Hypertension Flashcards
Define secondary HTN
caused by renal disease (CKD) adrenal disease (exces aldosterone secretion), OSA, or drugs. There is increased activity of the sympathetic nervous system (SNS) and the RAAS, leading to increased levels of neurohormones (NE, ANG 2, aldosterone) that can increase BP
BP equation
SVR x CO
CO equation
Stroke volume x HR
normal BP
> 120/<80
elevated BP
120-129/<80
Stage 1 HTN
SBP 130-139 or DBP 80-89
Stage 2 HTN
SBP > 140 or DBP > 90
Drugs that can inc. BP (7)
ADHD drugs cocaine Decongestants ESA Immunosuppressants NSAIDs Systemic steroids
BP goals
<130/80 for all patients
initial drug selection for non-black (4)
thiazide
ccv
acei
arb
initial drug selection for black (2)
thiazide
ccb
initial drug selection for CKD
acei
arb
initial drug selection for DM with albuminuria
acei
arb
BP meds CI in pregnancy
ACEi
ARB
DRI: aliskiren
Drugs of choice for HTN in pregnancy (3)
labetalol
nifedipine
ER methyldopa
When to treat HTN in pregnancy
if SBP > 160 or DBP > 105
Thiazide diuretic MOA
inhibit Na reabsorption in the DCT causing increased excretion of Na, Cl, H20, and K
Major allergy CI with thiazides
sulfonamide hypersensitivty
At what CrCl are thiazides not effective
CrCl < 30
List DHP CCB
amlodipine
nifedipine
nicardipine
List Non-DHP CCB
diltiazem
verapamil
DHP CCB MOA
inhibit Ca ions from entering vascular smooth muscle and myocardial cells; this causes peripheral arterial vasodilation (which dec. SVR and BP) and coronary artery vasodilation.
Common SE in DHP CCB (4)
reflex tachycardia
HA
flushing
peripheral edema
DHP CCB to use in pregnancy
nifedipine ER
Clevidipine is a lipid emulsion and provides how many kcal/mL
2 kcal/mL
which CCB is preferred for HTN
DHP
Non-DHP CCB indication
control HR in certain arrhythmias
sometimes HTN
sometimes angina
Non-DHP CCB MOA
inhibit Ca ions from entering vascular smooth muscle and are myocardial cells, but they are more selective for the myocardium
ACEi MOA
block the conversion of antiotensin 1 to 2 resulting in decreased vasoconstriction and dec. aldosterone secretion and block the degration of brady kinin
ARB MOA
block Ang 2 from binding to the angiotensin 2 type-1 receptor on vascular smooth muscle preventing vasoconstriction
Caution with entresto and ACEi
36 washout period required
List K-sparing diuretics (4)
traimterene-Na channel inhibitor
amiloride-Na channel inhibitor
spironolactone-aldosterone antagonist
eplerenone-aldosterone antagonist
preferred add on treatment for patients with resistant HTN
spironolactone
epleronone
resistant HTN
uncontrolled BP despite max tolerated dose of CCB + thiazide +ACEi/ARB
difference b/w spironolactone and epleronone
spironolactone -non-selective -also blocks androgen epleronone -selective -no endocrine SE
K-sparing diuretic MOA
compete with aldosterone at receptor sites in the DCT and CD, increasing Na and H2O excretion and conserving K
Major SE of spironolactone
gynecomastia
breast tenderness
impotence
BB MOA
competitively blocking beta-1 and/or beta-2 adrenergic receptors resulting indecreases in HR nad myocardial contracility
major BB that are beta-1 selective (3)
atenolol
esmolol
metoprolol
caution with BB in DM
can worsen hyperglycemia or hypoglycemia and mask hypoglycemic symtpoms
alpha-2 agonist MOA
decrease BP by stimulating alpha-2 receptors in the brain and reducing sympathetic outflow of norepinephrine, which decreases SVR and HR
List Alpha-2 agonist
clonidine
guanfacine
methyldopa
caution with d/c a-2 agonists aburptly
rebound hypertension
List vaodilators (2)
hydralzine
minoxidil
define HTN crisis
BP > 180/120
2 types
-HTN emergency: acute target organ damage (encephalopathy, stroke, AKI, ACS)
-HTN urgency: no acute organ damage
