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Flashcards in HTN Deck (45):
1

Age can increase your risk for CVD what are these ages?

Male >= 45 yo Women >= 55 yo

2

Family history can play a part in CVD risk what are these guidelines?

Family history of a premature CVD even (MI, Stent, Angioplasty....) Women

3

What are some risk factors for CVD?

HTN, Cigarette smoking Dyslipidemia DM CKD Antinflammatory disease

4

What is the leading cause of death in the US

CVD

5

Primary HTN includes? And this accounts for what percentage of HTN?

  • Idiopathic (Spontaneously)
  • Benign 
  • Essential 

 

Accounts for 90% of HTNs

6

Secondary HTN includes?

  • Renal dx 
  • hyperaldosteronism
  • RAS
  • Pheochromocytoma (Adrenal tumors)
  • Preganany - Eclempsia (Seizures that occur during pregnancy) 
  • Thyroid
  • Drugs 
  • Anemia 

7

What are the classifications of blood pressure?

A image thumb
8

What the the JNC 8 dosing guidlelines?

  • A) Start one drug, titrate to maximum dose and then add second drug
  • B) Start one drug and then add a second drug before acheiving max dose of initial
  • C) Begin with 2 drugs at the same time, either 2 separate pills or as single combo

9

What is the first recommendation per JNC 8 for the management of HTN?

for patients >=60

  • In general population >= 60 years 
  • Want to initiate treatment to lower Bp when 
    • SBP >= 150 or DBP >=90 
  • Treatment goal is to lower SBP < 150 and <90 DBP

10

What is the second recommendation per JNC 8 with patients <60? with DBP

  • Initiate pharmacologic treatment to lower bp at 90 mmHg
  • Goal is to be below DBP 90 
  • Ages 30-59 Grade A
  • 18-39 
  • Grade E, expert opinion 

11

Recommendation 3 patients <60 JNC 8 

 

Initiate pharm treament if SBP is >= 140 

Grade E 

12

Recom 4 JNC 8 >= 18 with CKD

GFR <60 

Lower BP >= 140 or DBP >= 90 

less than those 

13

JNC 8 18 or older with DM

>= 140/90 

14

General JNC 8 medication recommendation for nonback population including ones with DM

Initial Treatment?

  • Thiazide diuretics 
  • CCB
  • ACEI 
  • ARBs 
    • Grade B 

 

15

Recommendation 7 black population including DM 

Initial treatment 

Thiazide or CCB 

For general black 

Moderate B 

DM grade C 

16

Recommindation 8-9 

Patients >= 18 with CKD

Patient >= to 18 with CKD

Treatment should include an ACE and an ARB regardless of race or DM status 

If Bp goal is not reached within a month add a second drug from the recommendations from #6 

17

What were the key messages in JNC 7?

  • For those > 50 SBP is more important than DBP as a CVD risk factor 
  • Starting at 115/75 risk doubles for each increment of 20/10 
  • Those normotensive at age 55 have a 90% lifetime risk of developing HTN 
  • Certain high risk conditions are compeling indications for certain drug classes 
  • Most patients require 2 or more antihypertensive med to achieve goal 

18

Post MI patients initial therapy options?

  • BB, ACEI, Aldosterone antagonists 

19

Patients with high CAD risk shoudl use?

BB and CCBs mostly 

20

Patients with DM should use what meds?

ACE and ARBs

21

Patients with CKD should use?

ACEI, ARBS

22

What is the best choice for blacks? And what is the combination used that gives there treatment a similar effect as the nonblack populations?

Diuretics and CCBs

Thiazide + ACE is best 

23

What should pregnant patients use? 

What should be avoided?

Methyldopa, hydralazine, BBs

Avoid ACEI, ARBs, Renin-I

24

In elderly you would treat them the same as you would any patient but you should avoid?

 

Vasodilators, central a2 agonists, and a-blockers 

25

ACEIs should be avoided in patients with? 

History of angioedema 

26

Chlorthalidone is more effective than ____ and it is a?

HCTZ and is a thiazide diuretic 

Not used in patients with renal insufficiency 

27

Thiazides are best for what population? 

These are synergisitic with?

Can cause?

Black population 

Synergistic with ACE and BBs

Hypokalemia, Hyperlipidemia, Hyperglycemia, Hyperuricemia

28

Diuretics increase? what cholesterol?

LDL and TGs 

29

Potassium ___ diuretics are often used in combination with wht?

Caution should be used in patients with what insufficiency?

Caution when using with?

HCTZ

Renal insufficiency 

Caution with ACEI, ARBs and Renin-I

30

Loop diuretics are reserved for patients with?

Renal insufficiency 

31

Patients with CKD, HF, DM, post-mi, recurrent stroke should use what meds?

Who has a better response white or blacks?

ACE-I 

Whites are more response 

32

ACEI inhibitor side effects?

Contraindicated in patients with?

Caution in patients with?

Cough, hyperkalemia, 

Pregnancy, RAS, angioedema 

Renal insufficiency

33

ACE inhibitors can cause?

Hyperkalemia, Rash, Cough, Postural Hypotension, Renal Artery Stenosis

34

ARBs should be use when?

Patients should be using ACEI but it is intolerable 

Increases SCr just like ACEs

35

What types of patients should use CCBs?

Elderly, blacks, angina, PVD, Migraine px 

Added to diuretics 

36

Dihydropyrodines are more potent at what?

Lowering Bp and angina

37

What are some adverse effects of dihydropyridines? Like amlodipine

  • All CCBs cause headache, dizziness, postural hypotension 
  • Dihydros cause
    • GERD, Edema, Flushing, Reflex tachycardia

38

BBs should be used in patients with? what color

  • Whites
  • CHD
  • A-fib
  • Migraine
  • Post-MI
  • Anxious
  • Tachycardia

39

BBs can cause what AEs and when should they be stopped?

  • Fatigue
  • Insomnia/weird dreams
  • Depression 
  • Should not be stopped abruptly 

40

Aliskirenin is a?

Renin Inhibitor

41

Alpha 1 blockers?

Used in patients with?

Doxazosin and Terazosin

HTN, BPH, and Lipid abnormalities

42

Alpha 2 agonists like methyldopa should be used in patients ewith?

Pregnant patients , add on therapy, 

43

What drugs can exacerbate HTN?

My Bp was exacerbated when I started taking birthcontrol. I also take ibuprofen all the time and drink 32 beers a day. I chew, drink energy drinks. I just started using steroids and I copy my mom all the time, I just got a transplant and have been having a lot of nerve pain veins 

  • Oral contraceptives
  • NSAIDs
  • Caffiene, Nicotine
  • Sympathomimetics
  • MAO I 
  • Steroids
  • Cyclosporine
  • ETOH
  • Venlafaxine

44

What is a HTN emergency?

Want to decrease Bp fast but gradually 

positive target organ damage

IV meds

45

Urgencies are?

Po meds 

negative target organ damage 

Ambulatory setting