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Therapeutics 2 - Fall 2017 > HTN - Kaakeh > Flashcards

HTN - Kaakeh Flashcards

1
Q 
List the risk factors for HTN:
\_\_\_\_ Na+ intake
\_\_\_\_\_\_ ethnicity
\_\_\_\_\_\_\_ 
\_\_\_\_\_ K+ intake
excess \_\_\_\_\_\_ intake
\_\_\_\_\_\_\_\_\_ (FH)
A

HIGH Na+; African American; Obesity; low K+; excess alcohol; genetic predisposition

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2
Q

Tobacco use - HTN or CVD risk factor?

A

CVD

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3
Q

Each increment of ___/___ mmHg doubles the risk of CVD across the entire BP range starting from ___/___ mmHg

A

20/10;

from 115/75

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4
Q

What are CVD risk factors?

A
  • HTN
  • Tobacco use
  • Overweight
  • Dyslipidemia
  • Diabetes Mellitus
  • Age
  • FH
  • Physical Inactivity
  • Microalbuminuria or GFR < 60
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5
Q

How to be classified with normal Adult BP

A

Sys < 120 AND Dias < 80

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6
Q

How to be classified with Pre-HTN Adult BP

A

Sys : 120 - 139 OR Dias 80-89

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7
Q

How to be classified with stage 1 HTN Adult BP

A

sys: 140 - 159 OR Dias 90-99

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8
Q

How to be classified with stage 2 Adult BP

A

sys > 160 OR dias > 100

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9
Q

Lowering BP helps lower the incidence of what 3 things

A

stroke; MI; HF

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10
Q

what are some prescription drugs that can elevate BP

A 
NSAIDs
Corticosteroids
Estrogens/OCs; Progesterone; Androgen
Sympathomimetic Amines
Erythropoietin
Ketoconazole
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11
Q

what are the 2 determinanys of BP

A

cardiac output & peripheral resistance

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12
Q

is it primary or secondary cause of HTN?

drug induced

A

secondary

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13
Q 
is it primary or secondary cause of HTN?
Humoral abnormality (RAAS, natriuretic hormone, insulin resistance)
A

primary

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14
Q

is it primary or secondary cause of HTN?

vascular endothelial mechanisms abnormality

A

primary

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15
Q 
is it primary or secondary cause of HTN?
neuronal mechanisms (alpha and beta) abnormality
A

primary

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16
Q

is it primary or secondary cause of HTN?food substances

A

secondary

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17
Q

is it primary or secondary cause of HTN?

Obstructive sleep apnea

A

secondary

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18
Q

is it primary or secondary cause of HTN?

CKD

A

Secondary

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19
Q

is it primary or secondary cause of HTN?

Peripheral autoregulation abnormality

A

primary

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20
Q

is it primary or secondary cause of HTN?

primary aldosteronism

A

secondary

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21
Q

is it primary or secondary cause of HTN?

renovascular disease

A

secondary

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22
Q

is it primary or secondary cause of HTN?

Chronic steroid therapy & Cushings Syndrome

A

secondary

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23
Q

is it primary or secondary cause of HTN?

Pheochromocytoma

A

secondary

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24
Q

is it primary or secondary cause of HTN?

electrolyte disturbances

A

primary

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25
Q

is it primary or secondary cause of HTN?

Coarctation of the aorta

A

secondary

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26
Q

is it primary or secondary cause of HTN?

thyroid/parathyroid disease

A

secondary

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27
Q

what food substances can cause HTN

A

sodium; licorice; ethanol

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28
Q

Illicit Drugs that may elevate BP

A

ketamine
ectasy
cocaine

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29
Q

Possible symptoms of primary aldosteronism

A

HA, muscle cramps, polyuria

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30
Q

Primary Aldosteronism:
______kalemia
______natremia
metabolic _______

A

HYPOkalemia; HYPERnatremia; alkalosis

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31
Q

what types of patients should be tested for primary aldosteronism?

A
  • drug resistant HTN
  • mod - severe HTN
  • Adrenal tumors
  • HTN of FH of HTN before age 40
  • if pt has HTN and has 1st degree relative with PA
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32
Q

BP = _____ x _____

A

CO x TPR

TPR = total peripheral resistance

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33
Q

CO = _____ x _____

A

HR x SV

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34
Q

What meds can be used to control SV (stroke volume)

A

diuretics

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35
Q

what meds can be used to control HR (heart rate)

A

beta blockers; some CCBs

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36
Q

what meds can be used to control TPR (total peripheral resistance)

A
  • ACEIs
  • ARBs
  • Hydralazine
  • Sympatholytics
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37
Q

how to treat primary aldosteronism

A

surgically remove adrenal tumorl

pretreat w/ 3 - 4 wks of spironolactone 100 mg - 400 mg PO QD

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38
Q

What is the normal range for MAP

A

70 - 100 mmHG

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39
Q

what value of MAP is needed to perfuse/sustain perfusion of organs

A

60 mmHg

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40
Q

what 5 areas of the body can be damaged by HTN

A
  • brain
  • heart
  • eyes
  • kidneys
  • vasculature
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41
Q

what can happen to the brain if HTN is persistent

A

stroke; hemorrhage; TIA

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42
Q

what can happen to the heart if HTN is persistent

A

LVH (left ventricle hypertrophy); CHD; CHF

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43
Q

what can happen to the eyes if HTN is persistent

A

Retinopathy; AV nicking

44
Q

what can happen to the kidneys if HTN is persistent

A

Renal failure; Proteinuria; CKD

45
Q

how is eye damaged measured (when talk about HTN..?)

