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Clinical Pharmacy 2 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is the formula that described the pathophysiology of hypertension?

A

BP = CO x PR

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2
Q

What parameter do diuretics act on?

A
  • diuretics act on CO (cardiac output)
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3
Q

What are some of the main complications of HTN?

A
  • cerebrovascular disease
  • coronary artery disease
  • congestive heart failure
  • renal failure
  • peripheral vascular disease
  • dementia
  • atrial fibrillation
  • erectile dysfunction
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4
Q

What are the 2 highest risk factors for having a cardiovascular event?

A
  • smoking

- diabetes

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5
Q

What should the hypertension goals be?

A
  • 140/90
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6
Q

Describe the sprint trial?

A
  • a randomized trial of intensive vs standard blood pressure control
  • left sided heart failure or stroke patients are not included in the study
  • they did both an intensive (<120) vs standard (<140) BP control
  • trying to push the blood pressure levels to being under 120 systolic - can lead to serious adverse events (life threatening permanent disability, hospitalization)
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7
Q

What other factors are important to consider when looking to manage blood pressure?

A
  • diet
  • if he is a smoker
  • exercise habits
  • stress level
  • familial history of cardiac events
  • any allergies
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8
Q

What are some of the major drug causes of high blood pressure?

A
  • NSAIDs
  • decongestants
  • alcohol
  • estrogen
    • some herbal supplements**
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9
Q

How long do non drug measures usually take to take effect?

A
  • 3-6 months until non drug measures take effect
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10
Q

What are some of the non drug interventions to lower blood pressure?

A
  • watch salt intake and diet
  • watch fat content in food
  • stress management
  • DASH diet
  • aerobic exercise
  • weight reduction (BMI should be between 18.5-24.9)
  • moderation of alcohol intake
  • caffeine reduction
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11
Q

What should the sodium level be at for optimal blood pressure control?

A

2,000 mg

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12
Q

What are the main mechanisms in which blood pressure is reduced?

A
  • reduction of contractility with minimized vasoconstriction
  • reduction of peripheral resistance
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13
Q

What are the effects of calcium channel blockers vs thiazides vs ACE inhibitors in lowering blood pressure?

A
  • all have about the same effect in how they lower blood pressure
  • all are quite similar on their effects on mortality
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14
Q

Why is it important to not give ACE inhibitors to someone that is also taking an NSAID?

A
  • ACE inhibitors vasodilate the efferent arterioles coming out of the glomerulus, while NSAIDs are vasoconstricting the afferent arterioles that are coming into the kidneys - turns it into a “dripping tap”
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15
Q

What are the common ADRs when using thiazides?

A
  • dizziness, increased urination, increased sensitivity to sun, muscle cramps, biochemical abnormalities (decreased K, Na, increased lipids, increased uric acid and glucose)
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16
Q

What are the cautions to keep in mind with thiazides?

A
  • watch in gout, hypokalemia and hyponatremia
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17
Q

What are the common ADRs for ACE inhibitors?

A
  • dry cough, increased K and increased serum creatinine

- increase in over 30% is a concern in SCr

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18
Q

What are the cautions to keep in mind with ACE inhibitors?

A
  • history of bilateral renal artery stenosis, NSAID use
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19
Q

What are the common ADRs to keep in mind with ARBs?

A
  • increased K and increased serum creatinine
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20
Q

What are the cautions to keep in mind with ARBs?

A
  • history of bilateral renal artery stenosis, NSAID use
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21
Q

What are the ADRs associated with beta blockers?

A
  • cold extremities, fatigue, nausea, decreased HR, decreased exercise tolerance, vivid dreams and impotence
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22
Q

What are the cautions associated with beta blockers?

A
  • history of asthma, severe PAD, heart block, age over 60
23
Q

What are the main ADRs associated with DHP calcium channel blockers?

A
  • flushing, ankle edema, headache, increased HR
24
Q

What are the main ADRs associated with non DHP CCBs?

A
  • decreased HR, flushing, edema, headache, heart block, worsened HF, constipation
25
Q

As a general rule for anti hypertension medications, using _______ will lead to only 20% less blood pressure reduction

A

1/2 of the standard doses

26
Q

What was the effect that was found when studying the effects of beta blockers in treating hypertension alone?

A
  • BB reduction vs placebo:
    — <60 y/o: better
    — >60 y/o: similar to placebo
    (vs other antihypertensives it even caused MORE CV events such as stoke in those over 60)
27
Q

What is the dosing frequency of thiazide diuretics? What other considerations must be taken into account?

A

dose OD

  • less effective id ClCr is <30 mL/min
  • chlorthalidone comes in 50 mg or 100 mg tabs
28
Q

What is the dosing frequency of ACE inhibitors?

