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therapeutics 2 > Hypertension Therapy > Flashcards

Hypertension Therapy Flashcards

1
Q

what is the step line therapy for HTN in stable ischemic heart disease

A

-first line: beta blockers
may also use ACEi, ARB
-CCBs can be used if BP still uncontrolled

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2
Q

what is the step line therapy for HTN in heart failure

A

-reduced ejection fractions: follow most recent HF guidelines. avoid non DHPs
-preserved ejection fraction: diurectics, ACEi/ARB, beta blocker

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3
Q

what is the step line therapy for HTN in CKD

A

-CKD stage 1 or 2 and albuminuria: ACEi or ARB
-CKD stage 3 or higher: ACEi or ARB

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4
Q

what is the step line therapy for HTN in cerebrovascular disease

A

ACEi/ARB, thiazide diuretic, or combo

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5
Q

what is the step line therapy for HTN in diabetes

A

all first line classes are good options
if albuminuria use ACEi or ARB

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6
Q

what is the step line therapy in HTN for pregnancy

A

methyldopa, nifedipine, labetalol

contraindications: ACEi, ARB, direct renin inhibitors

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7
Q

what HTN therapy works best in black patients

A

Thiazide or CCB unless HF or CKD

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8
Q

thiazide diuretic drug choices

A

HCTZ, chlorthalidone, indapamide, metolazone

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9
Q

thiazide adverse effects

A

-hypokalemia
-hyperuricemia
-sexual dysfunction
-increase in lipids

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10
Q

thiazide DDIs

A

lithium toxicity w/ concurrent use

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11
Q

thiazide contraindications

A

sulfa allergy
anuria

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12
Q

aldosterone antagonists drug choices

A

spironolactone, eplerenone

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13
Q

aldosterone adverse effects

A

-hyperkalemia
-hyponatremia
-gynecomastia

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14
Q

aldosterone DDIs

A

ACEi/ARB/renin inhibitors/NSAIDs
increase risk of hyperkalemia

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15
Q

aldosterone contraindications

A

concomitant use of potassium sparing diuretics

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16
Q

Potassium sparing diuretics agents

A

amiloride, triamterene

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17
Q

diuretic clinical pearls

A

-don’t dose at bedtime
-thiazides are first line for most HTN
-spironolactone is first line for resistant HTN
-don’t use potassium sparing as monotherapy
-check CrCl when choosing diuretic
-monitor potassium (and other electrolytes)

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18
Q

ACEi mechanism

A

inhibits conversion for angiotensin I to angiotensin II

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19
Q

ARB mechanism

A

block effects of angiotensin II by binding to target receptors

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20
Q

renin inhibitors mechanism

A

inhibits conversion of angiotensinogen to angiotensin I

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21
Q

ACEi agents

A

“prils”

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22
Q

ACEi adverse effects

A

-angioedema
-cough
-hyperkalemia
-acute renal failure

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23
Q

ACEi contraindications

A

-history of angioedema on an ACEi
-concomitant use of aliskiren in patients with DM
-pregnancy/breastfeeding

24
Q

ACEi clinical pearls

A

-first line HTN treatment
-PM dosing to ensure BP dipping overnight
-HTN effects via vasodilation, reduced PVR, and increased diuresis

25
Q

ARB clinical pearls

A

-first line HTN treatment
-back up if ace is not tolerated
-can use with history of angioedema
-PM dosing to help with dipping
-HTN effects by vasodilation, reduced PVR, and increased diuresis

26
Q

ARB drug agents

A

sartans

27
Q

ARB adverse effects

A

hyperkalemia
angioedema (less likely)
acute renal failure

28
Q

ARB contraindications

A

-angioedema on ARB
-concomitant use of aliskiren
-pregnancy/breastfeeding

29
Q

ACEi/ARB monitoring

A

-baseline potassium and renal function
-every 6-12 months potassium and renal function
hold or reduce dose if potassium greater than 5.5 or SCr increases >30%

