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CDM1 > HTN > Flashcards

HTN Flashcards

(51 cards)

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1
Q

First line agents in HTN

A

ACEi, ARBs, CCB, Thiazide Diuretics

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2
Q

When do we initiate pharmacological therapy?

A

130-139/80-89 ASCVD >10%. 1 month FU
>140/90 in <10% risk, or STROKE

If <10% suggest non-pharm therapy and reasess in 3-6 months

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3
Q

Goal once started on pharmacological therapy

A

<130/80 unless medically unsafe to do so. Ex, fall risk

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4
Q

RAAS Inhibitors

A

ACEi
ARBs
Direct Renin Inhibitor
Aldosterone Antagonist

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5
Q

Excessive RAAS stimulation leads to

A

Increased sympathic activity
Increased PVR
Water/salt retention.

All leading to Elevated BP. Inhibiting RAAS lowers BP

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6
Q

Direct Renin Inhibitor Acts

A

Directly on Renin, less release from kidneys.

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7
Q

ACEi Acts

A

On ACE enzyme, converting AT1 to AT2

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8
Q

ARB Acts

A

Blcoks Angiotensin 2 On AT1 type receptor- vasoconstriction/dilation of arteries.

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9
Q

Aldosterone Antagonists Act

A

Decrease Aldosterone secretion from kidney. Increases NaCl and H2O excretion while conserving K+

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10
Q

ACE Clinical Pearls

A

Causes peripheral vasodilaton.

Increases bradykinin- cough SA

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11
Q

ACE Agents + Dosing

A

Enalapril 5-40mg 1-2xD

Linsinopril 10-40 mg D

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12
Q

ACE Clinical Considerations

A

Renal protective- use with DM, DKD, or CKD.
Use Post MI & HFrEF
Contraindicated in pregnancy, avoid in childbearing years.

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13
Q

ARB Agents + Dosing

A

Irbesaran 150-300mg D
Losartan 50-100mg 1-2xD
Valsartan 80-320mg D

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14
Q

ARB Clinical Considerations

A

Use is similar to ACEi, Do not use ACE/ARB together. Contraindicated in pregnancy.

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15
Q

ACE/ARB ADE

A 
Slight rise in SCr at iniiation
HYPERKALEMIA- monitor K- increased risk of CKD
Dry cough
RARE Angioedema
Pregnancy Cat D
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16
Q

ACE/ARB DDinx

A

K sparing diuretics

K supplements

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17
Q

ACE/ARB Monitoring

A

BP, SCr, Bun, K
Angioedema, cough
Assess blood test for elecrolytes and renal fxn 2-4 weeks after initating therapy

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18
Q

Direct Renin Inhibitor Considerations/ADE

A

Do not use with ACE/ARB, preg. Same considerations.
Slight rise in BUN, SCr at initiation.
HYPERKALEMIA

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19
Q

Aldosterone Antag Considerations/ADE

A

Avoid if Anuria, renal insufficency, High K

Hyponatremia, Gynecomastia, Impotence

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20
Q

Aldosterone Antag SP

A

Used in HFrEF, and Resistant HTN

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21
Q

Non-Dihydropyridine MOA

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A

Decreasing contractility (decrease HR and conduction across AV node), decreasing SV, decreases CO. CARDIAC Smooth Muscle Ca Channels. Inhibits Ca2+ Influx

22
Q

Dihydropyridine MOA

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A

Dilating peripheral arterioles, decreasing PVR. PERIPHERY smooth muscle ca channels. Inhibiting Ca2+ Influx.

