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AC-AGNP I > HTN and Lipidemia > Flashcards

HTN and Lipidemia Flashcards

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1
Q

What is the definition of HTN

A

SBP is 140 mmHg or higher and/or DBP is 90 mm Hg or higher

following repeated examination (2-3 office visits 1-4 week intervals, out of office BP measurements preferred)

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2
Q

When can HTN be diagnosed at a single office visit

A

if BP is 180/110 mm Hg or higher and evidence of CVD

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3
Q

idiopathic form of HTN, genetic predisposition, environmental factors

A

primary HTN

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4
Q

form of HTN with identifiable cause - suspect in patients who are below 30 years of age, resistant HTN and/or malignant HTN

A

secondary HTN

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5
Q

malignant HTN

A

hypertensive emergency characterized by presence of severe BP elevation (usually >200/120 mm Hg) and advanced retinopathy, defined as bilateral presence of flame‐shaped hemorrhages, cotton wool spots, or papilledema.

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6
Q

common causes of secondary HTN

A

renovascular disease, OSA, hypothyroidism/hyperthyroidism, cushing syndrome, primary aldosteroism, pheochromocytoma (adrenal tumor), coarctation of aorta, drug or alcohol induced

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7
Q

screening for secondary HTN

A

drug resistant HTN? new onset of hTN? adding more hypertensives to previously controlled? below 30 years of age? malignant Htn? disproportionate target organ damage for degree of HTN (retinopathy, stroke, LVH, pulmonary edema, etc)? onset of diastolic HTN in older adults? unprovoked or excessive hypokalemia

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8
Q

common medication/substances that can cause secondary HTN

A

alcohol, amphetamines, antidepressants (MAOIs, TCA, SNRI) caffeine, NSAIDS, atypical antipsychotics (clozapine, olanzapine), st johns wort, decongestants, immunosuppressants (cyclosporine), oral contraceptives, cocaine, bath salts, corticosteroids, nicotine replacement therapy, withdrawal (beta blocker withdrawal, etc)

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9
Q

First 4 classes of drugs for HTN treatment (no compelling indications, no sign of organ issues)

A

ACE inhibitors, ARBs, DHP-CCBs, thiazide direutics

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10
Q

Step 1 of treatment of essential HTN

A

ACE/ARB and a CCB

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11
Q

Step 2 treatment of essential HTN

A

increase dose of ACE and CCB

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12
Q

Step 3 treatment of essential HTN

A

ACE/ ARB, CCB at increased dosages and add thiazide

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13
Q

Step 4 treatment of essential HTN

A

ACE/ARB, CCB, thiazide, add spironolactone or other agents depending on comorbities

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14
Q

blood pressure goals

A

< 130 / 80 mmHg (except for elderly patients) – control within 3 month of pharmacological intervention

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15
Q

What meds to start for HTN in patients with heart failure

A

ACE/ARB, spirnolactone, and beta blocker

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16
Q

What meds to start for HTN in patients with MI/CAD

A

ACE/ARB, beta blocker (add CCB for angina)what

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17
Q

what meds to start for HTN in patients with DM

A

ACE/ARB for first line reduce albuminuria (renal protector)

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18
Q

What meds to start for HTN for patients with CKD

A

ACE/ARB reduce albuminuria

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19
Q

Considerations for ethnicity in treating HTN

A

black populations need to be started on two agents right away given resistance to HTN treatment; thiazide and CCB (or CCB and ARBs but consider angioedema)

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20
Q

first choices for HTN treatment in pregnant patients

A

CCB (nifedipine)
beta blockers (in first trimester)

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21
Q

ACE inhibitors (prils) - MOA

A

prevent conversion of angiotensin I to II (which stimulates aldosterone and increases Na and water absorption and vasoconstriction ) – decreased Na/H2o retention and decreased peripheral resistance

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22
Q

ACE inhibitor& ARBs - side effects

A

dry cough - more so with ACE (1-2 weeks after initaiton - can switch to ARBs)
monitor for hypokalemia (especially on potassium sparing diuretics, RAS)
risk of ARF in patients with RAS
do not use WITH arbs/direct renin inhibitors
contraindicated in patients with history of angioedema with ACEI
avoid in pregnancy