30
Q

direct renin inhibitors agents

A

aliskiren

31
Q

renin inhibitor clinical pearls

A

-not first line
-very expensive
-avoid in pregnancy

32
Q

renin inhibitor monitoring

A

-potassium
-BUN
-SCr

33
Q

renin inhibitor adverse effects

A

diarrhea
musculoskeletal effects
dizziness
headache
hyperkalemia
renal insufficiency
orthostatic hypertension

34
Q

calcium channel blocker agents

A

DHPs: “pines”
non DHP: verapamil and diltiazem

35
Q

DHP CCB pearls

A

-may benefit reynaud’s syndrome and elderly patients w/ isolate systolic HTN
-more potent vasodilators than non DHP
-avoid short acting DHPs

36
Q

DHP CCB adverse effects

A

reflex tachycardia
flushing
dizziness
headache
peripheral edema (high doses)

37
Q

DHP CCB warnings and DDIs

A

-increased risk of angina/MI in patients with coronary disease (IR CCBs only)
-grapefruit juice and CYP3A4

38
Q

non DHP CCB clinical pearls

A

-additional benefit in Afib and patients with angina who cannot tolerate BB
-slows AV node (negative ionotropic effects)
-extended release preferred for HTN

39
Q

non DHP CCB adverse effects

A

bradycardia, headache, dizziness, AV node block, constipation (verapamil)

40
Q

non DHP CCB DDIs and contraindications

A

DDIs: use of BB, grapefruit juice, CYP3A4
CI: heart block, left ventricular dysfunction

41
Q

CCB overall clinical pearls

A

no monitoring necessary
first line for HTN
peripheral edema is dose dependent
extended release formulations are preferred
if CCB needed for HF choose amlodipine

42
Q

beta blocker clinical pearls

A

not first line HTN
additional benefit for tachyarrhythmias, tremors, migraines, thyrotoxicosis
decreases HR + force of contraction -> decrease in CO
avoid abrupt cessation

43
Q

cardioselective beta blockers

A

atenolol, betaxolol, bisoprolol
metoprolol, nebivolol

44
Q

nonselective beta blockers

A

nadolol
propranolol
avoid in bronchospastic airway diseases

45
Q

intrinsic sympathomimetic activity beta blockers

A

acebutolol
penbutolol
pindolol
avoid in HF

46
Q

mixed alpha/beta beta blockers

A

carvedilol
labetalol
more BP lowering

47
Q

beta blocker contraindications

A

second or third degree heart block
decompensated HF
Post MI
severe bradycardia
sick sinus syndrome
reactive airway diseases

47
Q

direct arterial vasodilator agents

A

hydralazine, minoxidil

47
Q

beta blocker adverse effects

A

bronchospasm, bradycardia, fatigue, exercise intolerance, depression
CAN MASK SIGNS OF HYPOGLYCEMIA

48
Q

direct arterial vasodilator clinical pearls

A

last line
reserved for special indications or uncontrolled BP
concomitant therapy w/ diuretic and BB needed
caution with renal impairment

48
Q

alpha-1 blockers

A

doxazosin, prazosin, terazosin
always second line with concomitant BPH
associated with orthostatic hypotension

48
Q

direct arterial vasodilator adverse effects

A

palpitations
tachycardia
GI side effects
headache
lupus like syndrome (hydralazine)
hair growth (minoxidil)

49
Q

minoxidil black box warning

A

may cause pericarditis
exacerbation of angina
should be given with diuretic and BB

50
Q

central alpha-2 agonists

A

clonidine, methyldopa, guanfacine
last line due to AEs (CNS depression)
avoid abrupt cessation
methyldopa is preferred in pregnancy

51
Q

what are the steps of resistant HTN therapy

A
  1. maximize life style and optimize 3 drug regimen
  2. substitute optimized thiazide like diuretic
  3. add spironolactone
  4. add BB if HR > 70 bpm (may consider clonidine patch if BB contraindicated or HR < 70 bpm
  5. add hydralazine
  6. substitute minoxidil for hydralazine

therapeutics 2 (24 decks)

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