Flashcards in HTN Deck (64)
Loading flashcards...
31
What are side effects/CI of diuretics (HCTZ)
Hypokalemia, Mg, Na
Hypercalcemia
Hyperurecemia
Dyslipidemia
Hyperglycemia**
-Contraindicated with Sulfa drugs
32
What are side effects in loop diuretics (Furosemide)
Hypokalemia/Na/Mg/Ca
Hypercholesterolemia
Glucose disturbance
--Supplement potassium!
33
What is special about loop diuretics
Poor anti-HTN med, much better as diuretic
Reserved for patients with renal dz of fluid retention
34
What are side effects/CI of K Sparing diuretics (Triamterene)
Hyperkalemia
Nephrolithiasis
Renal dysfunction
-Contraindicated in hyperkalemia, renal failure, liver Dz
35
What should you use caution combining K sparing diuretics with
Ace, Arb, DRI, K supplement
-Weak anti-HTN
36
What are side effects/CI of Aldosterone Antagonists (spironolactone)
Hyperkalemia, Gynecomastia
-Contraindicated in renal impairment, DM, hyperkalemia
37
What are the types of CCB and how do they work
Non-DHP (cardiac depressants, verapamil/Diltiazem) and DHP (selective vasodilator, nifedipine, amlodipine)
-Inhibit the influx of calcium into myocardial and smooth muscle cells= less contractile= vasodilation
-Reduce PVR
38
Who should and shouldn't use CCB
-Very effective in african american
DHP Contraindicated in acute MI or emergent HTN release
Non-DHP contraindicated in acute MI, AV block, HF, WPW, V-tach, etc
39
What are side effects of CCB
DHP- Peripheral deems, HA, flush
Non-DHP- brady, gingival hyperplasia, HF, constpation
40
What are side effects/CI of ACE inhibitors
Cough!
Hyperkalemia, angioedema, acute renal failure
-Less effective in african americans
-Contraindicated in pregnancy, angioedema, renal artery stenosis
41
Who are ACE inhibitors especially good for
patients with CKD, DM, HF, post-MI
42
What are the side effects/CI of ARB's
hyperkalemia, angioedema, acute renal failure
-Contraindicated in pregnancy and renal artery stenosis
43
What are the side effects/CI of Direct Renin Inhibitors (Aliskiren)
Hyperkalemia, hypersensitivity reactions, renal impairment
-DO NOT combine with ACE or ARB
Don't use in pregnancy
44
What are the types of BB
Cardioselective (Metoprolol, atenolol)
Non-cardioselective (Propranolol, Nadolol)
Combination non-selective: Carvedilol, Labetolol
45
What are side effects/CI of BB
-Exercise intolerance, bradycardia, fatigue, sexual dysfunction
-Do Not use in AV block, cariogenic shock, unstable HF, hypotension
Do not use if with COPD or asthma
-Caution with depression/DM
-AVOID abrupt cessation
46
What are side effects/CI in Central alpha-2 bockers
anticholinergic effects, bradycardia, dizziness
Clonidine: constipation, blurry vision
Methyldopa: hepatitis, fever, anemia
-DO NOT use methyldopa in liver disease
Avoid abrupt cessation (rebound HTN)
47
What are side effects of alpha-1 blockers
Reflex tacky, Dizzy, orthostatic hypotension
-First Dose Effect- give at night time for elderly
-Doxazosin=increased risk of HF
48
What can alpha-1 blockers be used for
treatment of BPH!
(Also HTN, PTSD, Raynauds)
49
How should you initiate treatment always
Lifestyle interventions (f/u 3-6 months depending on their numbers)
50
What treatment should you start if lifestyle modifications don't work
Pharm therapy (f/u at 1 mo)
Continue med if at goal. If not at goal, increase dose or add 2nd med
If 3+ meds don't work, consider HTN specialist referral
51
How should you monitor HTN once BP goal is met
every 3-6 months
Monitor SrCr and K+ 1-2x annually
52
What are the treatment strategies for JNC7, JNC8, and AHA/ACC
JNC7: Diuretic first, then follow indications
JNC8: THIAZ, ACE, ARB, or CCB first line (in Af. Am. Thiaz or CCB first) (In CKD, ACE or ARB first)
AHA/ACC: First line agents same as JNC8
53
What are first line pregnancy drugs
Methyldopa (central alpha agonist)
Nifedipine (CCB)
Labetolol (BB)
-Avoid ACE, ARB, DRI; known teratogenic effects
54
What CVD indicators have a poor prognosis
**LVH
Men >55, Women >65
smoking, dyslipidemia, DM, FHx premature CVD, Abd. obesity, high pulse pressure
55
What other indicators have poor prognosis
**Carotid wall thickening or plaque
**Low GFR, Microalbuminemia
**ABI <0.9 (mild marker for PAD)
Retinopathy
56
What comorbid conditions have poor outcomes
Premature CVD
HF
LVH
Ischemic stroke
Intracerebral hemorrhage
CKD/ESRD
PAD
Retinopathy
57
How can therapy benefit prognosis
Lowering BP reduces risk of:
MI, stroke, HF, CKD
58
What is Resistant HTN
failure to achieve BP goal in compliant patient with 3 drugs, including a thiazide
OR
at goal but requiring 4+ anti-HTN meds
59
What are causes of resistant BP
improper BP measurement
volume overload/retention
Med induced
obesity
excess alcohol
60
