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Karboski's Pharmacology - UT AEMSN > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What are the first line classes for HTN?

A

Thiazides, ACEi, ARBs, and CCBs

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2
Q

Why are first line Rx’s considered first line Rx’s?

A
  • *Double check w/ lecture recording**
    1) Able to prove ↓ M/M in long-term
    2) Not a great deal of SE
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3
Q

1) What is the BP goal for HTN + stable ischemic heart dz (SIHD), HF, CKD, and DM? JNC8
2) ACC/AAHA?

A

JNC8 <140/90 mmHg
ACC/AHA < 130/80 mmHg
2) They Have HTN + known CVD and/or ASCVD risk >/= 10%

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4
Q

What two Rx’s are used for HTN with angina

A
  1. BBs or 2. dhpCCBs
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5
Q

What Rx is used for HTN with MI or ACS?

A

BBs

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6
Q

What Rx is used for HTN with CAD?

A

BBs and/or ANY CCB

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7
Q

What are the 7 BBs proven beneficial in SIHD?

A
  • Carvedilol N
  • Metoprolol tartrate
  • Metoprolol succinate
  • Nadolol N
  • Bisprolol
  • Propanolol N
  • Timolol N
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8
Q

What are the Rx’s to use in HTN + HF?

A
  • ACEi/ARB/ANRI
  • BB’s (carvedilol, metoprolol succinate, or bisprolol)
  • Aldo Antag’s
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9
Q

1) What Rx’s should you avoid in HTN + HF?

2) Why?

A

1) CCBs

2) Negative inotropy, especially verapamil

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10
Q

1) What Rx’s can be used in HTN + CKD/DM?

A

1) (+) albuminuira = ACEi or ARB

2) (-) albuminuria = any 1st line

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11
Q

Why are African Am populations at greater risk for HTN complications (vs. other sub pop’s)?

A

1) HTN at younger age
2) Absolute pressures often higher

DIET Lifestyle etc…

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12
Q

1) Most effective HTN Rx therapy for African Am?

2) Less effective?

A

1) Thiazides AND CCBs

2) BBs, ACEi, ARBs

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13
Q

What are the preferred Rx’s for Chronic and gestational HTN during pregnancy?

A
  • Magnesium ACUTE???

labetalol, nifedipine (long-acting) methyldopa

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14
Q

Alternatives to preferred Rx’s for HTN during pregnancy?

A
  • Other BB’s and CCBs
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15
Q

What Rx’s contraindicated in pregnancy?

Why?

A
  • ACEi, ARB, and direct renin inhibitors

teterogenic

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16
Q

1) JNC 8 HTN Goals for >/= 60 yo?

2) ACC et. al HTN Goals for >/= 65 yo?

A

1) <150 / <90

2) <130 / <80

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17
Q

What Rx’s to generally avoid in >/= 65 (elderly) Pts with HTN?

A

Central and peripheral alpha blocking agents –> risk of orthostasis, falls, and Duke having to do q15 neurochecks and V/S

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18
Q

How is hypertension different in the elderly?

How should you guide treatment?

A

1) Present often with isolated systolic HTN
2) No specific agent more effective, follow general guidelines
3) Start secondary Rx’s @ lower doses

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19
Q

What two things should be considered with HTN in children/adolescents?

A

1) Fatty’s more common to have HTN

2) 2nd HTN more common so look for kidney dz

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20
Q

What Rx’s are supported by evidence to use in children and adolescents?

A
  • HTN first lines
    ACE/ARB/CCB/Thiazides
    and BB’s
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21
Q

What criteria qualifies for non pharmalogic management of HTN IN JNC and ACC/AHA

A

everything above normal includes non pharmacologic therapy.

22
Q

Which diuretic is the best of the diuretic class for idiopathic HTN?

A

Thiazides

23
Q

When are loop diuretics best used for HTN?

A

Only for high BP r/t vol overload (CKD)

24
Q

When are K-sparring diuretics used for HTN?

A

To prevent K-wasting from other diuretics (has weak anti-HTN effect)

25
Q

When are Aldo Antag’s used in HTN?

A

Not really used, little long-term data on M/M

26
Q

How are thiazides used in HTN?

A
  • Used in combo

- Offsets Na retention of other HTN agents

27
Q

How do thiazides lower BP?

A
  • Initially ↓ BP via diuresis

- Then probably ↓ PVR by Na/H2O movement from arteriolar walls

28
Q

Thiazide diuretic names

A

Hydrochlorothiazide, chlorthalidone, metolazone

29
Q

What is the best thiazide dosing and why is it best at that level?

