Week 5 CARDIOVASCULAR: HTN/HEART FAILURE Flashcards
Pharmacologic treatment for HTN is indicated for primary prevention
No CVD, 10 year ASCVD <10%, and SBP >=140 or DBP >=90 OR NoCVD, 10 year ASCVD >=10% and SBP >=130 or DBP >=80
First line pharmaceutical options for treatment of HTN
Diuretics, ACE inhibitors, ARBs, CCB
Class of antihypertensive drug that should be used with caution in individuals with gout
Thiazide diuretics
Pharmacologic agent that prevents conversion of Angiotensin 1 to Angiotensin II
ACE inhibitor
Antihypertensive of choice (2) in the black population
Thiazide diuretics and CCB
Antihypertensive of choice for individuals with CKD
ACE inhibitor (or ARB if not tolerated)
Side effect of ACE inhibitors related to blocking of bradykinase
cough
Mechanism of Action: ARB
Blocks access of angiotensin II
Mechanism of Action: CCB
Blocks calcium influx resulting in vasodilation
Block only Beta receptors in heart and kidneys
Cardio-selective Beta Blocker
Class of antihypertensive that should be used cautiously in individuals with lung disease
Non selective beta blocker
Class of antihypertensive that has a common side effect of orthostatic hypotension
Alpha blockers
Hypertension caused by a co-morbid condition or drug
Secondary Hypertension
Cornerstone of treatment of HF
Ace inhibitors and beta blockers
Drugs routinely used in addition to ACEI and Beta blockers in HFREF (Stage C)
Diuretics (loop) and Aldosterone antagonist (spironolactone)
Goal in dosing ACE inhibitors in HF
Maximal dose tolerated
Medication class that minimizes cardiac remodeling
ACE inhibitors
Goals of treatment of HF (Stage A)
Healthy lifestyle, prevent vascular/coronary disease, prevent LV structural abnormalities
Class of diuretic most commonly used to treat HF
Loop diuretics (e.g. furosemide, bumetanide)
Common OTC analgesic that interacts with loop diuretic
NSAIDS
Drug recommended for treatment of HF and SVT or atrial fibrillation
Digoxin
Effect of combination of isosorbide dinitrate and hydralazine
Decrease preload and afterload
Major adverse effect of aldosterone antagonists / Mineralcorticoid receptor antagonists
Hyperkalemia and renal failure
Mechanism of action of Mineralcorticoid receptor antagonists
Inhibit aldosterone to produce a mild diuretic effect and potassium sparing
Medication used to treat HF that may have endocrine side effect profile such as gynecomastia in men and menstrual irregularity in women
Sprinolactone
Effect of digoxin
Positive inotrope (increase contractility)
Blanche, 46 years old, presents for her annual Well exam. Her BP today is 136/84 with a repeat of 139/88. She brings in her blood pressure reading from the health fair at work which is 138/80. Blanche is considered to have:
A) stage 1 HTN
B) Accelerated HTN
C) Hypertensive crisis
D) Normal
A) stage 1 hypertension
Which of the following is NOT a first line option for pharmacologic treatment of hypertension:
A) Thiazide diuretic
B) Beta Blocker
C) ACE inhibitor
D) ARB therapy
B) Beta blocker
The best first choice for treating hypertension in individuals with CKD:
A) Beta Blocker
B) Thiazide diuretic
C) ACE inhibitor
D) Calcium Channel Blocker
C) ACE inhibitor
Frank, a black male, age 56 is diagnosed with Stage 1 HTN. His ASCVD risk is 15%. He has no CKD. The NP chooses which medication as the best first choice to treat his hypertension?
A) Furosemide
B) Amlodipine
C) Metoprolol
D) HCTZ
B) Amlodipine
Adverse drug reactions associated with the dihydropyridine calcium channel blockers include all of the following EXCEPT:
A) Diarrhea
B) Hypotension
C) Edema
D) Gingival Hyperplasia
A) diarrhea
Stage 1 HTN
130-139 SBP
OR
80-89 DBP
Stage 2 HTN
> = 140 SBP
OR
= 90 DBP
Elevated BP
120-129 SBP and < 80 DBP
Pharmacologic treatment with one first line agent
Stage 1 HTN and ASCVD risk >10%
or known CVD, DM or CKD
Pharmacologic treatment with two first line agents is the protocol for which stage of HTN?
Stage 2 HTN
Hypertensive Urgency
SBP >=180
or
DBP >=120 and no target end organ damage evident
Preferred first line medication for patients with CKD or DM with microalumuria
ACE inhibitor
Preferred first line treatment for black population with no CKD
Calcium channel blocker or thiazide diuretic
Preferred thiazide diuretic due to duration of action
Chlorthalidone
Drug used in individuals who do not tolerate ACE inhibitors due to cough
Angiotensin receptor blocker
Recommended management and follow up if Stage 1 HTN and clinical ASCVD < 10%
Lifestyle changes and FU in 3 -6 months
Recommended management and follow up if Stage 1 HTN and clinical ASCVD >= 10% or known CKD, DM, or CVD
Lifestyle changes, a single pharmaceutical agent and FU in 1 month
Recommended management and follow up if Stage 2 HTN
Lifestyle changes, two pharmaceutical agents and FU in 1 month
Most common cause of secondary HTN
Obstructive Sleep Apnea
Compelling use for this medication if history of MI
Beta blocker or CCA
BP Threshold for treatment if no CVD and 10 year ASCVD risk <10%
> = 140/90
Overweight / Obesity
Modifiable risk factor
Low socioeconomic status
Relatively fixed risk factor
Reduction in BP for each 1 Kg of weight loss
1 mm Hg
Accounts for up to 95% of HTN
Primary (essential) HTN
What are the first choice of Thiazide diuretics in mild HF, corticosteroid and estrogen therapy, premenstrual syndrome and limited renal dysfunction?
A) furosemide and hydrochlorothiazide
B) spironolactone and chlorthalidone
C) hydrochlorothiazide and chlorothalidone
D) metolazone and hydrochlorothiazide
Answer= C
Rationale
A) furosemide is a loop diuretic and not a thiazide
B) spironolactone is a potassium sparing diuretic, not a thiazide
C) see page 331, second paragraph of Edema Associated with…
D) Both metolazone and HCTZ are classified under thiazide diuretics, but metolazone is not the preferred thiazide in this situation.
