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Flashcards in HTN Deck (64)
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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

What is Hypertensive Urgency

SBP 180+ and/or DBP 120+
May be asymptomatic
Can be due to non-adherence to anti-HTN med or non-adherence to low sodium diet