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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
Q

thiazides are C\I in what condition?

A

gout (causes increase in uric acid and can cause gout exacerbations)

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26
Q

there is some controversy over whether thiazides cross react with an allergy to what class of medication?

A

sulpha

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27
Q

what are some of the notable ADRs of thiazides?

A

decreased Na and K, increased blood glucose, increased uric acid, increased lipids, photosensitivity, frequent urination

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28
Q

what is a concern related to the photosensitivity caused by HCTZ?

A

has been some evidence to suggest it may increase risk for non-melanoma skin cancer

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29
Q

what monitoring needs to be done with thiazide and when?

A

same baseline tests as with all HTN therapy & electrolyte 1-2 weeks after starting or changing dose and the Q6-12 months once stable

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30
Q

give 3 examples of combination diuretics

A
  1. aldactazide (HCTZ & spironalactone)
  2. Triazide (HCTZ & triamterene)
  3. moduret (hctz & amiloride)
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31
Q

what type of diuretic is triamterene?

A

K sparing

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32
Q

list 10 ACE-Is mentioned in lecture

A 
Benazepril
captopril
cilazapril
enalapril
fosinopril
lisinopril
perindopril
quinapril
ramipril
trandolapril
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33
Q

what is the basic overview of the MOA of ACE-Is?

A

inhibit teh conversion of angiotensin 1 to angiotensin 2, which will cause a decrease in aldosterone and decreased vasoconstriction

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34
Q

how are ACE-I used in the black population?

A

not as effective unless combined with HCTZ, but still used for compelling indications like MI, diabetes, renal Dx and HF

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35
Q

what are some of the notable ADRs of ACE-Is?

A

cough, angioedema, increased K and SCr, dizziness

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36
Q

what should be monitired on ACE-I and when?

A

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

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37
Q

ACE-Is should be used with caution when combined with what other medications?

A

K sparing diuretics, lithium, NSAIDS, K supplements

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38
Q

ACE-I are C\I in what condition?

A

renal artery stenosis , may cause renal failure

39
Q

list the 7 ARBs mentioned in lecture

A 
candesartan
eprosartan
irbesartan
losartan
olmesartan 
telmisartan
valsartan
40
Q

ARBs are C/I in what conditions?

A

renal artery stenosis, pregnancy

41
Q

ARBs can elevate the levels of ___ and ___

42
Q

which cardio selective B blockers are mentioned in lecture?

A

acebutanol, atenolol, bisoprolol, metoprolol, nebivolol

43
Q

which non-selective B blockers are mentioned in lecture?

A

nadolol, pindolol, propranolol, sotanol, timolol

44
Q

what are the combo B and alpha blockers mentioed in lecture?

A

carevdiolol and labetolol

45
Q

what is the general MOA of beta blockers for HTN?

A

decrease cardiac output and peripheral resistance; some cause vasodilation

46
Q

what are some of the ADRs of beta blockers?

A

fatigue, insomnia, vivid dreams, lowered exercise tolerance, bradycardia, bronchospasm, masked hypoglycemia, depression, cold extremities, erectile dysfunction

47
Q

agents like acebutonol, pindolol and maybe labetolol have positive ____ activity, which may have less negative effects on HR, glucose, lipids, and respiratory system

A

intrinsic sympathomimetic (ISA)

48
Q

acebutonol is lacking ___ data

A

CV outcome

49
Q

can b blockers be stopped abruptly?

A

no, need to be tapered over 2-4 weeks

50
Q

beta blockers cannot be combined with what type of CCBs?

51
Q

give 3 examples of DHP CCBs

A

amlodipine, felodipine, nifedipine

52
Q

give 2 examples of non-DHP CCBs

A

diltiazem, verapamil

53
Q

what is the general MOA of CCBs?

A

decrease peripheral resistance and increase peripheral vasodilation

54
Q

which type of CCB have more effect on peripheral vasculature? Which type of CCB have more effect on the heart?

A

DHP; non-DHP

55
Q

what are the different formulations of diltiazem?

A

regular, SR, CD, tiazac, XC

56
Q

Nifedipine XL is often used for what indications?

