Tuesday HTN highlights Flashcards
slide 60-130
NEVER EVER put a patient on an _______ and ________ together or direct renin antagonist (i.e. only one med that affects angiotensin-aldosterone system)
ACEi and ARB
Acc/AHA 2017 HTN guidelines:
1) What should you Rx the general black population?
2) What abt the general non-black population?
1) Thiazides and CCB
2) Thiazides, CCB, & ACEi or ARB
Acc/AHA 2017 HTN guidelines:
1) What should you Rx any patient with CKD?
2) What should you do if the pt’s BP isn’t at the goal after 1 month?
3) What should you NOT use together?
1) Tx should incl. ACEi or ARB
2) Up-titrate or add Rx
3) ACEi and ARBs
What are 2 key parts of the DASH diet?
1) Eating vegetables, fruits, and whole grains
2) Limiting foods that are high in saturated fat, such as fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel, and palm oils
Do not use an ______ & _________ together in same patient
ACEi; ARB
(don’t give to pregnant patients either)
AHA/ACC guidelines: patients with an initial BP of 130/80 mm Hg or higher and a high cardiovascular risk should be treated initially with what?
lifestyle modifications AND pharmacotherapy
What is contraindicated in gout?
Thiazide diuretic (causes decreased excretion of uric acid)
In patients 18 and older with ______, treatment should include ACEi or ARB
CKD
Calcium channel blockers: List, define, and give and example of the 2 primary groups
1) Dihydropyridines: vasodilators with little to no negative effect on cardiac contractility (inotropic) or AV nodal conduction (chronotropic)
-Amlodipine
2) Non-dihydropyridine: less effective vasodilators and more affect to slow the AV node (negative chronotropic) and decrease contractility (negative inotropic)
-Verapamil > diltiazem
Give 4 examples of dihydropyridines (Ca+ channel blockers)
1) Amlodipine
2) Felodipine
3) Nicardipine
4) Nifedipine
Give 2 examples of non-dihydropyridines (Ca+ channel blockers)
1) Verapamil
2) DiltiazemER
Dihydropyridines: List the doses Amlodipine comes in
2.5, 5.0, or 10 mg daily
Differentiate between verapamil and diltiazem
Verapamil has a stronger effect on HR
HTN & Ischemic heart disease:
AHA guidelines recommend ____________ and/or ACEi for HTN in patients with stable ischemic heart disease – angina, HF, Previous MI, tachyarrhythmias, migraine HA
B-blockers
You should avoid what 3 things in pregnancy bc they’re teratogenic?
ACEi and ARBs, & aldosterone receptor antagonists
1) Define resistant HTN
2) What is the most common cause of resistant HTN?
3) What 2 things should you check/ look for?
1) Persistent HTN despite 3 or more drugs
2) Poor compliance w/ lifestyle and Rx
3) Exogenous substances + secondary HTN
List the 5 steps of HTN evaluation
1) Is it real?
2) Address Life-style and compliance with current Rx – are they trying?
3) Consider secondary causes
4) Optimal regimen
5) Adjunctive therapy
Spironolactone (potential fourth drug) is potassium sparing and a ______________ ____________
aldosterone antagonist
What can cause a tolerance to thiazides or “braking” effect?
Restrict salt intake
ACEi and ARB relatively contraindicated in __________ vascular disease
Renal
Renal vascular disease: Angioplasty is tx of choice for __________________ dysplasia
fibromuscular
Rx induced renal function decline with use of any antihypertensive: Which are most likely to do this?
ACEi and ArB’s
What is generally the ULN (physiologic) of increase in creatinine when starting an Rx?
up to 30%
A hypertensive ________________ with severely elevated BP is often acute
emergency
What BP is defined as severe asymptomatic HTN?
> 180/110
What is a common example of end-organ damage?
Papillary edema
What are 2 types of severe HTN (HTN crisis)
1) Hypertensive emergency
2) Severe asymptomatic HTN
Differentiate between a hypertensive emergency and severe asymptomatic HTN (3 main differences)
1) HTN emergency: requires hospitalization, often acute, incl. end-organ damage
2) Severe asymptomatic HTN: outpatient mgmt, usually chronic, no end-organ damage
Sx of severe HTN:
What 6 Sx are considered mild and NOT acute target organ injury?
1) Mild Headache
2) Lightheadedness
3) Nausea
4) Palpitations [or new/ changed chest pain]
5) Epistaxis
6) Anxiety
Sx of severe HTN:
Patients with chest pain should receive appropriate evaluation for what?
Chest pain, not severe asymptomatic hypertension
What does GDMT stand for?
Guideline directed medical therapy
1) What is the short term risk of severe asymptomatic HTN (HTN urgency)?
2) Where is it managed?
3) BP control is best achieved with GDMT with what?
1) Short term risk is low
2) Outpatient
3) Gradual lowering of BP over several days to weeks using PO medications [in an outpatient setting]
American College of ER physicians ____________ recommend routine labs in HTN urgency (severe asymptomatic HTN)
does not
Serious adverse events related to severe asymptomatic HTN (death, ARF, CV events, ruptured AA) are ____________, even with delayed follow up
rare (one study < 1%)
What is not a primary neurologic issue?
Syncope
List the 5 steps you should take if BP is not controlled
1) Alter thiazide to chlorthalidone or indapamide
2) Add spironolactone or eplerenone
3) Add B-blocker. Alternative is alpha-blocker or diltiazem Qday.
4) Add hydralazine (3x/day). Add isosorbide if HFrEF
5) Substitute minoxidil. Involve specialist if not effective.
Differentiate between neurogenic and non-neurogenic orthostatic hypotension
1) Neurogenic = baroreflex dysfunction
2) Nonneurogenic = external factors (e.g. medications) inhibiting normal compensatory physiologic function
Give the criteria for Dx of orthostatic hypotension
Drop of 20 mm Hg or more SBP or drop of 10 mm Hg or more DBP
What is especially important in treating elderly pts with orthostatic hypotension?
Medication review
