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PBL PY2 Fall > Hypertension Therapeutics > Flashcards

Hypertension Therapeutics Flashcards

1
Q

Most of the pathophys of HTN involves RAAS, but other factors include ___

A

natriuretic hormone, peripheral & central nervous systems, sodium\water excretion, nitric oxide etc.

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2
Q

what mathematic equation demonstrates BP?

A

cardiac output x peripheral resistance

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3
Q

what is cardiac output?

A

stroke volume and heart rate

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4
Q

what is peripheral resistance?

A

changes in blood viscosity or change in lumen size of vessesl

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5
Q

why treat HTN?

A

prolonged HTN leads to organ damage such as CVD, cerebrovascualr disease, retinopathy, renal dysfunction or renal failure and peripheral vascular disease

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6
Q

essential HTN accounts for ___% of cases

A

90

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7
Q

what is essential HTN?

A

attributable to internal factors like genetics, that affect sodium, renin, aldosterone, and adrenal steroids

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8
Q

the other 10% of HTN cases is attributable to what factors?

A

things like excessive alcohol use, high sodium intake, NSAIDs, corticosteroids, anabolic steroids, oral contraceptives, oral decongestants, renal dysfunction, obstructive sleep apnea, stimulants etc.

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9
Q

___% of Canadians aged 20-79 are diagnosed with HTN

A

23

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10
Q

____% of Canadians aged 60-79 with HTN is

A

51

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11
Q

____% of Canadians aged 40-59 have HTN

A

22

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12
Q

____% of patients with HTN are unaware

A

29

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13
Q

which sex has a higher prevalence of HTN?

A

male

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14
Q

high BP on a home monitor

A

135/85 +

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15
Q

high BP on an automated office monitor

A

135/85+

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16
Q

high BP on a non-automated office monitor

A

140/90 +

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17
Q

high BP on an ambulatory monitor

A

mean awake 135/85+; mean 24hr 130/80+

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18
Q

what is masked HTN?

A

when BP is lower in the office setting, but higher at home

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19
Q

what is the target systolic BP for isolated systolic HTN?

A

<140 SBP

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20
Q

what is the target BP in diabetic pts?

A

<130/80

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21
Q

what is the target BP in pts at high risk for CV events?

A

<120 SBP

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22
Q

what are the high risk factors for CV events?

A

age 75+, presence of clinical of subclinical CVD or FRS >15%, CKD

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23
Q

what are the 3 common thiazide and thiazide-like diuretics?

A

HCTZ, chlorthalidone, indapamide

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24
Q

what is a minor inconvenience of chlorthalidone?

A

there are not many strengths available, so you may need to half or quarter tablets to get the prescribed dose

