Therapeutics - Hypertension (Ginzburg) Flashcards by amanda kastel

what is a normal BMI and what is considered obses

around 19-25

obese is over 30

(between 25 and 30 is overwight)

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what is considered normal BP

systolic less than 120 and diastolic less than 80

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what numbers are considered “ELEVATED” blood pressure (not hypertension yet)

120-129 systolic

less than 80 diastolic

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what numbers are considered stage 1/stage 2 hypertension?

stage 1: 130-139 systolic
80-89 diastolic

stage 2: 140 and over
90 and over diastolic

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3 general organs/systems that can be affected by high blood pressure

cardiovascular disease

kidney disease

retinopathy

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explain how high BP affects the cardiovascular system

double the risk for stroke and heart attack for every 20 points systolic and 10 points diastolic over 115/85

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how are high BP and kidney disease related

CKD can cause HBP and HBP can cause CKD

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how does HBP affect vision

can lead to bleeding, blurred vision, or complete vision loss

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true or false

being male is a risk factor for HBP

true

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is diabetes a risk factor for HBP?

Is it considered modifiable?

yes and yes

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name a class of drugs that is a risk factor for developing HBP

NSAIDS like naproxen

can also affect the kidneys and cause renal issues

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prior to assigning a HBP diagnosis, it is very important to do what?

DO NOT RELY ON JUST 1 NUMBER!!!!!!

ask the pt if they had caffeine, smoked, or exercised in past 30 mins, potentially have white coat HTN and need to check at hoome as well

also make sure the BP was taken properly and recheck 15-20 min later

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true or false

caffeine is a risk factor for developing hypertension

FALSE

it can increase the numbers if you drink it right before taking, but it won’t actually cause HTN

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explain how to get an ACCURATE BP reading

dont talk. empty bladder, put cuff on BARE ARM and use correct size

support the arm at heart level
do not cross legs, support your back and feet

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true or false

being in pain does not affect blood pressure readings

FALSE - it does significantly

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can environmental exposures be the cause of high BP?

YES

ie - having too much salt, not enough K, Ca, mgphysically inactive, or drinking tooo much alc

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can genetic predisposition be a cause of high BP?

yes

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true or false

drugs cannot be the cause of hypertension

FALSE - they van!!

so many drugs can cause - NSAIDS, drinking LOT of caffeine a day, immunosuppressants, PO contraceptives (only high doses), oral corticosteroids, amphetamines, etc

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name 2 types of “out of office” blood pressure monitoring

ambulatory care pressure monitoring - continuous readings every 24 hours (best method)

home BP monitoring (more practical)

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best NON pharmacologic interventions for preventing AND treating hypertension

weight loss, DASH diet, reduced sodium and enhanced potassium, physical activity, reduce alc intake

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what is DASH diet

fruit, vegetables, whole grains, decreased salt and fat

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to prevent/treat HBP, men should reduce alcohol to ____ drinks daily what about women>

men - 2 or less
women - 1 or less

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salt can be changed to what other seasoning

fresh herbs and spices, onion powder, garlic powder, mrs dash

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name 4 seasonings that should be avoided

sazon
adobo
onion salt
garlic salt

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how many mg sodium is maximum: -per day -per meal -per snack

per day - 1500mg or less meal - 500mg or less snack - 140mg or less

true or false if a can of soup says "heart healthy" recommend a patient to purchase it

FALSE - you need to look at the ingredients most are still extremely high in salt

true or false high potassium levels can be a cause of HBP

FALSE low potassium levels

name some causes of secondary hypertension

renal disease drugs OSA (sleep apnea) cushings thyroid alodosteronism

what are some basic lab tests that should be conducted for someone wiht primary HTN

glucose - check for diabetes lipids serum creatinine sodium, postassium, calcium levels TSH urinalysis CBC electrocardiogram for baseline

3 OPTIONAL tests for primary hypertension

echocardiogram uric acid albumin: creatinine

what is considered the "trifecta" and all should be checked for if a patient has 1 of the 3 conditions

hypertension hyperlipidemia diabetes

if the patient has a normal BP, what is the action taken?

promote lifestyle habits for prevention (optional) And reassess them in 1 year

patient has ELEVATED bp what is the plan of action? what numbers are considered "elevated"

120-129 systolic and less than 80 diastolic nonpharm therapy, and reassess in 3-6 months NO DRUGS YET

patient has stage 1 HTN what is plan of action? as recap - what numbers are considered stage 1 hypertension

130-139 systolic 80-89 diastolic use the risk calculator for 10 year CV disease risk if GREATER THAN 10% --- non pharm therapy AND start BP lowering medication and reassess in 1 month if LESS than 10% --- nonpharm therapy and reassess in 3-6 months

as mentioned, if a patient has stage 1 hypertension and a CV disease risk over 10%, we start nonpharm therapy, AND a BP lowering medication and reassess them in 1 month what happens at this 1 month visit

if the BP goal has been met, reassess them in 3-6 months if it hasn't been met - assess their adherence and consider raising dose

patient has stage 2 hypertension what is the plan of action? what numbers are considered stage 2?

