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Fall 2024 > Pharm HTN > Flashcards

Pharm HTN Flashcards

1
Q

What are the first line HTN agents?

A

Thiazide diuretics
ACEs
ARBs
D-CCB
ND - CCB

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2
Q

Thiazide drugs?

A

Hydrochlorothiazide
Chlorthalidone
Indapamide

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3
Q

Thiazide diuretic adverse effects

A

Hyponatremia
Hypokalemia
Hyperuricemia
Extracellular fluid depletion

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4
Q

In what groups should ACEi/ARBs be avoided?

A

Angioedema
Pregnancy

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5
Q

With what labs should you use caution with ACEi/ARBs

A

SBP <80
SrCr >3mg/dL
Na <130
K >5
Bilateral renal artery stenosis

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6
Q

D-CCB MOA and adverse effects?

A

Potent vasodilator - best for HTN and angina

Flushing
Reflex tachy
headache
peripheral edema

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7
Q

Secondary HTN agents?

A

Beta blockers
Potassium sparing diuretics
Loop diuretics
Central alpha agonists
Direct renin inhibitor
Direct arterial vasodilators
Alpha-1 blockers

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8
Q

Which beta blockers are B1 selective

A

Acebutolol
Atenolol
Betaxolol
Bisoprolol
Esmolol
Metoprolol

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9
Q

Which meds are potassium sparing diuretics?

A

Amiloride
Triamterene
AA - spironolactone and eplerenone

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10
Q

Which meds are central alpha agonists

A

Clonidine
Guanfacine
Methyldopa

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11
Q

Which meds are direct arterial vasodilators

A

Hydralazine
Minoxidil

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12
Q

Which meds are loop diuretics

A

Furosemide
Bumetanide
Torsemide

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13
Q

What is a direct renin inhibitor

A

Aliskiren

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14
Q

Which meds are Alpha 1 Blockers

A

Prazosin
Doxazosin
Terazosin

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15
Q

Normal BP

A

<120 AND <80

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16
Q

Elevated BP

A

120-129 AND <80

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17
Q

Stage 1 HTN

A

130-139 OR 80-89

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18
Q

Stage 2 HTN

A

> =140 OR >=90

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19
Q

Individual 40-70 years old each increment of __mm Hg SBP or __mm Hg DBP doubles the risk of CVD across the range of ___/__ - ___/___ mm Hg

A

20
10
115/75 - 185/115

20
Q

AntiHTN meds cause
____% reduced stroke
____% reduced MI
____% reduced HF

A

35-40
20-25
50

21
Q

In what case is the BP threshold >=140/90 rather than 130/80

A

No clinical CVD and 10 risk <10% AND
Secondary stroke prevention

22
Q

Always make sure you use the _____ BP to make treatment decisions

A

Average

23
Q

Approach to patient with BP <120/80

A

Promote healthy lifestyle and reassess in 1 year

24
Q

Approach to patient with BP 120-129/80

A

Promote healthy lifestyle and reassess in 3-6 months

25
Q

Approach to patient with BP 130-139/80-89 AND ASCVD <10%

A

Promote healthy lifestyle and reassess in 3-6 months

26
Q

Approach to patient with BP 130-139/80-89 AND ASCVD >10%

A

Promote healthy lifestyle AND use BP lowering med

Reassess at 1 month

If at goal, reassess in 3-6 months
If not at goal, assess adherence and consider therapy intensification, reassess at 1 month

27
Q

Approach to patient with BP >=140/90

A

Promote healthy lifestyle AND implement either 1 or 2 BP lowering meds

Reassess at 1 month

If at goal, reassess at 3-6 month
If not at goal, assess adherence and consider therapy intensification, reassess at 1 month

28
Q

Approach to patient is stable ischemic heart disease with HTN

A

BB or ACE/ARB as first line

If goal not met, add D-CCB, thiazide diuretic and/or aldosterone agonist

29
Q

Approach to patient with HFpEF and HTN

A

manage volume overload first with diuretics

Then, use ACE/ARB and BB titrated to achieve SBP<130

*avoid ND-CCB

30
Q

Approach to patient with HFrEF and HTN

A

Titrate GDMT to reach SBP<130

ACE/ARB
BB
Diuretics as needed
AA

31
Q

Approach to patient with DM and HTN

A

All first line agents effective

If albuminuria, use max tolerated ACE/ARB as first line

monitor serum creatinine, eGFR, and serum K levels

32
Q

Approach to patient with CKD and HTN

A

ACE inhibitor to slow progression

ARB if ACE not tolerated

No preferred agent in patient with CKD and no significant proteinuria

33
Q

Approach to patient with kidney transplant and HTN

A

ARB or D-CCB are first line

34
Q

Secondary stroke prevention in patient with HTN

A

restart antihypertensive treatment after the first few days of event

thiazide diuretic, ACE/ARB, or combination

35
Q

Approach to patient with COPD and HTN

A

ARB
CCB
Diuretic
BB B1 selective for selected pts

36
Q

Approach to patient with HTN and depression

A

Do not use chlorthalidone if patient on SSRI/SNRI –> hyponatremia

Avoid BB –> depression is adverse effect

Avoid clonidine

37
Q

Approach to patient with sexual dysfunction and HTN

A

BB or AA

Phosphodiesterase inhibitors are safe with antihypertensive meds

38
Q

Approach to african american patient with HTN

A

Thiazide diuretic OR CCB

> =2 meds recommended

39
Q

Approach to elderly patient with HTN

A

If limited life expectancy and multiple comorbidities, weigh risk/benefit ratio

BP lowering prevents cognitive decline/dementia

40
Q

Effects of antihypertensives on women

A

2 x more likely to have adverse effects
More likely to have ACE cough
HypoK and hypoNa more common with diuretics

41
Q

Approach to patient that is pregnant and HTN

A

Transition to:
Methyldopa
Nifedipine
Labetalol

DO NOT use ACE, ARB or direct renin inhibitor

42
Q

How to manage HTN urgency

A

Treat outpatient with oral antihypertensives

Reduce BP no more than 25% in 24 hours

Follow up 1 week after episode

43
Q

How to manage HTN emergency

A

IV antihypertensives

Lower MAP no more than 25% in the first hour then 160/110 in next 2-6 hours

Once stabilized titrate down IV agent and transition to oral therapy

44
Q

HTN emergency best treatment options

A

Preferred: labetalol and esmolol
NTG and sodium nitroprusside for patients with MI, acute pulmonary edema or aortic dissection

45
Q

What is the one exception to lowering BP slowly

A

Aortic dissection

46
Q

All medication options for HTN emergency

A

Labetolol
Esmolol
Nicardipine
Clevidipine
NTG
Sodium nitroprusside
Fenoldopam
Hydralazine
Enalaprilat

Fall 2024 (34 decks)

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