5080 - HTN & Hyperlipidemia Flashcards
Exam 1 study guide review (94 cards)
1
Q
CMA
A
Cost minimization analysis - compares cost of 2 different interventions where outcomes are not necessarily equal or even measured. Should only be used when outcomes are identical.
2
Q
Cost minimization analysis
A
How hospital formularies are developed
3
Q
CBA
A
Cost benefit analysis - dollar signs assigned to treatments as well as outcomes. As ratio or an actual dollar amount.
4
Q
CEA
A
Cost effectiveness analysis - commonly used. Compares multiple treatments that have different costs.
5
Q
CUA
A
Cost utility analysis - takes patient preference into analysis. Often reported as quality adjusted life years.
6
Q
quality adjusted life years
A
CUA - cost utility analysis
7
Q
Medicare PART A
A
hospital insurance
8
Q
Medicare PART B
A
outpatient medical insurance
9
Q
Medicare PART D
A
prescription drug plan
10
Q
Dosage form versus delivery system
A
Delivery system talks about how the dose form is delivered
11
Q
Routes of administration
A
Oral: PO
Parenteral: IV, SC, IM
Sublingual; Inhalation; Rectal; Vaginal; Ocular; Nasal; Transdermal
12
Q
How many Americans have HTN?
A
75 million
13
Q
90% of people over 55 have:
A
HTN
14
Q
Primary hypertension:
A
90% of cases - multifactorial response
15
Q
Secondar hypertension:
A
10% of cases - with specific and known direct cause. Most common in renal dysfunction. Also sleep apnea, Cushing’s and other.
16
Q
Meds can cause HTN specifically:
A
Stimulants, immunosuppressants, decongestants, high-dose NSAIDs
17
Q
Uncontrolled HTN can lead to:
A
MI, stroke, renal failure and death
18
Q
Measure what doubles cardiovascular risk in HTN:
A
Every 20/10 reading
19
Q
MAP is:
A
1/3 SBP + 2/3 DBP
20
Q
BP patho is:
A
Cardiac output + total peripheral resistance
21
Q
RAAS stands for:
A
Renin angiotensin aldosterone system
22
Q
RAAS does what:
A
effects blood pressure by manipulating sodium., potassium and blood volume
23
Q
BP 140/90 is:
A
prehypertension
24
Q
BP 160/100 is:
A
stage 1 hypertension
25
BP >160/100 is:
stage 2 hypertension
26
Clinical presentation of BP:
Asymptomatic
27
Risk factors for HTN:
Age, DM, hyperlipidemia, family hx, obesity, inactivity, tobacco use
28
Lab tests for HTN:
BUN, serum creatinine, fasting lipids, blood glucose, electrolytes, Hb/Hct. Values may be normal, but will help identify other cardiac risk factors or end organ damage
29
HTN complications:
kidney disease, stroke, CVD, retinopathy, PAD
30
ACE inhibitors:
Inhibits conversion from angiotensin 1 to angiotensin 2. Also blocks bradykinin which causes cough from ACE inhibitors.
31
ACE inhibitors are proven to:
Reduce cardiovascular risk as well as chronic kidney disease.
32
ACE inhibitors are first-line therapy for:
DM, stroke, and post MI
33
ACE inhibitors can increase which electrolyte:
Potassium
34
Do not use ACE inhibitors during:
Pregnancy
35
ARB (angiotensin receptor blockers) are:
Similar to ACE inhibitors by blocking angiotensin 2 regardless of pathway. No cough with ARBs. Generally equivalent to ACE however fewer side effects.
36
Thiazide diuretics are:
First-line medications for HTN or as a combination. They are preferred.
37
What is the classifications of: Benezepril, Catopril, Enalapril, Fosinopril, Lisinopril, Moxepril, Periindopril, Quinapril, Ramipril, and Trandolapril?
ACE inhibitors for treating HTN
38
What are the classifications of: Azilsartan, Candesartan, Eprosartan, Irbesartan, Losartan, Olmesartan, Telmisartan, and Valsartan?
ARBs (angiotensin receptor blockers) for treating HTN
39
Thiazide diuretics are dosed in:
The morning
40
Thiazide diuretics adverse events are:
Electrolyte abnormalities and hyperuricemia (high uric acid in the blood)
41
What is the classification of: Chlorthalidone, Hydrochlorothiazide, Indapamide, Metolazone?
Thiazide diuretics
42
Calcium channel blockers two classes are:
Dihydropyridines (potent vasodilators) and Non-dihydropyrides (decrease heart-rate and AV node conduction)
43
Calcium channel blockers work by:
Inhibiting the influx of calcium across the membrane
44
What is the classification of: Amlodipine, Felodipine, Isradipine, Nicardipine, Nifedipine, and Nisoldipine?
Dihydropyridine calcium channel blockers
45
What is the classification of: Diltiazem (SR, CD, XT, XR, LA), and Verapamil (SR):
Non-dihydropyridine calcium channel blockers
46
Adverse effects of non-dihydropyridine calcium channel blockers:
Hypotension, AV block, bradycardia
47
Drug interactions of non-dihydropyridine calcium channel blockers:
CYP 3A4 inhibitors and grapefruit juice
48
Loop diuretics are:
Treatment of HTN but NOT first-line tx
49
What is the classification of: Bumetanide, Furosemide and Torsemide:
Loop diuretics
50
Adverse events of loop diuretics
Hypokalemia and hypocalcemia
51
What is the classification of: Amiloride, and Triamterene:
Potassium sparing diuretics (for HTN)
52
What is the classification of: Eplerenone, Spironolactone:
Aldosterone antagonists (for HTN)
53
What is the classification of: Atenolol, Meteprolol tartrate/succinate?