A

1) 25 mg/day

2) Most SE are dose related and most ADRs limited at 25 mg/day even though 50 mg/day is most effective dose

30
Q

What is the advantage of using ACEi/ARB for HTN?

A

Treats HF comorbidity at the same time

31
Q

What are the ADRs for all ACEi/ARBs?

A
  • Hyperkalemia
  • Orthopnea
  • ARF
32
Q

What are the 3 dosing considerations for ACEi/ARBs?

A

1) start low and titrate up
2) 1/2 starting dose if risk of HoTN
- vol depleted, HF exacerb, super old, taking other vasodil or diuretics
3) 1/2 starting dose if risk of severe renal dz
- old, current CKD

33
Q

What are the dihydropyridine CCBs?

A
  • amlodipine
  • felodipine
  • isradipine
  • nicardipine
  • nifedipine
  • nisoldipine
34
Q

What action is common to all CCBs?

A

All CCBs relax arterial/coronary SM and produce peripheral/coronary vasodilation –> ↓ BP

35
Q

What two effects distinguish DHP CCBs from non-DHP CCBs?

A

1) Strength of inotropy: both are inotropes, but baroreceptor-mediated ↑ SNS tone offsets DHP CCB inotropic effect = non-DHP are stronger inotropes
2) Cardiac conduction effects: DHP CCBs have very weak AV conduction effects while non-DHP CCBs ↓ SA node rate and ↓ AV conduction

36
Q

What acute reaction can DHP CCBs cause?
Which drug causes it the most?
Why do other DHP CCBs not cause this as much?

A

1) Reflex tachycardia
2) Short-acting nifedipine
3) All others are longer sustained-release and have longer DoA –> less “peak effect”

37
Q

What kind of efficacy can you approx from CCB peak levels?

A

Vasodilatory efficacy

38
Q

What is a common SE of verapamil?

A

Constipation

39
Q

What is a common SE of DHP CCBs?

What can you used to correct this?

A

1) Peripheral edema

2) Intermittent doses of diuretic

40
Q

What should always be done when D/C’ing BB’s?

Why is this necessary?

A

1) Taper the doses over 1-2 weeks

2) Sudden D/C –> Rebound HTN d/t upregulation of agonist, beta receptors, and sensitivity

41
Q

What are the Non cardioselective BBs?

What are the selective BBs?

A

1) Have B1+B2 or B1+A XXX ilol, Carvedilol alol Labetalol,
and these exceptions Nadolol, Propanolol, Timolol
2) Primary B1 only except at higher doses
XXX.olol

42
Q

What phenomena occurs as BB dose is increased?

A

Cardioselective properties decrease and they become more non-selective

43
Q

Peripheral alpha blockers

A

XXX.azosin Pr, Ter, Dox block peripherial A norepi receptors

44
Q

Central alpha blockers

A

Methyldopa, Clonidine Prevent Norepi release by stimulating central A Norepi receptors

45
Q

What are the AHA/ACC definitions for HTN

How do you treat

A

Normal <120/<80 reassess 1 year
S incriments of 10
D any increase stage 1 then 10

Elevated 120-129/<80 lifestyle mods

Stage 1 130-139/80-89 IF ASCVD risk <10 lifestyle mods, If ASCVD >10 throw a drug at it + Life mods

Stage 2 >140/>=90 throw 2 drugs at it + Life mods

46
Q

How should HTN be classified if S and D pressures are in different stages?

A

Use highest stage.

47
Q

What are the JNC8 reference ranges for HTN

A

Normal <120/<80 reassess 1 yr
S incriments of 20 D increments of 10

Prehypertension 120-139/80-89 Life mods
Stage 1 140-159/90-99 Life mods +1 drug
Stage 2 >160/>=100 Life mods +2 drugs

48
Q

what is the expected change in SBP after completing this test?

A

decrease >20 SBP

49
Q

JNC Goals

A

get everyone down into preHTN 140/90

Healthy Old people >60 can be 150/90

50
Q

AHA /ACC Goals

A

<130/80

if ASCVD >10 Recommended <10 Reasonable

51
Q

A Agonist not first line

A

Used in combination with other drugs
HoTN common side effect
Old people fall when going to bathroom at night makes Marc do paperwork so should be first line screw the old people and Marc!!

52
Q

What are the 3 ISA BB’s

What does Intrinsic Sympathomimetic Activity mean.

A

Acebutolol
Penutolol
Pindolol

Can be overridden by body when needed….. Exercise

Karboski's Pharmacology - UT AEMSN (11 decks)

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