90 if needed based on pt

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18
Q

Special considerations in elderly people?

A

consider combo meds with lower doses to reduce side effects

confirm med adherence before increasing dose

counsel patients on ACEI/ARB or thiazide to stay hydrated and avoid NSAIDs

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19
Q

Which medications make ED worse?

A

Thiazide and Beta blockers

20
Q

Which medications are pretty neutral for ED?

A

ACEi’s and CCBs

21
Q

HTN in pregnancy

A

Usually goes away once give birth

Preeclampsia can occur -> turns into eclampsia if seizures occur

22
Q

Preferred medications in Pregnancy HTN

A

Hydralazine or labetalol to manage severe elevations of BP

Nifedipine

Methyldopa - best data but limited due to potency

Labetalol or nifedipine are more commonly used

23
Q

Which meds contraindicated in pregnancy HTN?

A

ACEIs, ARBs, aliskiren, and spironolactone

24
Q

Heart Failure Goal HTN?

A

<130/80

25
Q

1st line therapy for HFrEF

A

GDMT Beta Blocker + diuretic (loop) + ACEI/ARB/ARNI +/- aldosterone antagonist (Based on LEVF)

Add on if uncontrolled: CCB (DHP)

26
Q

Patients with HFpEF who present with symptoms of volume overload, what drugs should be prescribed to control HTN?

A

Diuretics

27
Q

Adults with HFpEF and persistent hypertension after management of volume overload, what drugs should be prescribed

A

ACEi or ARBs and Beta Blockers

28
Q

GDMT Beta Blockers

A

Metoprolol Succinate
Carvedilol
Bisoprolol

29
Q

Which CCB should be avoided in patients with HF?

A

Non-DHP due to negative chronotropic/ionotropic effects

30
Q

Post MI BP goal?

A

<130/80

31
Q

1st line drugs in post-MI HTN?

A

ACEi/ARBs plus BB

Should use BB w/o intrinsic sympathomimetic activity (usually start with metoprolol)

Usually B1 selective are used

32
Q

Add on therapy in post MI HTN?

A

CCB or thiazide

33
Q

SIDH BP goal?

A

<130/80

34
Q

1st line therapy SIHD?

A

BB and ACEi/ARB

Avoid Atenolol

35
Q

Add on therapy if HTN uncontrolled SIHD?

A

w/ angina = DHP CCB

w/o angina = DHP CCB/ Thiazide Diuretic/ or Aldosterone Antagonist

36
Q

BP goal for diabetes with ASCVD or ASCVD score >15%

A

<130/80

37
Q

BP goal for diabetes with ASCVD score <15%

A

<140/90

38
Q

Treatment for HTN w/ Diabetes without kidney disease ?

A

ACEi/ARB, DHP CCB or Thiazide diuretic

39
Q

Treatment for HTN w/Diabetes with kidney disease

A

ACEi or ARB will be 1st line therapy

40
Q

How can ACEi improve Kidney function?

A

Block AT2, causing dilation of efferent part of nephron and allows for better flow.

improves kidney function

41
Q

BP goal in Chronic Kidney Disease?

A

<130/80

42
Q

Therapy for CKD with UACR >300

A

ACEi (preferred) or ARB

Add on CCB and Thiazide

43
Q

Therapy of pt who have already had a stroke?

A

1st line = ACEi/ARBs, Thiazide or combo of 2
2nd line = CCB and Aldosterone Antagonist

combo ACEi/ARB + Thiazide shown to reduce incidence of recurrent stroke

44
Q

BP goal for patient who already had stroke?

A

<130/80

45
Q

Treating HTN in Black pt with Diabetes?

A

CCB or Thiazides

46
Q

Treating HTN in pt with Diabetes and proteinuria?

A

ACEi/ARB

CDM 1 Exam 1 (14 decks)

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