140 and greater over 90 non pharm therapy AND Bp lowering medication --- 2 agents of different classes then we reassess in 1 month, and follow same plan as greater than 10% risk in stage 1

patient is a candidate for pharmacologic treatment for their hypertension they have no compelling indication (ie - caused by chronic kidney disease) what are considered the 1st line agents?

thiazide (chlorthalidone preferred - most potent) dihydropyridine calcium channel blocker ACE inhibitor or an ARB (NEVER BOTH)

if the hypertensive patient ahs chronic kidney disease (esp albuminuria) also, what drug(s) is (are) recommended? why?

an ACE inhibitor or an ARB because they decrease thhe progression of CKD and also help with the blood pressure

hypertensive patient has diabetes with albuminuria (over 30) what is recommended treatment

ACE inhibitor or ARB if no albuminuria - any of the 3 1st line agents

antihypertensive treatment can be initiated with TWO agents, especially if,,,,,,

the systolic is over 20 and the diastolic is over 10 above goal

note to self

i skipped all the specific conditoins - waiting for email back

true or false meds alone are enough to recommend to a patient to lower their BP

FALSE the meds must go along with lifestyle modifications

true or false if a patients BP is controlled, they can be weaned off the medicaiton

FALSE the meds are typically life long if you stop, the BP will shoot up again since they are life long, make sure the pt is adherent and give combo pills if available

name 4 thiazide/thiazide-like diuretics

chlorthalidone hydrochlorothiazide indapamide metolazone

ALL of the thiazide/thiazide-likes are doses how?

once a day

usual dosage range for chlorthalidone

12.5-25

usual dosage range for HCTZ

25-50

usual dosage range for indapamide

1.24-2.5 mg ( a day)

usual dosage range for metolazone

2,5-10mg/day

why is chlorthalidone considered the preferred diuretic

has a long half life and better potency - proven in trials to lower the risk of CV disease

4 things that should be monitored when a patient is on a thiazide diuretic

hyponatremia hypokalemia high uric acid and calcium levels

thiazide diuretics should be used in caution in which patients

with history of acute gout! (unless pt is on uric acid lowering therapy) bc diuretics can increase uric acid levels

MOA thiazide diuretics and where do they work

inhibit Na and Cl reabsorption into the body in the aascending loop of henle (in the DCT)

thiazide diuretics: which is ineffective at an eGFR below 30mL/min? which can be used until the eGFR is all the way down to 10mL/min?

HCTZ cannot be used below 30 chlorthalidone can be used all the way down to 10

ACE inhibitors should not be used in combo with ___ or ___

ARBS or direct renin inhibitors

ACE inhibitors should NOT be used in patients with a hisotry of....

angioedema!!!!! (with ACE inhibitors) if they get angioedema wiht an ACE inhibitor, can wait 6 WEEKS and then start ARB BUT if they get angioedema on an ARM, CANNOT GO ON ACE INHIBITOR OR ARB

increased risk of ____ when on ACE inhibitors, especially in patients....

hyperkalemia with CKD or on potassium supplements or potassium sparing drugs

ACE inhibitors have a risk of acute ____ in patients with severe bilateral renal artery stenosis

renal failure

true or false both ACEI's and ARBSs cannot be used in preganncy

true

when taking ACE inhibitors or ARBS, the patient may get an initial increase in serum creatinine if the bump is above ____%, it's an issue, but if lower it's fine

30%

how often should electrolytes and renal function be monitored for patients on ACE inhibitors and ARBS

baseleine, then 2-4 weeks after starting or increasing therapy, and then just periodically

true or false ACE inhibitors can be renal protective, yet also renal toxic

TRUE can be renal protective in diabetic patients - no proteinuria in a case of shock (LOW pressure in kidney) - can be toxic

dihydropyridine calcium channel blockers should be avoided in patients with _______ ONLY if required, which 2 may be used?

HFrEF amlodipine or felodipine

dihydropyridine calcium channel blockers are associated with _____ (adverse effect) is this more common in men or women?

dose-related pedal edema (swelling in feet and ankles) more common in women if it happens, cut back dose

true or false lab monitoring is needed for calcium channel blockers

FALSE - not needed

is dyhydro or nondihydro recommended

dihydro - it's 1 of the 23 1st lines

which type of calcium channel blockers are centrally acting? which are peripherally acting?

central - non dihydropyridines peripheral - dihydropyridine

true or false non dihydropyridine calcium channel blockers are NOT used in patients with HFrEF

true

are nondihydropyridines and beta blockers used together?

not routinely can increase risk of bradycardia and heart block

major concern with nondihydropyridine calcium shannel blockers

DDI CONCERN!!! majorCYP3A4 substrate and moderate inhibitor of CYP