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MJ- Foundations 2 Exam 2 > HTN 3 > Flashcards

HTN 3 Flashcards

1
Q
  • “Last resort” medication
  • Clonidine (Catapres)
  • Methyldopa
A

Central Alpha Agonists

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2
Q

MOA:

Stimulate Alpha 2 adrenergic receptors in the brain which reduces CNS sympathetic outflow

A

Central Alpha Agonists

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3
Q

Which med is okay in pregnancy?

A

Central Alpha Agonist : Methyldopa

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4
Q

How do you prevent rebound HTN when using Central Alpha Agonists?

A

Avoid abrupt cessation

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5
Q

Which med?

Side effects:

  • Anticholinergic side effects
  • Bradycardia
  • Orthostatic hypotension
  • Dizziness
  • Rebound HTN
A

Central Alpha Agonists

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6
Q

What are the 3 side effects of Central Alpha Agonist : Methyldopa

A
  • Hepatitis
  • Hemolytic anemia
  • Fever
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7
Q

1 contraindication of Central Alpha Agonists

A

Methyldopa in liver disease

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8
Q

End in “zosin”

A

Alpha Blockers

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9
Q

Which med?

  • Not utilized frequently
  • Doxazosin (Cardura)
  • Terazosin (Hytrin)
  • Prazosin (Minipress)
A

Alpha Blockers

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10
Q

MOA:

  • Targets Alpha 1 receptors on vascular smooth muscle, causing a decrease in peripheral vascular resistance (PVR)
  • –> thus decreasing BP
A

Alpha Blockers

(Zosin)

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11
Q

Which med?

  • Use in mild - moderate HTN
  • Not for monotherapy
  • ALLHAT trial showed increased risk of HF w/ _____
  • Compelling indication for BPH (which means this med is helpful for both BPH and HTN)
A

Alpha Blockers

  • doxazosin
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12
Q

Which med?

Side effects:

  • Orthostatic Hypotension (severe w/ 1st use)
  • Reflex tachycardia
  • Dizziness
A

Alpha Blockers

(zosin)

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13
Q

What tx should you always start a patient on w/ HTN?

A

Lifestyle interventions

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14
Q

After implementing lifestyle changes, when should you FU w/ pt?

A

3 to 6 months

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15
Q

After initiating pharmacologic therapy, how soon should you reassess pt?

A

1 month

(monitor labs if necessary depending on meds given)

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16
Q

If the patient is not at their goal BP after starting a medication at the 1 month FU, what should you do?

A
  • Increase dose

or

  • add 2nd medication
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17
Q

If the patient is not at their goal BP after being placed on 3 medications, what should you do?

A

Consider consulting a HTN specialist

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18
Q
  • Once the patient’s BP is controlled, how often should FU appointments be?
  • What 2 things should you monitor?
A
  • Every 3 to 6 months
  • Serum K and creatinine once or twice annually **(electrolytes)**
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19
Q

Which guidelines?

  • 1st: Diuretic
  • Follow compelling indications
A

JNC 7

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20
Q

Which guidelines?

  • 1st: Thiazides / ACE-I / ARB / CCB
  • African Americans: Thiazides / CCB
  • ***CKD patients: ACE or ARB***
21
Q

Which guidelines?

  • 1st: TZD (Thiazolidinediones) / CCB / ACE-I / ARB
A

AHA/ACC 2017

22
Q

Which 2 meds would you give patients w/ CKD?

23
Q

Which 2 meds would you give for recurrent stroke prevention patients?

A
  • Diuretics
  • ACE-I
24
Q

Heart failure patients can receive all meds except for which one?

25
Which 2 meds should you not give post-MI patients?
* ARB * CCB
26
Which 2 meds should you not give patients w/ high risk of coronary disease?
* ARB * Aldo ANT
27
DM patients can receive all but which med?
Aldo ANT
28
What is the goal BP of patients w/ _stable ischemic heart disease?_
\< 130/80
29
Which meds to give for patients w/ _stable ischemic heart disease?_
* Beta Blockers * ACE-I * ARBs
30
If a patient w/ _stable ischemic heart disease_ BP goal is not met and they _have angina_ what should you do?
add CCB (dihydropyridine)
31
If a patient w/ _stable ischemic heart disease_ BP goal is not met, _without angina_, what should you do?
add **CCB (dihydropyridine)** or **Thiazide** or Minerlocorticoid receptor antagonist **(spironolactone)**
32
* What is the BP goal of a patient _w/ HF_ _w/ reduced ejection fraction?_ * What med should you NOT give this pt?
* \< 130/80 * CCB - nondihydropyridine
33
What is the goal BP of a patient w/ CKD (chronic kidney disease)?
\< 130/80
34
* What tx for patient w/ CKD, w/o albuminuria? * What tx for patient w/ CKD, w/ albuminuria?
* Use the usual 1st line med * ACE-I or if they can't tolerate that, give ARB
35
* What is the BP goal of pt w/ DM? * Which classes of drugs are most useful in these patients? * DM patient w/ albuminuria, what should you give?
* \< 130/80 * ALL classes are useful in DM patients * ACE-I or ARB
36
* What 3 medications are given to pregnant women w/ HTN? * \*\*\*What 3 meds are _NOT_ given to pregnant women??\*\*\*\*\*\*
* Methyldopa, Nifedipine, Labetalol * **\*\*\*DO NOT GIVE:** ACE-I, ARB, or DRI\*\*\*
37
Prognosis for HTN patients is poor in which 5 diseases?
1. Cardiovascular Disease 2. Cerebrovascular Disease 3. Kidney Disease 4. Retinopathy 5. Vascular Disease
38
* In patients w/ HTN and Cardiovascular Disease, prognosis is poor if the patient has _Left Ventricular Hypertrophy._ * _As well as:_ Women over ___ years old Men over ____ years old
Women \>65 Men \>55
39
**Carotid wall thickening or plaque** is associated with _which disease_ as an indicator of poor prognosis in patients w/ HTN?
Cerebrovascular disease
40
**Low eGFR and Microalbuminuria** are associated with _which disease_ as an indicator of poor prognosis in patients w/ HTN?
Kidney Disease
41
**ABI (ankle brachial index) \<9** is associated with _which disease_ as an indicator of poor prognosis in patients w/ HTN?
Vascular Disease
42
* _Failure to achieve BP_ goal in patient adhering to full dose tx of _3 drug regimen_ (thiazide diuretic) * _Achieving BP goal_, but requires _4+ antihypertensives_
Resistant HTN
43
* What BP measurement classifies pt has "Hypertensive Urgency?" * What are the sxs? * What is the etiology?
* SBP \> or equal to 180 * Asymptomatic * Etiology: non-compliant w/ meds or non-compliant w/ low Na diet
44
* What is the BP measurement of a patient w/ a "Hypertensive Emergency?" * What is it associated with?
* DBP \> or equal to 120 * Acute End-Organ Damage
45
* How do you tx Hypertensive Urgency? (Overall Goal) * Which drug is contraindicated?
* Gradual reduction to safe levels (\<160/100) * If too rapid, can lead to: * cerebral ischemia * myocardial ischemia * MI * Sublingual Nifedipine
46
When would it be appropriate to send a patient w/ Hypertensive Urgency to the ED?
New occurence of HTN
47
What is the tx for pt w/ Hypertensive Emergency?
Hospitalized (ICU)
48

MJ- Foundations 2 Exam 2 (18 decks)

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