Cardioselective beta blockers (for HTN)
54
What is the classification of: Nadolol, Propranolol
Nonselective beta blockers (for HTN)
55
What is the classification of: Carvedilol, Nebivolol:
Mixed alpha and beta blockers (for HTN)
56
What is the classification of: Doxazosin, Prazosin, Terazosin:
Alpha blockers (for HTN)
57
What is the classification of: Aliskiren:
Direct renin inhibitors (for HTN)
58
What is the classification of: Clonidine, Methyldopa:
Central alpha2-agonists (for HTN)
59
What is the classification of: Reserpine:
Peripheral Adrenergic Antagonists (for HTN)
60
What is the classification of: Minoxidil, Hydralazine:
Direct arterial vasodilators (for HTN)
61
Monitor __ for ACE & ARBs:
BP, BUN, Serum Creatinine, Potassium
62
Monitor __ for Calcium Channel Blockers and Beta Blockers:
BP, HR
63
Monitor __ for diuretics:
BP, BUN, Serum Creatinine, Potassium, Magnesium, Sodium - and uric acid for thiazides
64
Nonpharmacological therapy for HTN:
Weight loses, sodium restriction, limit alcohol, increase physical activity, smoking cessation
65
Compelling indications for HTN therapy are:
Heart failure with reduced ejection fraction; post MI; Coronary artery disease; DM; Chronic kidney disease; stroke
66
Chylomicrons, VLDL, LDL, HDL are:
Lipoproteins
67
Atherogenic development causes/is evidenced by:
Angina, MI, arrhythmias, stroke and PAD
68
Cytokine recruitment and plaque formation is cause by:
Inflammatory cascade promoted by LDL on the artery wall
69
Laboratory tests for hyperlipidemia:
TC, LDL, Triglycerides, HDL, CRP, ApoB
70
Assess these risk factors: ___ every ___ years in patients __ to __ years old.
1: Medical history, physical exam, fasting lipid panel, ASCVD risk. 2: 4- years. 3: 20-79 years old
71
```
Target lab values for cholesterol:
Total:
HDL:
LDL:
Triglycerides:
```
Total: <200 mg/dL
HDL: >= 60 mg/dL
LDL: <100 mg/dL
Triglycerides: <150 mg/dL
72
HMG-CoA Reductase Inhibitors are:
Statins
73
What statin intensity of:
Atorvastatin 80mg
Rosuvastatin 40mg
High intensity LDL >=50%
74
```
What statin intensity of:
Atorvastatin 20mg
Rosuvastatin 10mg
Simvastatin 20-40mg
Pravastatin 80mg
Lovastatin 80mg
Pitavastatin 4mg
```
Moderate intensity LDL 30-50%
75
```
What statin intensity of:
Fluvastatin 10-20mg
Lovastatin 20mg
Pitavastatin 10-20mg
Simvastatin 10mg
```
Low intensity LDL <30%
76
Statin metabolism for Lovastatin, Simvastatin and
| Atorvastatin:
CYP 3A4
77
Statin metabolism for Fluvastatin and Rosuvastatin:
CYP 2C9
78
Statin metabolism for Pitavastatin:
UGT1A3
79
Statin metabolism for Pravastatin:
Not oxidized
80
Adverse events of statin medications for hyperlipidemia:
Rhabdomyolysis (death of muscle fibers = muscle injury), elevated serum transaminase, PREGNANCY CATEGORY X
81
Clinical controversies with statin medications:
Cancer, diabetes and cognition
82
Statin myopathy is __ and how to reverse:
Myopathy, myalgia (muscle pain), myositis (muscle inflammation), rhabdomyopathy - so alway measure baseline CK before initiating - to reverse adverse effects, DC offending agent.
83
Ezetimibe (Zetia) is:
Cholesterol absorption inhibitor by blocking NPC1L1. Used as second line agent. It lacks the morbidity or mortality benefit in cardiovascular disease. Reduces LDL by 19% as single agent.
84
What classification is: Fenofibrate, Gemfibrozil:
Fibrate medication that reduces triglycerides by 50%, reduces CVD mortality, provides small increase in HDL.
85
When is Fenofibrate or Gemfibrozil used:
When triglycerides are >500 mg/dL to treat cholesterol
86
Adverse events of Fibrates:
Myalgias, renal insufficiency
87
Drug interactions of Fibrates:
Warfarin (INR concerns) and with Gemfibrozil, statins.
88
What classification is: Cholestyramine, Colestipol, Colesevela,:
Bile acid sequestrates. Usually have high adverse drug reactions in GI and high drug interaction profiles.
89
What is a second line agent that can increase HDL and decrease TGs:
Niacin, by reducing hepatic synthesis of VLDL and decreases hepatic removal of HDL.
90
Adverse effects of Niacin:
flushing, itching, hepatotoxicity, concern for pre-existing gout and DM
91
What OTC with primary use to treat hypertriglyceridemia and reduce CAD risk:
Omega-3 fatty acids
92
What adverse event concern with Omega-3 fatty acids:
Alter INR
93
Nonpharmacological interventions for hyperlipidemia:
Dietary counseling, reduce saturated fats, increase fiber, weight control, physical activity
94
Treatment goal of hyperlipidemia therapy:
Prevention of ASCVD using fixed dose statin therapy (in moderate to high)