A

with KW values ( KW 1 - 4; KW 4 = most damage)

46
Q

Initial add on treatment for someone that has CKD (regardless of race or DM)

A

ACEI or ARB

47
Q

5 different NON-PHARM life modifications that can be done to help control BP

A
  • weight reduction
  • DASH eating plan
  • Dietary Na reduction
  • Aerobic physical activity
  • Moderation of alcohol consumption
48
Q

DASH diet: what is there Na restriction recommendation?

A

2300 mg/day

49
Q

what is the DASH LOWER Na+ restriction recommendation?

A

1500 mg/day

50
Q

what groups of patients should be using the LOWER Na+ restriction value?

A 
if pt is over 51 YO
has diagnosed HTN
has DM
has CKD
or 
is African American
51
Q

per JNC 8 -

what is the preferred thiazide

A

Chlorthalidone (longer 1/2 life and more potent)

HCTZ (cheap af tho)

52
Q

per JNC 8 -

what is the preferred ACEI

A

enalapril (BID)

Lisinopril (QD)

53
Q

Special Indications for HTN:

If a pt has CAD (coronary artery disease) what is their standard pharmacotherapy

A

Beta blocker then add ACEI or ARB

THEN CCB

THEN Thiazide

54
Q

Special Indications for HTN:

standard pharmacotherapy for post MI pts

A

Beta blocker then add ACEI or ARB

55
Q

Special Indications for HTN:

standard pharmacotherapy for pt who has HF w/ reduced ejection fraction

A

Diuretic w/ ACE or ARB
THEN beta blocker
THEN aldosterone antagonist

56
Q

Special Indications for HTN:

Recurrent stroke prevention pt - what is their standard pharmacotherapy

A

Thiazide or Thiazide w/ ACEI

57
Q

If a pt is in stage 1 HTN (and no compelling indications)

how should drug therapy be initiated?

A

Monotherapy of the 4 first line agents
OR
2 drug combo of ACEI (or) ARB with CCB (or) thiazide

58
Q

If a pt is in stage 2 HTN (and no compelling indications)

how should drug therapy be initiated?

A

Two drug combo:
ACEi or ARB with CCB
OR
ACEi or ARB with thiazide

59
Q

JNC8 Treatment Strategies aka wtf to do:

If goal BP not met after 1 month of treatment…..

A
  • increase dose of initial drug (maximize if tolerated)
    or
  • add 2nd drug - CAN add 2nd drug before achieving max dose of initial drug (watch for ADEs)
60
Q

JNC8 Treatment Strategies aka wtf to do:

May consider start w/ 2 drugs at the same time if…..

A

if SBP > 160 and/or DBP > 100
OR
if SBP > 20 and/or DBP > 10 ABOVE goal

61
Q

JNC8 Treatment Strategies aka wtf to do:

If goal BP not met w/ 2 meds….

A

add/titrate 3rd medication

*DO NOT use ACEI and ARB together tho - possible kidney failure

62
Q

JNC8 Treatment Strategies aka wtf to do:

when to start using other classes of drugs (aka when to use drugs other than the 4 first line agents)

A
  • Goal BP NOT met with 3 meds

- Contraindication ot thiazide, ACEi/ARB, or CCB

63
Q

what drug classes are known to be 2nd line therapy

A
  • Loops/K+ sparing diuretics
  • Beta-blockers
  • Vasodilators (hydralazine)
  • alpha blockers
  • Direct renin inhbitors
64
Q

4 classes of diuretics

A
  • loops
  • thiazides
  • K+ sparing
  • Aldosterone antagonists
65
Q

What drugs are apart of the thiazide diuretic class?

A
  • chlorthalidone
  • HCTZ
  • indapamide
  • metolazone
66
Q

What drugs are apart of the loop diuretic class?

A

bumetanide; furosemide; torsemide

67
Q

What drugs are apart of the K+ sparing diuretic class?

A

amiloride; triamterene

68
Q

What drugs are apart of the aldosterone antagonist diuretic class?

A

eplerenone; spironolactone

69
Q

which diuretic can cause DM?

A

thiazides

70
Q

which diuretic can help with osteoporosis?

A

thiazides - because they cause hypercalcemia/slow demineralization in osteoporosis

71
Q

what are the clinical indications for diuretics

A
  • HTN
  • Edema
  • CHF
  • kidney disease
  • Hepatic cirrhosis
  • Hypercalcemia
  • diabetes insipidus
72
Q

which diuretic can cause a flare of gout?

A

thiazide

73
Q

______ diuretics are more effective than ______ diuretics unless CrCl < 30 mL/min

A

thiazide; loop

74
Q

T or F: Thiazides have a contraindication for sulfa allergy

A

True!