A

OD or BID

29
Q

What other considerations must be taken into account when giving ACE inhibitors/ARBs/beta blockers?

A

may be less effective in black patients

30
Q

What interactions must be kept in mind when dosing calcium channel blockers?

A
  • CYP 3A4 interactions
31
Q

What lab value would you look at to when assessing kidney function in a patient having newly started a medication? What is norma; for this value?

A

urinary albumin/creatinine ratio

- anything under 2.0 is normal

32
Q

Why might the urinary albumin/creatinine ratio be high?

A
  • albumin is a large molecule - proteins of this size should not be able to get into the urine and into the bladder
  • when we are peeing out large amounts of albumin compared to creatinine, then that means that the kidneys are starting to get a little leaky
33
Q

What are the effects of a SBP under 120 vs under 140?

A
  • 0.2% reduction in stroke, 0.4% increase in significant adverse effects
34
Q

What is the effect of aiming for a SBP target of <140 in those with diabetes mellitus?

A

if systolic blood pressure is less than 140 mm Hg, then further treatment is associated with increased risk of cardiovascular death with NO observed benefit

35
Q

What is the drug recommendation for those with cardiovascular or kidney disease (including microalbuminuria) or with CVD risk factors in addition to diabetes or hypertension?

A
  • an ACE inhibitor

- an ARB– these are both recommended as initial therapy

36
Q

For people with diabetes and hypertension WITHOUT cardiovascular or kidney disease, what is the recommendation for drugs to tx hypertension?

A
  • ACE inhibitors
  • ARBs
  • dihydropyridine CCBs
  • thiazide/thiazide like diuretics
    (give NO difference in the incidence of end stage renal disease between the options)
  • no difference in CHD, stroke or CVD
37
Q

what is the only drug that can be used to recede the incidence of microalbuminuria in diabetes?

A

ACEIs or ARBs

these reduce the progression of nephropathy to ESRD

38
Q

What its the main blood pressure target that we should be aiming for?

A
  • 140/85-90
39
Q

FOR THOSE WITHOUT KINDEY DISEASE, ACE AND ARB DO WHAT?

A
  • they reduce the liklihood of developing microalbuminuria, but nor doubling of SCr or ESRD
40
Q

FOR THOSE WITH DIABETIC KIDNEY DISEASE WHAT DO ACE AND ARBS DO?

A

both delay the progression of nephropathy to ESRD

41
Q

Using half standard doses of blood pressure medications results in what?

A
  • 20% less bp reduction
42
Q

What happens when you add 2 separate blood pressure medications together?

A
  • you stack the effects, but do not stack the AE

- – this is a very good thing!

43
Q

Generally, when should blood pressure medications be taken?

A

using antihypertensive medications at bedtime reduces the incidence of CV events more than use of all drugs in the morning

44
Q

What are the risks of treating hypertension in the elderly?

A
  • increased orthostatic hypotension
  • increased morbidity and increased risk of falls
    (they are more sensitive to sympathetic inhibition and volume depletion)
45
Q

Elderly aged > 85 years old with a systolic bp <120 are associated with what?

A

with increased mortality

46
Q

Elderly aged ~70 with a diastolic bp (<65) is associated with what?

A

associated with increased stroke and CV event risk

47
Q

Isolated systolic HTN and wide pulse pressures are associated with what in the elderly?

A

increased risk of MI, stroke and renal failure

48
Q

What is the target blood pressure in the very elderly with comorbid conditions?

A

BP <150/80

49
Q

What was the effect of BP reduction to <150/80?

A
  • 3% decrease over 2 years of CV events

- 2.2% decrease in mortality

50
Q

What is a good starting medication to use in the elderly?

A
  • thiazide
51
Q

Compare chlorthalidone vs HCTZ?

A
  • chlorthalidone has longer DOA and is more potent than HCTZ

- chlorthalidone has better BP reduction vs HCTZ

52
Q

Are all thiazides created equal?

A
  • NO

- chlorthalidone and indapamide are likely superior to HCTZ in reducing BP and improving clinical outcomes

53
Q

What consideration needs to be given when treating hypertension after a stroke?

A
  • strong consideration needs to be given after the initiation of an antihypertensive therapy after the acute phase of a stroke or TIA (patient needs the blood flow to the brain to perfuse their brain)
  • following the acute phase of a stroke, blood pressure lowering treatment is recommended to a target of consistently lower than 140/90 mmHg
  • treatment with an ACEI and diuretic combination is preferred
  • – do NOT combine ACE and ARB in stroke patients

Clinical Pharmacy 2 (18 decks)

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