Flashcards in First line HTN meds Deck (55):
What is BP?
Surrogate marker for CV risk
What is the cause of HTN in most pts?
What is HTN w/ an identifiable cause?
What is the MAP formula?
Cardiac output x Total peripheral resistance
What hormonal aspects are involved in HTN?
When does pharmacotherapy start for HTN?
SBP > 130
DPB > 80
What do the new guidelines mean for HTN pts?
Lots more need meds
What is the 1st line agent for HTN?
What are examples of thiazide diuretics?
Which thiazide diuretics are effective for CrCl <30?
Is the hypotensive effect of thiazide diuretics longer or shorter than the half life?
*not sure why
What is the half life of chlorthalidone?
What is the half life for hydrochlorthiazide?
What time of day do you give thiazides and why?
Minimize nocturnal diureses
Are chlorthalidone and hydrochlorthizaide effective at CrCl<30?
For what populations do you use thiazides with caution in?
Pts > 65
Pts w/ low or borderline low serum Na+
What is the max of hydrochlorthiazide and chlorthalidone?
HCTZ: 25-50 mg
C: 25 mg
What do ACEIs do?
Block RAAS-mediated conversion of AT to ATII (potent constrictor)
What do ACEIs prevent?
When are ACEIs 1st line?
Prevention of ischemic stroke
How many times daily are ACEIs dosed? What is an exception?
At higher doses of which ACEI meds do pts require BID dosing?
What do ALL ACEIs do?
Increase serum K+
What is an SE of ACEIs?
What happens to SCr when on ACEI that does not call for DC?
Increase of 30% or absolute increase of < 1 mg/dL
What happens if SCr increases more than previously listed while on ACEIs?
Discontinuation or dose reduction
What populations is the SE of angioedema more prevalent?
What does angioedema do w/ ACEIs?
Precludes any future ACEIs
What % of pts develop dry, persistent cough?
What does the ACEI cough warrant?
Switching to an ARB
When are ACEIs completely contraindicated?
What do you not combine w/ ACEIs?
How is Enalapril administered, what is the dose, and how often (ACEI)?
What is the dosing of Lisinopril and how often is it given?
Do ARBs block bradykinin metabolism?
What does the lack of bradykinin metabolism do to make ARBs more preferable for some pts?
Little to no bradykinin induced cough
What are ARBs missing due to continued bradykinin metabolism?
Regression of myocyte hypertrophy and fibrosis
Should you use ACEIs and ARBs together?
Why shouldn't you use ACEI and ARBs together?
Increased risk of hyperkalemia
When can you not use ARBs?
What is the rate of SEs with ARBs?
The lowest incidence of SEs of all hypertensives
Give two examples of ARBs
Is there generic availability?
What are the two classes of calcium channel blockers?
Are dihydropyridines vasodilators or rate controllers?
Are non-dihydropyridines vasodilators or rate controllers?
What is a SE of dihydropyridine CCB?
Reflex tachycardia due to potent vasodilation
With what agents is CCB reflex tachycardia more likely?
More pronounced w/ 1st generation DHP
With what agents is reflex tachycardia less likely?
Much less pronounced with newer agents
What is IR nifedipine associated with?
What is an example? What does this mean?
Increased adverse CV advents
Ex: AMI in angina pts
Means not approved for HTN
What are some examples of dihydroperidine that are dosed once per day?
What are some examples of non-dihydropyridine CCBs?
What is a negative SE of verapamil?
When is combination therapy recommended for HTN?
Stage 2 HTN pts
What is an advantage of combination BP pharmacotherapy?
Better BP control w/ fewer SEs