Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHRM 844 > Therapeutics of Hypertension 2 > Flashcards

Therapeutics of Hypertension 2 Flashcards

1
Q

ACC/AHA Recommendation for Choice of Initial Medication

For initiation of antihypertensive drug therapy, first line agents include (4)

A
  1. thiazide diuretics
  2. CCBs
  3. ACE-i or ARBs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ALLHAT

Antihypertensive and Lipid-lowering Treatment to Prevent Heart Attack Trial
- patinets older tha 55 with HTN and 1 addition CV risk factor
- results: ___ > amlodipine and lisinopril-based therapy in preventing stroke, MI, and HF

TAKEAWAYS:
1) ___ should be used-first line.
2) Pts who cannot take a diuretic, consider prescribing a ___ or ___.
3) Most patients with high blood presure need more than 1 drug

A
  • chlorthalidone
  • thiazides
  • CCB, ACE-i
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

T or F: All first line medication combinations are acceptable.

A

FALSE

Preferred
- ACE-i/CCB
- ARB/CCB
- ACE-i/diuretic
- ARB/diuretic

Acceptable
- CCB/diuretic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Patient Specific Factor: Stable Ischemic Heart Disease

First line
- ___ (reduce CV events and anginal symptoms)
- ___ (reduce MI, stroke, and CVD)

___ CCBs can be used if still uncontrolled

A
  • BB
  • ACE-i/ARBs
  • dihydropyridine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Patient Specific Factor: HF

Reduced ejection fraction
- avoid ___ CCBs due to no clinical benefit/worse outcomes

Preserved ejection fraction
- ___ : fluid overload
- ___ : elevated BP
- ___ : elevated HR

A

Reduced
- non-dihydropyridine

Preserved
- diuretics
- ACE-i/ARB
- BB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Patient Specific Factor: CKD

CKD 1 or 2 AND ____
- >300 mg/day or > 300 mg/g albumin:creatinine ratio: ___

CKD 3 or higher: ___

Post kideny transplantation: ___ CCBs are preferred due to improved ___ and kidney survival

A

albuminuria
- ACE-i/ARBs
- ACE-i/ARBs
- dihydropyridine, GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Patient Specific Factor: Cerebrovascular Disease

Secondary stroke prevention
- ___
- ___
- or combo of both

Usefulness of initiating antihypertensive treatment for BP < 140/90 is not well established

A

-ACE-i/ARBs
thiazide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Patient Specific Factor: Diabetes

  • ___ first-line classes of antihypertensive agents are useful and effective
  • in the presence of albuminuria: ___
A
  • all
  • ACE-i/ARBs

albuminuria is greater than 300 mg/day or 300 mg/g albumin:creatinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Patient Specific Factor: Pregnancy

Preferred agents: ___ , ___ , ___

Contraindicated: ACE-i, ARBs, direct renin inhibitors

A
  • methyldopa
  • nifedipine
  • labetalol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Patient Specific Factor: Ethnicity and Race

In black adults with HTN (w/wo DM) and WITHOUT HF or CKD
- initial anti-hypertensive treatment should include a ___ or ___
- better data for lowering BP and reducing CV events

A
  • thiazide, CCB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Diuretics

thiazide
- 4 examples

loop
- 3 examples

aldosterone antagonists
- 2 examples

potassium-sparing
- 2 examples

A

thiazide
- chlorthalidone, HCTZ, indapamide, metolazone

loop
- furosemide, torsemide, bumetanide

aldosterone antagonists
- spironolactone, eplerenone

potassium sparing
- amiloride, triamterene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Diuretics in HTN

initial anti-hypertensive effects
- diuresis = ___ SV = ___ in PVR

chronic anti-hypertensive effects
- SV returns to ___ = ___ in PVR (below pre-treatment levels)

different sub-classes can be combined for additive/synergistic effects

SV = stroke volume
PVR = pulmonary vascular resisitance

A
  • reduced, increase
  • normal, decrease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Thiazide Diuretics

Agents: HCTZ, chlorthalidone, indapamide, metolazone
- ___ is the most studied and 1-2x more potent that HCTZ
- ___ for most HTN patients (ALLHAT)
- more effective than ___ diuretics with CrCl > ___ mL/min
- dose in the ___ to avoid nocturnal diuresis

A
  • chlorthalidone
  • first line
  • loop, 30 mL/min
  • morning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Thiazide Diuretics

Adverse effects:
- ___ kalemia
- ___magnesemia
- ___calcemia
- ___uricemia
- ___ glycemia
- ___lipidemia
- ___ dysfuntion
- ___ in TG/cholesterol

Drug interactions
- ___ toxicity with concurrent use

Contraindications
- ___ allergy, ___

A

AE
- hypokalemia
- hypomagnesemia
- hypercalcemia
- hyperuricemia
- hyperglycemia
- hyperlipidemia
- sexual
- increase

Drug interactions
- Li

Contraindications
- sulfa, anuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Thiazide Frequency

all thiazides are taken ___ daily

A

once

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Loop diuretics

Agents: furosemide, torsemide, bumetanide, and ethacrynic acid

___ first line for HTN
- preferred in HF for ___ managment
- more effective than thiazide diuretics with CrC < ___ mL/min