A

hypertensive crisis and pregnancy

57
Q

what is a common side effect of verapamil?

A

constipation

58
Q

should the long acting or short acting formulations of CCBs for HTN?

A

long-acting

59
Q

what is the indication of spironolactone?

A

resistant HTN

60
Q

spironolactone in relation to renal dysfunctio

A

use caution in renal dysfunction as this drug can increase SCr, BUN and K

61
Q

spironolactone decreases the amount of what electrolyte?

62
Q

what are some of the ADRs of spironolactone?

A

gynecomastia (enlarged breast tissue), GI symptoms

63
Q

what needs to be monitored on spironolactone?

A

all the regular things at baseline; SCr, electrolytes 1-2 weeks after starting or dose change, 6-12 months once stabilized

64
Q

central alpha agonists are ___line for HTN

65
Q

give 2 examples of central alpha agonists used for HTN

A

clonidine & methyl dopa

66
Q

methyldopa is commonly used in what condition?

67
Q

what are some of the ADRs of methyldopa?

A

sedation and dry mouth

68
Q

give 3 examples of alpha blockers used for HTN

A

doxazosin, terazosin, prazosin

69
Q

alpha blockers are ___line for HTN

A

third (not typically used)

70
Q

what are some of the ADRs of alpha blockers?

A

sedation, orthostatic HTN

71
Q

what is the purpose of combining a B blocker with a diuretic?

A

B blocker reduces reflex tachycardia and diuretic avoids sodium and water retention

72
Q

direct renin inhibitors are ___line for HTN

73
Q

give an example (the only example) of direct renin inhibitor

74
Q

what are the side effects of aliskiren?

A

diarrhea, headache, increased K, cough, angioedema, gout and increased SCr

75
Q

direct renin inhibitors are C\I in ___

76
Q

direct renin inhibitors cannot be combined with ___ or ___

A

ACE-I or ARB

77
Q

what is a preferred duo therapy for patients at high CV risk or patients with diabetes?

A

ACE or ARB with CCB

78
Q

is the combo of B blocker and ace/ARB a good combo?

A

not as effective as some other options, but can be used for compelling indications like MI or HF

79
Q

what are they typical treatments for uncomplicated HTN?

A

thiazide-like diuretics, ACE, ARB, CCB, beta blockers

80
Q

what are the typical treatments for isolated systolic HTN?

A

thiazide-like diuretics, DHP CCB, ARB

81
Q

what is the typical treatment for HTN in patients with diabetes with nephropathy, CVD or CV risk factors?

A

ACE or ARB

82
Q

what is the typical treamnet for HTN is diabetic patients?

A

ACE or ARB, thiazide or thiazide-like, DHP CCB

83
Q

what is teh typical treatment for HTN in patients with coronary artery disease?

A

ACE or ARB

84
Q

what is the typical treatment for HTN in patients with stable angina?

A

B blocker of CCB

85
Q

what is teh typical treatment of HTN in patients with recent MI?

A

B blocker AND ACE

86
Q

what is the typical treatment for HTN in heart failure?

A

ACE AND B blocker with or without a diuretic

87
Q

what is the typical treatment for HTN in patients with past CVA or TIA?

A

ACE AND diuretic

88
Q

what is the typical treatment for HTN in patients with renal dysfunction & proteinurua?

89
Q

what is teh typical tretament for HTN in patients with left ventricular hypertrophy (LVH)?

A

ACE or ARB, CCB, thiazide or thiazide-ilke

90
Q

what are some lifestyle modifications to reduce BP?

A
  1. weight
  2. balanced diet (DASH)
  3. reduce sogium to <2000mg/day
  4. dont smoke
  5. reduce alcohol
  6. cardio exercise
91
Q

what monitoring needs to be done in all HTN patients, including at baseline?

A

urinalysis, fasting blood glucose/A1C, lipids, SCr, electrolyes, 12 lead ECG

92
Q

what are the 1st line options for HTN in pregnancy>

A

labetolol, nifedipine XL, methyldopa

93
Q

what are the 2nd line options for HTN treatment in preganncy?

A

metoprolol, propranolol, verapamil

PBL PY2 Fall (21 decks)

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