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25
thiazides are C\I in what condition?
gout (causes increase in uric acid and can cause gout exacerbations)
26
there is some controversy over whether thiazides cross react with an allergy to what class of medication?
sulpha
27
what are some of the notable ADRs of thiazides?
decreased Na and K, increased blood glucose, increased uric acid, increased lipids, photosensitivity, frequent urination
28
what is a concern related to the photosensitivity caused by HCTZ?
has been some evidence to suggest it may increase risk for non-melanoma skin cancer
29
what monitoring needs to be done with thiazide and when?
same baseline tests as with all HTN therapy & electrolyte 1-2 weeks after starting or changing dose and the Q6-12 months once stable
30
give 3 examples of combination diuretics
1. aldactazide (HCTZ & spironalactone) 2. Triazide (HCTZ & triamterene) 3. moduret (hctz & amiloride)
31
what type of diuretic is triamterene?
K sparing
32
list 10 ACE-Is mentioned in lecture
``` Benazepril captopril cilazapril enalapril fosinopril lisinopril perindopril quinapril ramipril trandolapril ```
33
what is the basic overview of the MOA of ACE-Is?
inhibit teh conversion of angiotensin 1 to angiotensin 2, which will cause a decrease in aldosterone and decreased vasoconstriction
34
how are ACE-I used in the black population?
not as effective unless combined with HCTZ, but still used for compelling indications like MI, diabetes, renal Dx and HF
35
what are some of the notable ADRs of ACE-Is?
cough, angioedema, increased K and SCr, dizziness
36
what should be monitired on ACE-I and when?
baseline thinsg that are measured for every HTN patient; K and SCr 1-2 weeks after starting and dose changes, the q 6-12 months once stabel
37
ACE-Is should be used with caution when combined with what other medications?
K sparing diuretics, lithium, NSAIDS, K supplements
38
ACE-I are C\I in what condition?
renal artery stenosis , may cause renal failure
39
list the 7 ARBs mentioned in lecture
``` candesartan eprosartan irbesartan losartan olmesartan telmisartan valsartan ```
40
ARBs are C/I in what conditions?
renal artery stenosis, pregnancy
41
ARBs can elevate the levels of ___ and ___
K and SCr
42
which cardio selective B blockers are mentioned in lecture?
acebutanol, atenolol, bisoprolol, metoprolol, nebivolol
43
which non-selective B blockers are mentioned in lecture?
nadolol, pindolol, propranolol, sotanol, timolol
44
what are the combo B and alpha blockers mentioed in lecture?
carevdiolol and labetolol
45
what is the general MOA of beta blockers for HTN?
decrease cardiac output and peripheral resistance; some cause vasodilation
46
what are some of the ADRs of beta blockers?
fatigue, insomnia, vivid dreams, lowered exercise tolerance, bradycardia, bronchospasm, masked hypoglycemia, depression, cold extremities, erectile dysfunction
47
agents like acebutonol, pindolol and maybe labetolol have positive ____ activity, which may have less negative effects on HR, glucose, lipids, and respiratory system
intrinsic sympathomimetic (ISA)
48
acebutonol is lacking ___ data
CV outcome
49
can b blockers be stopped abruptly?
no, need to be tapered over 2-4 weeks
50
beta blockers cannot be combined with what type of CCBs?
non-DHP
51
give 3 examples of DHP CCBs
amlodipine, felodipine, nifedipine
52
give 2 examples of non-DHP CCBs
diltiazem, verapamil
53
what is the general MOA of CCBs?
decrease peripheral resistance and increase peripheral vasodilation
54
which type of CCB have more effect on peripheral vasculature? Which type of CCB have more effect on the heart?
DHP; non-DHP
55
what are the different formulations of diltiazem?
regular, SR, CD, tiazac, XC
56
Nifedipine XL is often used for what indications?
hypertensive crisis and pregnancy
57
what is a common side effect of verapamil?
constipation
58
should the long acting or short acting formulations of CCBs for HTN?
long-acting
59
what is the indication of spironolactone?
resistant HTN
60
spironolactone in relation to renal dysfunctio
use caution in renal dysfunction as this drug can increase SCr, BUN and K
61
spironolactone decreases the amount of what electrolyte?
Na
62
what are some of the ADRs of spironolactone?
gynecomastia (enlarged breast tissue), GI symptoms
63
what needs to be monitored on spironolactone?
all the regular things at baseline; SCr, electrolytes 1-2 weeks after starting or dose change, 6-12 months once stabilized
64
central alpha agonists are ___line for HTN
3rd
65
give 2 examples of central alpha agonists used for HTN
clonidine & methyl dopa
66
methyldopa is commonly used in what condition?
pregnancy
67
what are some of the ADRs of methyldopa?
sedation and dry mouth
68
give 3 examples of alpha blockers used for HTN
doxazosin, terazosin, prazosin
69
alpha blockers are ___line for HTN
third (not typically used)
70
what are some of the ADRs of alpha blockers?
sedation, orthostatic HTN
71
what is the purpose of combining a B blocker with a diuretic?
B blocker reduces reflex tachycardia and diuretic avoids sodium and water retention
72
direct renin inhibitors are ___line for HTN
2nd
73
give an example (the only example) of direct renin inhibitor
aliskiren
74
what are the side effects of aliskiren?
diarrhea, headache, increased K, cough, angioedema, gout and increased SCr
75
direct renin inhibitors are C\I in ___
pregnancy
76
direct renin inhibitors cannot be combined with ___ or ___
ACE-I or ARB
77
what is a preferred duo therapy for patients at high CV risk or patients with diabetes?
ACE or ARB with CCB
78
is the combo of B blocker and ace/ARB a good combo?
not as effective as some other options, but can be used for compelling indications like MI or HF
79
what are they typical treatments for uncomplicated HTN?
thiazide-like diuretics, ACE, ARB, CCB, beta blockers
80
what are the typical treatments for isolated systolic HTN?
thiazide-like diuretics, DHP CCB, ARB
81
what is the typical treatment for HTN in patients with diabetes with nephropathy, CVD or CV risk factors?
ACE or ARB
82
what is the typical treamnet for HTN is diabetic patients?
ACE or ARB, thiazide or thiazide-like, DHP CCB
83
what is teh typical treatment for HTN in patients with coronary artery disease?
ACE or ARB
84
what is the typical treatment for HTN in patients with stable angina?
B blocker of CCB
85
what is teh typical treatment of HTN in patients with recent MI?
B blocker AND ACE
86
what is the typical treatment for HTN in heart failure?
ACE AND B blocker with or without a diuretic
87
what is the typical treatment for HTN in patients with past CVA or TIA?
ACE AND diuretic
88
what is the typical treatment for HTN in patients with renal dysfunction & proteinurua?
ACE
89
what is teh typical tretament for HTN in patients with left ventricular hypertrophy (LVH)?
ACE or ARB, CCB, thiazide or thiazide-ilke
90
what are some lifestyle modifications to reduce BP?
1. weight 2. balanced diet (DASH) 3. reduce sogium to <2000mg/day 4. dont smoke 5. reduce alcohol 6. cardio exercise
91
what monitoring needs to be done in all HTN patients, including at baseline?
urinalysis, fasting blood glucose/A1C, lipids, SCr, electrolyes, 12 lead ECG
92
what are the 1st line options for HTN in pregnancy>
labetolol, nifedipine XL, methyldopa
93
what are the 2nd line options for HTN treatment in preganncy?
metoprolol, propranolol, verapamil

PBL PY2 Fall (21 decks)

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