L6: Systemic HTN (Pt 3) Flashcards
1
Q
Dx of HTN
A
2
Q
Methods of BP Measurment
A
- Clinic.
- Home setting (self monitoring) (inaccurate).
- ABP monitoring (in white coat HTN).
3
Q
Methods of BP Measurment
- Clinic
A
4
Q
Methods of BP Measurment
- ABPM
A
5
Q
Methods of BP Measurment
- Out of Office Blood Pressure Measurement
A
6
Q
Methods of BP Measurment
- White Coat & Masked HTN
A
7
Q
Risk in White coat hypertension
A
- These subjects are at intermediate cardiovascular risk between normotensives and sustained hypertensives
8
Q
Dx of White coat hypertension
A
repeated office and out-of-office BP measurements
9
Q
TTT of White coat hypertension
A
NO treatment if there is no cardlovascular risk or (HMOD)
- But need lifestyle modification
10
Q
Dx of Masked HTN
A
Repeated office and out-of-office BP measurements
11
Q
TTT of Masked HTN
A
May require drug treatment aiming to normalize outof - office BP.
12
Q
TTT of HTN
A
13
Q
TTT of HTN
- Goals
A
14
Q
TTT of HTN
- Non-Pharm
A
15
Q
TTT of HTN
- Modification & Subsequent Effect
A
16
Q
TTT of HTN
- Pharm
A
17
Q
Pharmacological TTT of HTN
- Ideal Drug
A
18
Q
Pharmacological TTT of HTN
- Diuretics
A
19
Q
Diuretics in HTN
- examples
A
Hydrochlorothiazide
20
Q
Diuretics in HTN
- MOA
A
- Act by decreasing blood olume and cardiac output
- Decrease peripheral resistance during chronic therapy
21
Q
Diuretics in HTN
- DOC in …..
A
elderly hypertensives
22
Q
Diuretics in HTN
- SE
A
23
Q
Diuretics in HTN
- Notes
A
- Not safe in renal and hepatic insufficiency
- Thiazide Is most commonly used in the treatment of hypertension.
24
Q
Beta Blockers in HTN
A
25
Beta Blockers in **HTN**
- Examples
- Atenolol, Metoprolol, nebivolol
26
Beta Blockers in **HTN**
- MOA
27
Beta Blockers in **HTN**
- DOC in ....
- patients with co-existent coronary heart disease
28
Beta Blockers in **HTN**
- SE
29
Beta Blockers in **HTN**
- Not Safe in .....
patients with co-existing asthma and diabetes
30
**CCBs** in HTN
31
**CCBs** in HTN
- Examples
Amlodipine
32
**CCBs** in HTN
- MOA
33
**CCBs** in HTN
- DOC in ....
- elderly hypertensives
- Those with co-existing asthma
34
**CCBs** in HTN
- SE
Flushing, headache, Pedal edema
35
**CCBs** in HTN
- CI
HOCM, SVT, unstable Angina
36
**ACEIs** in HTN
37
**ACEIs** in HTN
- Examples
Ramipril, Lisinopril, Enalapril
38
**ACEIs** in HTN
- MOA
Inhibit ACE and formation of angiotensin ll and block its effects
39
**ACEIs** in HTN
- DOC in .......
- co-existent diabetes mellitus
- Heart failure
- Those with co-existing asthma
40
**ACEIs** in HTN
- SE
41
42
**ARBs** in HTN
43
**ARBs** in HTN
- Examples
Losartan
44
**ARBs** in HTN
- MOA
Block the angiotensin il receptor and inhibit effects of angiotensin II
45
**ARBs** in HTN
- DOC in ......
with co-existing diabetes mellitus
46
**ARBs** in HTN
- SE
safer than ACEI, hypotension, Hyperkalemia, Angioedema
47
**Alpha Blockers** in **HTN**
48
**Alpha Blockers** in **HTN**
- Examples
Prazosin
49
**Alpha Blockers** in **HTN**
- MOA
- Block a-1 receptors and cause vasodilation
- Reduce peripheral resistance and venous relurn
- Exert beneficial effects on lipids and insulin sensitivity
50
**Alpha Blockers** in **HTN**
- DOC in ......
Co-Existing BPH
51
**Alpha Blockers** in **HTN**
- SE
Postural hypotension
52
Central Alpha-2 Agonists in **HTN**
Methyldopa (Aldomet) / Clonidine (oral and patch) / Guanfacine
53
Blood vessel dilators (vasodilators) in **HTN**
....
54
What to use & What to avoid in
- HTN + HF
- ACE inhibitors, Diuretics
- Ca channel blockers
55
What to use & What to avoid in
- HTN + IHD
- B blocker or Ca channel blocker.
- Hydralazine
56
What to use & What to avoid in
- HTN + DM
- ACE inhibitors, Ca channel blockers
- B blockers (masking of warning signs of hypoglycemic coma)
57
What to use & What to avoid in
- Ederly >60
Calcium channel blockers, Diuretics
58
What to use & What to avoid in
- BPH
Alpha-Blockers
59
What to use & What to avoid in
- HTN + Renal Impairment
- BB, CCB, Diuretics (Lasix), a methyl dopa & ACE inhibitors but with monitoring of creatinine level
- ACE inhibitors in bilateral renal stenosis
60
What to use & What to avoid in
- HTN + Asthma or COPD
- Calcium channel blockers
- B blockers
61
What to use & What to avoid in
- HTN + Pregnancy
- a methyl dopa, Ca channel blocker, Hydralazine or Labetalol
- ACE inhibitors, B blockers, Diuretics.
62
What to use & What to avoid in
- HTN + Hyperthyroidism
B blocker
63
What to use & What to avoid in
- HTN + PVD
- Ca channel blockers, a blocker
- B blockers.
64
Drugs For HTN in **Pregnancy**
- Nifedipine, labetalol, hydralazine,
- beta-blockers, methyldopa, prazosin
65
Drugs For HTN in **IHD**
- Beta-blockers, ACE inhibitors,
- Calcium channel blockers
66
Drugs For HTN in
- CHF
- ACE inhibitors
- beta-blockers
67
Algorithm for TTT of **HTN**
68
Algorithm for TTT of **HTN**
- First Step
Lifestyle Modification
69
Algorithm for TTT of **HTN**
- Not at goal BP after LS Mod.
70
Algorithm for TTT of **HTN**
- Not at Goal BP after first Trial of Drugs
71
Initial TTT of **HTN**
72
Step 2 TTT of **HTN**
73
Step 3 TTT of **HTN**
