Pathophysiology and Pharmacotherapy of Hypertension 3 Flashcards
What are the primary first line agents for hypertension
Thiazide/thiazide type-diuretics, ACE inhibitors, ARBs, CCBs
What the secondary line agents for hypertension
Beta blockers, potassium sparing diuretics,
Drug combinations with similar mechanisms of action/clinical effects should usually be avoided but what are the exceptions
Diuretics, non-DHP and DHB-CCB
When would ACEI and ARBs be preffered over the other first line agents for hypertension
If a patient has CKD
What are the preferred first line medications for black patients who have hypertension
Thiazides and CCBs
What are the preferred first line medications for black patients who have CKD Stage 1 or 2 with proteinuria, CKD Stage 1 or 2 without proteinuria
ACEI or ARBs/ Thiazide or CCBs
What are the preferred medications for black patiens with and chronic heart disease after a heart attack
Beta blockers and ACEI/ARBs
When a patient has heart failure with reduced ejection fraction what agents show great efficacy
BBs, ACEI/ARBs, Anti-aldosterone
When a patient has had an MI what agents show great efficacy
BB, ACEI
T/F: When a patient as Diabetes all of the first line agents should be considered first
False: If a patient has diabetes all of the first line agents should be considered except thiazides, ACE/ARBs are first if albuminuria is present
If a patient is pregnant what medications should be used to treat hypertension
methyldopa, nifedipine, labetalol
T/F: If a person has BPH the best agent may be an alpha-blocker, if a person has atrial fibrillation/flutter rate Non-DHP CCBs and BBs should be avoided
True
What first line agent should be avoided to treat hypertension if th patient has gout as well
Thiazides
T/F: If someone has COPD/Ashtma if BBs are used they need to be as selective as possible
True
What first line drugs should be avoided if a patient is hyperkalemic
ACEI/ARBs
What drugs should be avoided if the patient has bradycardia/heart block
BB and Non-DHP CCBs
T/F: The ALLHAT study showed that Alph-Blockers can compete with first line hypertension medications
False: Alpha-Blockers have an increased risk of CVD when compared to the first line treatments
What must disease history must a patient have in order to reccomend a beta-blockers as a first line medication
Coronoray artery disease, myocardial infarction or Chronic heart failure
T/F: When a patient has a BP of 160/100 it is recommend to either start them on two medications or add a 2nd one to therapy
True
Why does combining and ACEI/ARBs and a diuretic have complementary effects
Diuretics can trigger RAAS -> ACE can blunt this effect leading to additive BP lowering
T/F: Combing ACEI/ARB with DHP-CCB have a complementary effect due to lessening peripheral edema due to the CCB
True
What is the definition of resistant Hypertension
Not at goal while on 3 BP medications (including a diuretic) OR controlled on 4 or more greater medications
What are the risk factors for having persistent hypertension
65 or older, obesity, DM, being Black
What are treatment options for treating Resitant hypertension
Asses/improve adherence, correct secondary causes, change diet, DC meds that aide in hypertension
T/F: If a patient has resistant hypertension then adding a beta or alpha blocker has shown efficacy in controlling the hypertension
False: If a patient has resistant hypertension then adding an Anti-aldosterone diuretic has shown efficacy in controlling the hypertension
When a patient is first put on therapy when should they be evaluated again
In a month
T/F: The closer a patient’s PDC is to 1 the better the adherence
True
What is one of the best ways to increase adhearance
Involve family members
What complications can arise due to a hypertensive emergency
Stroke, MI, acute renal failure, retinal hemorrhage
What BP readings signify a hypertensive Emergency
SBP greater than 180 or DBP greater than 120
T/F: Sudden BP drops can lead to target organ damage
True
T/F: If a patient is having a hypertensive emergency they should take their medication immediately
False: If a patient has a hypertensive emergency they should be admitted to the ICU
Without compelling conditions what is the goal to reduce the BP
Reduce by 25% in the first hour, reduce to 160/100 over the next 2-6 hours, then normalize over 1 to 2 days
What are the compelling conditions that would make a hypertensive emergency be treated much more aggressively
Aortic dissection, severe preeclampsia/eclampsia, pheochromocytoma
If patient has aortic dissection what should the blood pressure be lowered to in the 1st hour, preeclampsia/eclamsia and phenochromyctoma
less than 120, less than 140
