Module 5: Cardio-edited Flashcards
What are important considerations for pts on statins?
- Advise pt to stop therapy and order CK if pt reports muscle discomfort, weakness, or brown urine
- Do not take at same time as grapefruit juice
- Take at evening meal or at bedtime
What are the drug side effects for CCBs?
conductive defects, worse systolic dysfunction, nausea, headache, constipation with higher doses, ankle edema, flushing
What are the drug side effects for ß-blocker?
bronchospasm, bradycardia, heart failure, hypoglycemia, impaired peripheral circulation, insomnia, fatigue, hypertriglyceridemia
What is hypertension?
- Persistent elevation of SBP at >140mm Hg & DBP at >90mm Hg
- Essential HTN: likely multifactorial; BP remains elevated d/t net increase in peripheral arterial resistances 2° to renal retention of salt + water
- 2° HTN: BP elevation from identified cause (renal, endocrine, vascular, drug-induced)
- PreHTN: 120-139/80- 89
- Stage 1 HTN: 140-159/90-99
- Stage 2 HTN: 160/100
What are side effects for diuretics?
increases cholestoral, glucose, uric acid, calcium levels; decreased K, Na, Mg
What are the drug side effects for ACE inhibitors?
common: cough; rare: angioedema, hyperkalemia, rash, loss of taste, leucopenia
What are lifestyle modifications for hypertension?
- Lifestyle modifications are 1st line treatment for HTN*
- Weight loss of 4 kg or more if overweight (target body mass index: 18.5–24.9 kg/m2; waist circumference <102 cm in men and <88 cm in women).
- Healthy diet (DASH, Mediterranean)
- Sodium intake target of <2000 mg (88 mmol) per day
- Increase dietary potassium intake (e.g., fruit and vegetable component of DASH eating plan) if the patient is not at risk of hyperkalemia. Risk factors include renin-angiotensin inhibitors or other agents that can increase potassium, chronic kidney disease and serum potassium >4.5 mmol/L.
- Regular, moderate intensity cardiorespiratory physical activity for 30–60 minutes on most days or 150m/week 10min interval—mod intense cardiovascular
- Low-risk alcohol consumption (0–2 drinks/day or ≤10 drinks/week for women; 0–3 drinks/day or ≤15 drinks/week for men)
- Smoke-free environment
- Stress reduction
What are the non-pharmacologic interventions of health behaviour modifications for children in dyslipidemia?
- Age >2 can follow medical nutrition therapy for adults, healthy diet therapy for 6-12 months
- For those w/high LDL- r/o secondary causes- thyroid, liver, renal, fam hx),
- Screen family members, refer to specialist
What are the high CV risk conditions where tx w/statin is recommended in dyslipidemia?
Clinical Atherosclerosis (MI, ACS, stable angina, stroke, TIA, PAD, etc), AAA, DM, CKD (age 50), LDL-C ≥5.0 mmol/L
What are nonpharmacological interventions for hypertensions?
- Weight loss of 4 kg or more if overweight (target BMI: 18.5–24.9 kg/m2; waist circumference <102 cm in men and <88 cm in women).
- Healthy diet—high in fresh fruits, vegetables, soluble fibre and low-fat dairy products, low in saturated fats and sodium, e.g., DASH eating plan
- Sodium intake target of <2000 mg (88 mmol) per day.
- Increase dietary potassium intake (e.g., fruit and vegetable component of DASH eating plan) if the patient is not at risk of hyperkalemia. Risk factors include renin-angiotensin inhibitors or other agents that can increase potassium, chronic kidney disease and serum potassium >4.5 mmol/L.
- Regular, moderate intensity cardiorespiratory physical activity for 30–60 minutes on most days.
- Low-risk alcohol consumption (0–2 drinks/day or ≤10 drinks/week for women; 0–3 drinks/day or ≤15 drinks/week for men).
- Smoke-free environment
What are the 1st line statins for dyslipidemia?
- Lipitor and Crestor have greatest LDL lowering effects.
- Pravastatin metabolism is least affected by other drugs and has a lower risk of myopathy
- Atorvastatin 10-80 mg PO OD in PM (start with 10 mg, monitor every 6 weeks, increase gradually to max 80 mg)
What is dyslipidemia?
- Elevation of ≥1: cholesterol, cholesterol esters, phospholipids, or triglycerides
- Primary and significant risk factor for CHD & CAD
- HDL- good (delay atherogenesis, carries lipids away from blood vessels to liver for degradation)
- LDL bad- keep cholesterol in blood vessels, forming fatty deposits
- High levels of ApoB related to heart disease
What are the drug side Effects for ARBs?
(same as ACE inhibitors but no cough)
rare: angioedema, hyperkalemia, rash, loss of taste, leucopenia
What are the indications for drug therapy for diastolic and/or systolic hypertension?
- Initial therapy should be either monotherapy or single pill combo
1. Monotherapy choices: thiazide/thiazide-like diuretics, ß-blocker (pts 60 yrs), ACE inhibitor (non-black pts), ARB, CCB
2. Additional antihypertensive drugs should be used if target BP levels are not achieved with standard dose monotherapy: thiazide/thiazide-like diuretic or CCB
with either: ACE inhibitor, ARB, or ß-blocker - Caution in combining a non-dihyrdopyridine CCB and ß-blocker
- ACE inhbitors and ARB combo is NOT recommended
3. If BP still not controlled or there are adverse effects, other hypertensives may be added (consult expert)
4. Possible reasons for poor response should be considered (consult expert)
5. a-blockers are not recommended as 1 st line for uncomplicated HTN; ß-blockers
are not recommended as 1 st line for uncomplicated pts <60yrs; ACE inhibitors are not recommended as 1 st line therapy in uncomplicated, black pts
What medications are considered first-line for the management of hypertension in pregnancy that is not severe?
- Methyldopa
- Labetalol
- Nifedipine
