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PHRM 844 > Therapeutics of HTN pt. 4 > Flashcards

Therapeutics of HTN pt. 4 Flashcards

1
Q

Direct arterial vasodilators agents

A

Hydralazine, minoxidil

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2
Q

Are direct arterial vasodilators a last line therapy for HTN

A

Yes

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3
Q

Who are direct arterial vasodilators reserved for

A

Reserved for pts w/ special indications or very difficult to control BP (i.e. severe CKD or hemodialysis)

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4
Q

Which of the direct arterial vasodilators is more potent

A

Minoxidil is more potent than hydralazine

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5
Q

What is a requirement with direct arterial vasodilators

A

requires concomitant therapy w/ diuretic and B blocker

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6
Q

which of the direct arterial vasodilators is more preferred

A

Hydralazine is preferred over minoxidil

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7
Q

If a pt is on minoxidil, which class of diuretic must the pt be on

A

Loop diuretic

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8
Q

Direct arterial vasodilators AEs

A
  • Palpitations, tachycardia, chest pain, GI SEs, headache, hematologic dyscrasias, hepatotoxicity, fluid retention
  • Hydralazine specific - lupus like syndrome/rash
  • Minoxidil specific - hair growth
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9
Q

frequency of hydralazine

A

2-4/day

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10
Q

frequency of minoxidil

A

1-3/day

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11
Q

what are the boxed warning summaries of minoxidil

A
  • may cause pericarditis and pericardial effusion that may progress to tamponade
  • may increase oxygen demand and exacerbate angina pectoris
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12
Q

what should be used before minoxidil is ever added

A

maximum therapeutic doses of a diuretic and two other antihypertensives

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13
Q

direct arterial vasodilators use caution with:

A

CVA, renal impairment, CAD, liver disease, SLE

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14
Q

alpha 1 blockers agents

A

doxazosin, prazosin, terazosin

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15
Q

what is the use of alpha 1 blockers

A
  • NEVER considered 1st line for HTN
  • 2nd line for pts with concomitant BPH
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16
Q

what is alpha 1 blockers associated with (esp. in elderly)

A

orthostatic hypotension

17
Q

central alpha 2 agonists agents

A

clonidine, methyldopa, guanfacine

18
Q

what is the use of central alpha 2 agonists

A

last line for htn due to AEs

19
Q

which of the central alpha 2 agonists has the most severe AEs

A

clonidine

20
Q

central alpha 2 agonists AEs

A

CNS depression, dizziness, fatigue, anticholinergic effects, bradycardia, reflex tachycardia, fluid retention

21
Q

why should central alpha 2 agonists never be abruptly stopped

A

abrupt cessation causes rebound htn

22
Q

what central alpha 2 agonist is preferred in pregnancy

A

methyldopa

23
Q

clonidine dosage forms and strength

A
  • PO: 0.1-0.2 mg BID or TID (max 2.4 mg/day)
  • Transdermal weekly patch: 0.1-0.3 mg/24h
24
Q

what is an advantage the clonidine patch has over the oral route

A

lower risk of rebound htn and improved adherence with patch

25
Q

methyldopa strength and frequency

A

250-500 mg BID

26
Q

guanfacine strength and frequency

A

0.5-2mg daily

27
Q

what is the process to titrating off clonidine

A
  • slow wean; half dose every 2-3 days
  • concomitant B blocker prescribed
  • wean B blocker several days prior to clonidine wean
28
Q

what is the process of transitioning from oral clonidine to transdermal patch

A
  • overlap oral regimen for 3-4 days
  • Day 1: place patch, administer 100% of oral clonidine dose
  • Day 2: administer 50% of oral dose
  • Day 3: administer 25% of oral dose
  • Day 4: patch only
29
Q

what is the process of transitioning from clonidine patch to oral route

A

consider starting oral clonidine no sooner than 8 hours after patch removal

30
Q

what if pt is not at BP goal?

A
  • consider nighttime dosing of one antihypertensive (except diuretics)
  • assess adherence
  • educate on diet, exercise, smoking cessation
  • rule out white coat htn
  • d/c interfering substances
  • pt may have resistant htn
31
Q

what are the risk factors of resistant htn

A

older age, obesity, CKD, diabetes, AA

32
Q

what is step 1 of AHA stepwise guidance for management of resistant htn

A
  1. maximize lifestyle interventions; optimize 3-drug (ACEi or ARB, CCB, and diuretic)
33
Q

what is step 2 of AHA stepwise guidance for management of resistant htn

A
  1. substitute optimized thiazide-like diuretic (chlorthalidone, indapamide)
34
Q

what is step 3 of AHA stepwise guidance for management of resistant htn

A
  1. add mineralocorticoid receptor antagonist (spironolactone, eplerenone)
35
Q

what is step 4 of AHA stepwise guidance for management of resistant htn

A
  1. add BB (or diltiazem depending on HR) if HR >70 bpm
    consider central alpha 2 agonist (clonidine or guanfacine at bedtime) if BB CI and/or HR <70 bpm
36
Q

what is step 5 of AHA stepwise guidance for management of resistant htn

A
  1. add hydralazine
37
Q

what is step 6 of AHA stepwise guidance for management of resistant htn

A
  1. substitute minoxidil for hydralazine

PHRM 844 (13 decks)

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