HTN Flashcards
Stable ischemic heart diseas
Beta blockers ( reduce CV events and angina symptoms)
ACE-1/ARB (reduce MI, stroke, CV)
DHP CCB can be used if still not controlled
Heart failure
Reduced ejection fraction
- avoid NON-DHP CCB
Preserved ejection fractions:
fluid overload: diuretics
elevated BP: ACE-1/ARB
elevated HR: BB
CKD
CKD Stage 1 or stage 2 AND albuminuria > 300 mg/day: ACE-1/ARB
CKD stage 3-5: ACE-1/ARB
Post kidney transplant: DHP CCB
Cerebrovascular disease
secondary stroke prevention: ACE-1/ARB/THIAZIDE
only start if BP >140/90
Diabetes
All first line agents are acceptable UNLESS PRESENCE OF ALBUMINURIA (> 300 MG/DAY): ACE-1/ARB
Pregnancy
Labetalol
Methyldopa
Nifedipine
African Americans
If patient has HTN without HF or CKD: thiazide or CCB
Diuretic monitoring
Baseline electrolytes and renal function
1-2 weeks after initiation
3-4 weeks after initiation (loop and aldosterone antagonists only)
every 6-12 months
ACE-1/ARB Monitoring
Baseline potassium and renal function
1-2 weeks after initiation (1 week if elderly)
3-4 weeks after initiation (only needed if elevated Scr or potassium at 1-2 weeks)
every 6-12 months
Monitoring summary for common agents
ACE-1/ARB: BUN/SCR/Potassium
CCBS: HR (NON-DHP)
Aldosterone antagonists: BUN/SCR/potassium
Other diuretics: BUN/SCR, Electrolytes, uric acid
BBs: HR
PAH
What medications do you not want to stop abruptly?
BB AND CLONIDINE
Pearls for d/c clonidine
when d/c slowly wean off by reducing to half doses every 2-3 days
when also on BB wean off BB several days before clonidine
When switching from oral to patch clonidine
overlap for 3-4 days
Day 1: administer patch, give 100% oral
Day2: give 50 % oral
Day 3: give 25% oral
Day 4: patch only
Patch to oral
start oral no sooner than 8 days after patch removal