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23
Q

ARBs (sartans) - MOA

A

directly inhibit angiotensin II

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24
Q

calcium channel blockers

A

inhibit L type calcium channel in cells

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25
CCB: Dihydropyridines (-dipines)
potent vasodilator, do not affect cardiac contractility pedal edema common side effect avoid in heart failure /reduced EF as it causes refractory tachycardia (except for amolodipine and felodipine)
26
Which DHP -CCB can be used in HF patients
amlodopine and felodipine
27
Nondihydropyridines CCB (diltiazem, verapimil)
directly affect cardiac muscle reduce proteinuria constipation common side effect causes bradycardia, reduces CO
28
nondihydropyridines CCB (diltiazem, verapamil) are contraindicated in which patients
not used in heart failure / low EF/ sick sinus syndrome and heart blocks
29
Thiazide diuretics (Chlorathidone **, HCTZ, indapamide, metolazone)
decrease water and sodium reabsorption monitor for hyponatremia and hypokalemia use with caution in gout
30
why use thiazide with ACE inhibitors
ACE inhibitors retain potassium so counteracts hypokalemia affect of thiazide
31
aldosterone antagonists (spironolactone)
preferred agents in primary aldoesteronism add ons for stage IV HTN, and HF monitor for hyperkalemia gynecomastia and impotence***
32
beta blockers - indications, MOA, SEs
reserved for post MI/CHF/AF/pregnancy reduce heart and contractility not first line for HTN SEs - fatigue, bradycardia, increase glucose (can mask hypoglycemic awareness)
33
cardioselective B blockers (only work on beta 1)
beta 1 - those with asthma/COPD atenolol, betaxolol, bisoprolol, metoprolol
34
combined alpha and beta blockers
carvedilol and labetolol (often used in ICU settings) - very hypertensive patients
35
Non cardioselective beta blockers
nadolol, propranolol
36
beta blockers for HF
metoprolol, labetolol, bisoprolol
37
direct renin inhibitors (aliskiren)
SEs - RAS, hyperkalemia avoid in pregnancy do not use in combination with ACEI or ARBs
38
Vasodilators (-zosin)
add ons for BPH with HTN specifically for orthostasis so prescribed overnight
39
hydralazine (vasodilator)
stimulates nO production in endothelial cells SEs- fluid retention, reflex tachycardia (not good for patients with cardiac issues/HF)
40
minoxidil (vasodilator)
SEs- reflex tachycardia, fluid retention **used with resistant HTN, use with diuretic and beta blocker
41
Clonidine
last line treatment for HTN resistant HTN CNS side effects - need to wean to avoid HTN crisism
42
methyldopa
for pregnant patients
43
Loop direutics (-mides) when preferred?
symptomatic CHF replaces thiazide moderated to severe CKD with GFR of less than 30
44
Pharmacological approach to refractory HTN
HTN maintained on 4 meds; rule out reasons for secondary HTN maximize direuetic therapy --> add mineralcorticosteroid receptor antagonist (i.e. spirnolactone) add other agents with different mechanisms of action (SVR, preload, contractility/HR with beta blocker or CCB, etc) use loop diuretics with CKD or patients on minoxidil
45
HTN emergency vs HTN urgency
elevated HTn (SBP >180, DBP >120) with signs of TOD urgency - severe elevation in bP without acute TOD
46
Reduction of HBP in aortic dissection
rapid reduction in BP to SBP <120 mm Hg within 20 minutes; beta blockade first --> esmolol, labetalol
47
Reduction of HBP in acute pulmonary edema
clevidipine, nitro, nitroprusside --> BETA BLOCKERS CONTRINDICATED!!; diuretics
48
Reduction of HBP in ACS
esmolol, labetalol, nicardipine, nitro
49
Reduction of. HBP in acute renal failure
acute hypertensive hephrosclerosis proteinura, hematura, elevated creat clevidipine, fenoldopam, nicardipine
50
Reduction of HBP in eclampsia
rapid lowering of SBP <140 in 1st hour hydralazine, labetalol, nicardipine CONTRAINDICATED - ACE/ARB/ Renin I/ SNP
51
Reduction of HBP in acute ICH (less than 6 hours from onset)
reasonable to streat SBP > 220 with continous IV infusion with close BP monitoring Keep SBP < 150 labetalol, nicardipine, clevidipine
52
Management of HBP in acute ischemic stroke
bp is NOT lowered unless it is >185/100 in candidiates for reperfusion tx or 220/120 for those who are not candidates labetalol, nicardipine, clevidipine
53
Management of HBP in phemochromocytoma
rapid lowering of SBP <140 1st hour clevidipine, nicardipine, phentolamine
54
management of HBP due to ingestion of cocaine, amphetamines, tyramine with MAOIs
phentolamine, nitroprusside beta blockers contraindicated due to unopposed alphra-adrenergic vasoconstriction
55
Management of HBP due to severe autonomic dysfunction (guillian barre, acute spinal cord injury)
nitroprusside, phentolamine Beta blockers contraindicated
56
Management of HBP due to HTN agent withdrawal
happens usually with beta blockers and clonidine treatment includes reinstating agent, short acting IV initially
57
who goes straight to high intensity statin regimen
hx of heart disease, 40-75 years, LDL >190, dx DM or risk of CAD; risk greater than 7.5 % on 10 year risk
58
what should someone on statins avoid
grapefruit juice - can decrease breakdown of statins in blood and lead to higher side effects
59
initial labs before statin therapy
lipid panel, lft's, bmp ; lipid panel every 6 weeks after therapy and adjusting dosage and then every 4 months
60
what HTN medication for those with renal disease/kidney dysfunction
ACE/ARB
61
lovaza (omega 3 fatty acid) - dose? when to take? indication? caution?
4 g daily or BID with meals for severe (OTC fish oils hypertriglyceridemia caution in those with fish or shellfish allergy, heptic impairment, bleeding risk
62
fibrates (gemfibrozil, fenofibrate, clofibrate) - indications?
hypertriglyceridemia, hyper cholesteremia, mixed disylipidemia
63
what drug should be added to statin therapy for high risk patients before considering a pck 9 inhibitor
ezetimbie
64
when should a lipid panel be repeated after initiating therapy? how often are the panels repeated until levels are controlled? when control is achieved, how often do you repeat lipid panel
4-6 weeks repeat every 3-4 months every 6-12 months after control achieved
65
PCSK9 inhibitors
alirocumab, evolocumab
66

AC-AGNP I (1 decks)

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