75
Q

ADE’s of thiazides?

A

hypokalemia/hypomagnesemia
hypercalcemia/hyperuricemia
hyperglycemia/hyperlipidemia
sexual dysfunction

76
Q

what are the contraindications for thiazides?

A

sulfa allergy

Anuria (aka hella renal dysfunction - do not use if CrCl < 30 mL/min)

77
Q

Loop diuretics - sulfa allergy - yes or no?

A

yes - sulfa allergy is an issue

78
Q

ADEs of Loop Diuretics

A
  • hypokalemia/hypomagnesemia/hypocalcemia
  • hyperuricemia
  • ototoxicity
79
Q

what are the K+ sparing diuretics

A

Amiloride; triamterene

80
Q

who are K+ sparing diuretics used for?

A

pts that have had diuretic induced hypokalemia

81
Q

K+ sparing diuretics should be avoided in what types of pts?

A

CKD or diabetic pts

82
Q

What diuretics are aldosterone antagonists

A

spironolactone; eplerenone

83
Q

Due to increased risk of hyperkalemia, _________ is contraindicated in CrCl < 50 ml/min and pts with T2DM and proteinuria

A

eplerenone

84
Q

diuretic drug interactions

A
  • NSAIDs
  • Digitalis toxicity
  • Lithium toxicity
  • Corticosteroids
85
Q

What are the diuretic monitoring parameters?

A
  • BP
  • BUN/SCr
  • Serum electrolytes
  • Cholesterol/triglycerides
  • skin rash
  • uric acid
86
Q

Indications for ACEIs

A
  • HTN
  • Left ventricular systolic dysfunction
  • MI
  • diabetic nephropathy
87
Q

Indications for ARBs

A

HTN
CHF
Progressive renal impairment (diabetes)

88
Q

Contraindications for Angiotensin Inhbitors (ACEI/ARBs/Renin inhibitor)

A
  • Pregnancy/Nursing mothers
  • Hx of angioedema
  • Bilateral renal artery stenosis
  • Pre-existing kidney dysfunction
  • Hyperkalemia
89
Q

for ACE inhibitors: monitoring serum _____ & ____ within _____ of initiation of dose increase

A

K+; SCr; 4 weeks

90
Q

Reduce the starting dose for ACE inhibitors/ARBs by ______% if the patients have a _________ risk

A

50%; hypotension;

91
Q

What types of patients may need a 50% decrease in their starting dose for their ACEI/ARB

A
  • pts also taking a diuretic
  • Volume depletion
  • Elderly patients
    (everyone who has hypotension risk)
92
Q

what types of patients are at a higher risk of hyperkalemia when starting an ACEI/ARB

A

CKD patients
or
pts on other K+ sparing medications (K+ sparing diuretics/aldosterone antagonists)

93
Q

what are the compelling indications for Angiotension Inhibitors (ACEIs/ARBs)

A

DM - type 1 w/ proteinuria
HF
Post MI w/ Systolic Dysfucntion

94
Q

when is it appropriate to have someone on both an ARB and ACEI

A

if the pt has severe forms of nephrotic syndrome

95
Q

Indications for CCBs

A
  • HTN
  • Angina
  • Arrhytmias
  • (other: bipolar; HA; pulmonary HTN; diabetes)
96
Q

Contraindications for CCBs

A

Preexisting bradycardia
Conduction defects
HF due to systolic dysfunction

97
Q

______ is a contraindication to non-DHPs

A

Heart block

98
Q

what are CCB Drug interactions

A

non-DHPs and BETA blockers (low HR!!)

Increase CCB effect: Grapefruit juice; Cimetidine; ranitidine

Decrease CCB effect: Rifampin; Phenobarbital

99
Q

what drugs will increase CCB effect

A

grapefruit juice, cimetidine, ranititinde

100
Q

what drugs will decrease CCB effect

A

rifampin; phenobarbital

101
Q

monitoring for CCBs

A

BP
HR
Edema
Constipation

102
Q

potentially favorable effects of Beta Blockers…

A
  • shown to reduce mortality in pts w/ HF
  • useful in the tx of atrial tachyarrhytmias/fibrilation
  • migraines
  • thyrotoxicosis (short term)
  • essential tremor
  • perioperative HTN
103
Q

Potentially unfavorable effects of Beta Blockers

A
  • Asthma/Reactive airway disease
  • Renal insufficiency
  • Diabetes
  • HF exacerbation
  • 2nd/3rd Degree heart block
104
Q

frequent side effects of direct arterial vasodilators are ________

A

fluid retention; reflex tachycardia

105
Q

Contraindication for Direct Arterial Vasodilator

A

Dissecting aortic aneurysm (bc reflex tachycardia issue with direct vasodilators…)

106
Q

Which drug can have SLE side effects

A

Hydralazine (lupus like side effects - rash)

107
Q

which drugs are preferred for pregnant women (bc safety of fetus)

A

Methyldopa
BBs
Vasodilators

Therapeutics 2 - Fall 2017 (22 decks)

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