23
Q

Dihydropyridine Agents & Dosing

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A

Amlodipine 5-10mg D

Nifedipine 60-120mg D

24
Q

Non-Dihydropyridine Agents & Dosing

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A

Diltiazem 120-540mg D

Verapamil (LA/SR) 120-480mg D/BID

25
DHP Clinical Considerations
First line therapy. Preffered in Black patients. Effective in olderpatients with isolated systolic Hypertension.
26
Non-DHP Clinical Considerations
Cardiac Foucsed benefit: Angina, Afib, PSVT
27
CCB ADE
More frequenly from VASODILATION (DHP) Bradycardia (Non-DHP) Constipation (Verapamil) HA, OH, Dizzness ``` Reflex Tachycardia (DHP) Pedal Edema (DHP) ```
28
CCB Contraindications
Non-DHP: Heart Block, HF (amlodpine ok) Beta blockers ``` DDinx: Verapamil, Diltiazem (Non-DHP) P450 Substates EtOH increases CCB effects Limit Dosing w/Simvastatin -Amlodipine- NTE 20mg -Verapamil/Dilt. NTE 10mg ```
29
Direct Vasodilators MOA
Act Directly on Vascular smooth muscle Dilating ARTERIOLES. Decrease PVR Compensatory stimulation of baroreceptors (Inc. HR, Inc. NE/Epi Release)
30
Direct Vasodilators Agents & Dosing
Minoxidil 10-40mg 1-2xD | Hydralazine 20-200mg 2-4xD
31
Direct Vasodilators Clinical Considerations
Considered 4TH LINE or LATER | Likely add-on in resistant HTN
32
Direct Vasodilator ADE
Reflex Tachy, Palpations HA, Dizziness Na/H2O Retnetion Lupus-like syndrome (high doses of Hydralazine)
33
Direct Vasodilators Monitor
BP HR SCr Edema
34
Classes of Diuretics
Thiazide (HCTZ) Loop (Furosemide) K+ Sparing (Eplerenone)
35
Diuretic MOA
Thiazides- inhibit NaCl reabsorption in DCT Loops- Inhibit NaCl reabsorption in TA Loop of Henle K+ Sparing- Limit Na+ reabsorption, K+ Secretion
36
Thiazide Agents and Dosing
HCTZ 12.5-25mg D | Chlorthalidone 12.5-50mg D (much more potent, longer-acting)
37
Thiazide Clinical Considerations
First Line therapy. Do not use if allergy hx with Sulfonamides HCTZ doses >25mg increase risk of ADE, with little BP improvement Chlorthalidone doses >50mg could lead to HYPOKalemia 12.5mg Chlorthalidone=25mg HCTZ
38
Loop Diuretics Agents and Dosing
Furosemide 20-80mg 1-2xD
39
Loop Clinical Considerations
Preffered in symptomatic HF and mod to severe CKD eGFR<30 Can result in HYPOKalemia, give K+ if needed. Bumetenide 1mg=Torsemide 20mg=Furosemdie 40mg
40
K Sparing Agents
Amiloride Triamterene Triamterene/HCTZ
41
K Sparing Clinical Considerations
Not 1st line treatment. Weak diuretics, used to prevent HYPOKalemia caused by other agents Avoid in pts with significant CKD
42
a1 Blockers MOA
Selectively block a1-receptors on smooth muscle cells, decreasing PVR
43
a1 Agents and Dosing
Doxazosin 1-8mg D
44
a1 Clinical Considerations
No benefit in prevention of MI or CHD Consider 2nd line for men with BPH Give 1st dose in clinic d/t syncope
45
a2 Agonists MOA
Stimulate presynaptic recepotrs in the brain, increasing inhibtory neuron activity and decreasing sympathetic outflow.
46
a2 Agonists Agents
Clonidine & TTS | Methyldopa
47
a2 Clinical Considerations
Not a first line therapy Avoid in HF Indicated for Resistant HTN (Clonidine) Indicated for Pregnancy (Methyldopa)
48
BB MOA
Competitvely inhibit catecholamine neurotransmitters at B1 receptors (Heart), and B2 receptors (SM and lungs)
49
Nonselective BB options
Propranolol!
50
Beta1selective Agents and Dosing
AMEBBA Atenolol 25-100mg D Metorpolol Suc 50-400mg 1-2xD Metoprolol Tar 50-200mg BID Esmolol Betaxolol Bisoprolol Acebutolol
51
Mixed a1/BB Agents Dosing
Carvedilol CR 20-80mg D | Labetalol 200-800mg BID

CDM1 (5 decks)

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