39 - Hypertension Flashcards Preview

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Flashcards in 39 - Hypertension Deck (28):
1

What are the HTN targets?

General population: < 140/90
Diabetes: < 130/80
High risk of CV events: SBP < 120
Isolated systolic HTN: SBP < 140
Home setting: < 135/85

2

non-pharms

-healthy lifestyle
-weight loss of > 4 kg if overweight
-waist circumference < 102 cm in men
-waist circumference < 88 cm in women
-sodium < 2g/day
-increase K+ intake if patient not at risk for hyperkalemia
-exercise
-reduce alcohol
-stop smoking

3

If BP > ______ start meds and non-pharms at the same time

160/100

4

If BP is _______ start meds if patient has organ damage or other risk factors for CV disease

140-159/90-99

5

Dose increase every ____ weeks

2-4

6

What is 1st line for uncomplicated HTN?

low-dose thiazide or related diuretics

7

Diuretics can cause _____

hypokalemia

8

Consider alternate agent to thiazide diuretic if patient is strongly predisposed to _____ _____

serious arrhythmia

9

Use a _____ diuretic for those with renal impairment

loop

10

Diuretics can worsen _____

dysglycemia

11

Who are selective B1 blockers 1st line in?

< 60 yo, or who have stable angina, heart failure or a Hx of MI

also useful for those with migraines, tachycardia or essential tremor

12

BBs are not as effective as ARBs, CCBs or diuretics as initial Tx for primary prevention of ___ events in patients > 60 yo.

CV

13

What are examples of RAAS drugs?

-ACEis
-ARBs
-direct renin inhibitors
-spironolactone

14

Who are ACEis first line in?

non-black patients with uncomplicated HTN and for patients with DM, recent MI, HF or CKD

15

Who are ARBs 1st line in?

uncomplicated HTN, DM or ischemic heart disease
*they are a good alternative to ACEis

16

How do direct renin inhibitors work?

prevent renin from converting angiotensin to angiotensin I

17

Give an example of direct renin inhibitor

aliskiren

18

Place in therapy for direct renin inhibitors?

should be used as add-on agent after all 1st line therapies have been tried

19

Why don't you use short acting DHP CCBs?

bc they can increase CV events so you need to use long-acting DHP CCBs

20

What type of patients are particularly responsive to CCBs

-elderly patients with isolated systolic HTN
-black patients

21

When is it reasonable to start with 2 first line agents at the same time?

if SBP > 20 or DBP > 10 above the recommended target

22

What defines resistant HTN?

HTN despite being on 3 dose-optimized drugs, 1 of which is a diuretic

23

BB not recommended as initial therapy in patients over ____ yo

60

24

Pregnancy:
Women at high risk of preeclampsia (all women with HTN included) should be offered what?

-ASA 81 mg daily
-should get 1 g calcium supplement regardless of dietary intake

25

Pregnancy:
What options can we use?

methyldopa, labetalol and nifedipine XL for HTN that is not severe

can use clonidine or acebutolol, pindolol, propranolol or metoprolol

26

Pregnancy:
What can we use for severe HTN ?

IR oral nifedipine, parenteral labetaolol or parenteral hydralazine

27

Pregnancy:
What drugs do you want to avoid?

atenolol - associated with IUGR (intrauterine growth restriction)

avoid thiazide and loop diuretics, ACEi, and ARBs, and spironolactone

28

Breastfeeding:
What drugs do you want to avoid?

-diuretics suppress lactation
-avoid atenolol and other BBs with low serum protein-binding (which concentrate in breast milk)
-avoid long acting ACEi (ramipril, lisinopril, cilazapril, perindopril)

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