Hypertension and hyperlipidemia Flashcards
What type of drug ends in -pril, lisinopril, and can be considered cardio and renoprotective?
ACE inhibitors
What do you need when putting a patient on ACE inhibitors?
baseline Cr and K+ levels and repeat 1-2 weeks after initiation
do NOT in pregnancy
What type of drug ends in -sartan that you can prescribe if someone cannot tolerate beta blockers or ACE-I but you CANNOT give with ACE-I and cannot be given in pregnancy?
ARBs - angiotensin II blockers
What type of drug has two types (dihydropyridine like –dipine + nondihydropyridine) with nondihydropyridine that affects cardiac contractility/conduction like diltiazem or verapamil?
calcium channel blocker
What is the only calcium channel blocker that is safe for CHF?
amlodipine
What is the first line diuretic for uncomplicated HTN?
thiazides like hydrochlorothiazide, chlorthalidone
What are side effects of thiazides?
hyponatremia, hypokalemia, hypercalcemia, hyperglycemia
What are the type of diuretics like furosemide, bumetanide that cannot be used in a sulfa allergy and are the strongest diuretics?
loop diuretics
What are some side effects of loop diuretics?
hypokalemia, volume depletion, hypocalcemia, hyponatremia, hyperuricemia, ototoxicity
What are the weakest diuretics that can cause hyperkalemia?
potassium sparing diuretics
What are the drugs that end in -olol that treat HTN?
beta blockers
What beta blockers are cardioselective with beta one?
atenolol, metoprolol, esmolol
What beta blockers are non selective with beta 1 and 2?
propranolol
What beta blockers are both alpha and beta?
labetalol, carvedilol
What alpha antagonists can be used for HTN?
doxazosin, prazosin, terazosin
When should you treat with HTN medications?
all patients if lowers CV risk
BP above 160/100 needs 2 meds
those w/ 140-159/90-99 even if risk is low
What is non-pharmacological therapy for HTN?
weight loss, DASH diet, sodium intake, alcohol intake, exercise, mindfulness
When there is risk for advanced age when should you consider pharmacotherapy in BP?
> 130/80
When there is an increased risk for CV, when should you consider pharmacotherapy in BP?
> 130/80
When there is no risk when should you consider pharmacotherapy in BP?
> 140/90
When should you refer to cardiology with HTN?
severe, resistant to meds, or early/late onset
How do you treat CV risk factors?
statins (rosuvastatin low intensity) or low dose aspirin
What is step 1 in HTN treatment?
ACE inhibitor/ARB OR CCB OR thiazide diuretic
What is step 2 in HTN treatment?
ACE inhibitor/ARB + CCB OR thiazide
What is step 3 in HTN treatment?
ACE inhibitor/ARB + CCB + thiazide
What is step 4 in HTN treatment?
ACE inhibitor/ARB + CCB + thiazide + spironolactone
In a black patient, what is your first line treatment for HTN?
CCB or diuretic
What is your 2nd line HTN treatment for a black patient?
ARB or ACE inhibitor or beta blocker
What is your treatment of choice in ALL PATIENTS with resistance?
aldosterone receptor blocker
What would you add on for ALL PATIENTS with HTN?
central alpha agonist or peripheral alpha antagonist
How do you monitor a patient you just put on HTN meds?
follow up in 2 weeks, yearly monitoring of lipids, ECG every 2-4 years
What is first line for a HTN patient <55 “others”?
ACE inhibitor or ARB or CCB or diuretic
What’s second line for a HTN patient <55 “others”?
beta blocker
What’s first line for a HTN patient > 55 “others”?
CCB or diuretic
What’s second line for a HTN patient >55 “others”?
ARB or ACE inhibitor or beta blocker
How do you lower emergency HTN?
reduce no more than 25% within 1st hour and additional 5-15% over next 23 hours
What are the exceptions to slowly lowering BP?
acute ischemic stroke unless >180-200 or thrombolytics are given
acute aortic dissection and should be decreased to <120 and <60 within 30 minutes
What is used for emergency HTN?
combo of nicardipine or clevidipine + labetalol or esmolol
What’s first line treatment for hyperlipidemia?
statins
based on : presence of CVD or diabetes, LDL>190, age, 10 year risk
What statins are used for high intensity (and adjusted for lower)?
atorvastatin (40-80mg) or rosuvastatin (20-40mg) high
What are 4 groups of patients who benefit from statin medications?
1) individuals w ASCVD
2) individuals w/ LDL >190
3) individuals 40-75 w/ diabetes and LDL >70
4) individuals 40-75 w/o ASCVD or diabetes w/ LDL 70-189 and estimated 10 year risk of 7.5% or higher
What’s second line treatment for hyperlipidemia?
ezetimibe and bempedoic acid for:
- CVD whose LDL remains above relevant treatment threshold 55 or 70 on statin therapy
- possible familial hypercholesterolemia w/ LDL >190 baseline and still above 100 with treatment and remains above treatment threshold
- OR documented statin intolerance
-CAN add to therapy if at max statin and patient has high risk for CVD and high LDL
What are lifestyle recommendations for hyperlipidemia?
diet, exercise, smoking cessation, HTN control, weight loss, diabetes control, antithrombotic therapy
What do statins do?
reduce LDL
w/ CVD - need maximally tolerated dose
What are side effects of statins?
muscle aches, myositis, rhabdomyolysis, elevated risk of muscle injury or myopathy with highest dose, liver disease, DM
What does ezetimibe “zetia” do?
reduces LDL
When do you add ezetimibe/zetia to hyperlipidemia therapy?
max statin + high risk for CVD + high LDL
What do proportein convertase subtilisin/kexin type 9 inhibitors (alirocumba and evolocumab) do?
reduce LDL
When do you add proportein convertase subtilisin/kexin type 9 inhibitors (alirocumba and evolocumab) to statins?
- calcium scores >1000
- very high risk for recurrent CVD when on treatment for LDL and remains >55 or 70
OR >100 in patients w/ familial hypercholesterolemia w/o known CVD
What patients are considered very high risk for CVD?
- recent ACS within 12 months
- multiple prior MIs or strokes
- significant unrevascularized CAD
- polyvascular disease (CAD + cerebrovascular or PVD)
What do omega 3 fatty acids target?
triglycerides
What do bile acid binding resins target (cholestyramine, colesevalam, colestipol)?
reducing LDL
What do you HAVE to know about bile acid binding resins (cholestyramine, colesevalam, colestipol)?
- can increase TG levels so NO in high TG level patients
** only medication safe in pregnancy!!!! **
What do fibric acid derivatives (gemfibrozil, fenofibrate) target?
TGs by 40%
What do niacin/nicotinic acid target?
increasing HDL by 25-35%
BUT INTOLERANCE IS COMMON!!!
In these patients, what is indicated:
1) w/ hypercholesterolemia w/ LDL>100 w/ treatment
2) advanced subclinical atherosclerosis or high-risk patients w/ existing CVD where LDL>70 w/ treatment
3) very high risk patients w/ excisting CVD where LDL>55
4) many high risk patients w/ TG >150 or non HDL >100
combination therapy
What are some treatment recommendations for high triglyceride levels?
avoid alcohol, simple sugars, refined starches, fatty acids, control secondary causes
How is drug treatment for TGs reserved?
> 150 but <500 is only for those w/ established CVD with well-controlled LDL on maximal tolerated therapy