___ - ceiling dose response curve
- may need ___ doses with severely ___ renal function or fluid ___
- switching to another loop diuretic or from PO to ___ can help

Dose in the ___ or afternoon to avoid nocturnal diuresis

A

NOT
- symptom
- 30

High
- higher, reduced, overload
- IV

morning

17
Q

Loop Diuretics

AE:
- ___ kalemia
- ___ magnesemia
- ___ calcemia
- ___ uricemia
- ___ toxicity

Contraindications: ___ allergy

A
  • hypokalemia
  • hypomagnesemia
  • hypocalcemia
  • hyperuricemia
  • ototoxicity
  • sulfa
18
Q

Loop Diuretic frequency

  • Furosemide and Bumetanide are taken ___ or ___ daily
  • Torsemide is taken ___ daily
A
  • once, daily
  • once
19
Q

Aldosterone Antagonists

Agents: spironolactone and
eplerenone
- ___ is preferred with resistant HTN (PATHWAY-2)
- ___ develops in up to 10% of patients on spironolactone , can switch to eplerenone
- do not initiate aldosterone antagonist with K > ___ mEq/L
- dose in the ___ or ___ to avoid nocturnal diuresis

A
  • Spironolactone
  • gynecomastia
  • 5
  • morning, afternoon
20
Q

Aldosterone Antagonists

AE:
- ___ kalemia
- ___ natremia
- gynecomastia ( ___ )

Drug interactions
- ACEi-ARBs, renin inhibitors, NSAIDs (increase risk of ___)
Contraindications

Eplerenone
- impaired renal function (CrCL < ___ mL/min or SCr > ___ in males or ___ in females)
- ___ and proteinuria

Both
- concominant use of ___ diuretics

A
  • hyperkalemia
  • hyponatremia
  • spironolactone
  • hyperkalemia
  • 50, 2, 1.8
  • T2DM
  • K sparing
21
Q

Aldosterone Antagonists Frequency

both spironolactone and eplerenone are taken ___ or ___ daily
- consider holding or reducing dose if K is > ___ mEq/L or SCr increase > ___%

A

once, twice
- 5.5. 25%

22
Q

Potassium Sparing Diuretics

Agents: amiloride, triamterene
- minimal ___ effects
- used in combo with ___ to minimize ___
- used with caution in patients with ___ or CKD (GFR < ___ mL/min)
- dose in ___ to avoid nocturnal diuresis

A
  • BP
  • thiazide, hypokalemia
  • diabetes, 45
  • morning
23
Q

Potassium Sparing Diuretics

AE
- ___kalemia
- ___ uric acid
- ___glycemia

A
  • hyperkalemia
  • increased
  • hyperglycemia
24
Q

Potassium Sparing Diuretics Frequency

Amiloride and triamterene are both taken ___ or ___ daily

A

once, twice

25
Q

Diuretic Clinical Pearls

  • do not give at ___
  • ___ are 1st line for most HTN pts
  • ___ is 1st line for pts with resistant HTN
  • do not use K sparing diuretics as ___ for HTN
  • pay attention to ___ allergies
  • check ___ when choosing diuretic class
  • important to monitor ___
A
  • bedtime
  • thiazides
  • spironolactone
  • monotherapy
  • sulfa
  • CrCl
  • K
26
Q

Diuretic Monitoring

___ and ___ function should be checked at baseline, ___ - ___ weeks after initiation, and every ___ - ___ months
- additional check at ___ - ___ weeks after initiation only for ___ diuretics and ___ antagonists

A

electrolyte, renal, 1-2, 6-12
- 3-4, loop, aldosterone

27
Q

Summary of Patient Specific Factors

Stable ischemic heart disease

A

ACE-i/ARB and BB first, then CCB can be added if still not controlled

28
Q

Summary of Patient Specific Factors

HFrEF

A
  • ACE-i/ARB/ARNI
  • mineralocorticoid receptor antagonists
  • diuretics
  • BB

all first line

29
Q

Summary of Patient Specific Factors

HFpEF

A

First line: diuretics (if symptomatic)

if persistent HTN: ACE-i/ARB or BB (if HR elevated)

30
Q

Summary of Patient Specific Factors

CKD

A

if albuminuria, ACE-i/ARB first line

31
Q

Summary of Patient Specific Factors

Renal transplant

A

CCB first line over ACE-i (reduces graft loss and maintains higher GFR)

ACE-i would result in anemia, hyperkalemia, and lower GFR

32
Q

Summary of Patient Specific Factors

Secondary stroke prevention

A

thiazide, ACE-i/ARB, or combo

only need to start os BP is greater than 140/90

33
Q

Summary of Patient Specific Factors

DM

A

any first line option
- ACE-i/ARBs if albuminuria

34
Q

Summary of Patient Specific Factors

AFib

A

ARB

35
Q

Summary of Patient Specific Factors

Aortic disease

A

BB

36
Q

Summary of Patient Specific Factors

Black patients

A

thiazide or CCB (unless HF or CKD)

37
Q

Summary of Patient Specific Factors

pregnancy

A

methyldopa
nifedipine
labetalol

PHRM 844 (52 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions