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Pharmacology Spring 2021 > Hypertension: Part 1 > Flashcards

Hypertension: Part 1 Flashcards

1
Q

Evidence based guidelines are…

A

Indispensable (necessary)

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2
Q

What assist clinicians in providing the most effective care for clients?

A

Evidence based guidelines

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3
Q

What does JNC stand for?

A

Joint National Committee

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4
Q

How many JNC are there?

A

JNC 8

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5
Q

What did the JNC 8 do?

A

Issued a highly anticipated guideline HTN

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6
Q

When was the JNC 8 initially appointed?

A

2008

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7
Q

Who appointed the JNC 8?

A

National Heart, Lung, & Blood Institute

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8
Q

What event happened that prompted the JNC 8 and the American Society of Hypertension & the International Society of Hypertension to create their own guidelines?

A

The National Institutes of Health discontinued sponsorship of clinical recommendations

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9
Q

What guideline did the JNC 8 create after the National Institutes of Health discontinued sponsorship of clinical recommendations?

A

Guideline on management of hypertension

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10
Q

Where did the JNC 8 publish their guideline on management of hypertension?

A

Journal of the American Medical Association

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11
Q

When did the JNC 8 publish their Guideline on management of hypertension in the Journal of the American Medical Association?

A

The same week that the American Society of Hypertension & the International Society of Hypertension released their guideline.

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12
Q

Who did not endorse the JNC 8 Guideline on management of hypertension?

A
  1. American Heart Association

2. American College of Cardiology

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13
Q

Who makes up the JNC 8?

A

panel members

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14
Q

What study material is made based on these guidelines?

A

The two charts that we reviewed. SEE CHARTS.

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15
Q

What do guidelines do for all practitioners?

A
  1. allow us to all provide the same care for out clients by basing our practice on the same guidelines.
  2. If in court we can say we made a decision based on guidelines
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16
Q

What types of questions could a practitioner be asked in court that can be answered based on the guidelines?

A
  1. why did you do that?
  2. why did you put the patient on that medication?
  3. why did you order that diagnostic procedure?
  4. why did/didn’t you refer that patient?
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17
Q

What answer does not hold up in court when asked these questions?

A

I thought it was a good idea…

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18
Q

What is the most important preventable contributors to disease & death in the US?

A

HTN

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19
Q

HTN leads to _1__, __2__, and __3__, __4__ and more when __5___ & __6___ occur.

A
  1. MI
  2. stroke
  3. RF
  4. Blindness
  5. not detected early
  6. treated appropriately
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20
Q

What did the JNC 8 guideline on HTN cover?

A
  1. treatment thresholds
  2. goals
  3. medications
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21
Q

What year were these updated guideline released?

A

2014

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22
Q

What population does the JNC 8 guideline for HTN cover?

A

Adults

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23
Q

What are the most current HTN guidelines?

A

2017 ACC/AHA&JNC-8

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24
Q

How do the updated JNC 8 guidelines differ from the JNC 7 guidelines?

A
  1. more evidence-based
  2. use more “relaxed” thresholds for treatment
  3. attempt to simplify antihypertensive care
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25
Q

What is the official names of the updated HTN guideline created by the JNC 8?

A

2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)

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26
Q

Who should be most familiar with any changes in guidelines and why?

A
  1. ACLS or CPR providers

2. Need to know what is best for patient

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27
Q

What does ASCVD stand for?

A

Atherosclerotic cardiovascular disease

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28
Q

Top 10 Take-Home Messages for the Primary Prevention of Cardiovascular Disease

A
  1. to promote a healthy lifestyle throughout life
  2. team-based care approach
  3. Adults 40-75 yrs old & are being evaluated for CVD prevention should undergo 10-yr ASCVD risk estimation & have a clinician–client risk discussion before starting pharmacological therapy, such as anti HTN therapy, a statin, or ASA
  4. healthy diet
  5. physical activity
  6. DMT2- metformin is 1st line therapy
  7. assessed at every healthcare visit for tobacco use
  8. Aspirin should be used infrequently in the routine primary prevention of ASCVD
  9. Statin therapy is 1st line treatment for elevated LDL, DM, 40-70 yrs
  10. Nonpharmacological interventions are recommended for all adults with elevated BP or HTN. For those requiring pharmacological therapy, the target blood pressure should generally be <130/80.
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29
Q

What is VERY important to remember from the 10 take home messages for Primary Prevention of Cardiovascular Disease?

A

DMT2- metformin is 1st line therapy (oral)

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30
Q

When asking a patient about tobacco use what is important to keep in mind?

A

Not just cigarettes! Can be chewing, vape, hookah, cigar, pipe, etc…

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31
Q

What not to ask when assessing if a patient uses tobacco? why?

A

Are you a smoker? (bc they could use in another way or have just quit yesterday)

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32
Q

When is aspirin used in cardiac treatment?

A

CAD or MI

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33
Q

Why is aspirin NOT used in primary prevention of ASCVD anymore?

A
  1. lack of net benefit

2. can cause bleeding

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34
Q

How are the JNC 8 and the ANA/ACC guidelines similar? how are they different?

A
  1. the numbers are the same

2. category names are different

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35
Q

What are the categories of HTN according to the JNC 8?

A
  1. Normal
  2. Prehypertension
  3. HTN stage 1
  4. HTN stage 2
  5. Hypertensive crisis
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36
Q

What are the categories of HTN according to the ANA/ACC?

A
  1. normal
  2. elevated
  3. stage 1
  4. stage 2
  5. hypertensive crisis
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37
Q

JNC 8 HTN category parameters

A
  1. < 120 and < 80 (normal)
  2. > 120 or > 80 (pre)
  3. > 140 or > 90 (S1)
  4. > 160 or > 100 (S2)
  5. > 180 or > 110 (crisis)
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38
Q

What does the JNC suggest a person do when in hypertensive crisis?

A

Emergency care

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39
Q

AHA/ACC HTN category parameters

A
  1. < 120 and < 80 (normal)
  2. > 120 and < 80 (elevated)
  3. > 130 or > 80 (S1)
  4. > 140 or > 90 (S2)
  5. > 180 and/or > 120 (crisis)
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40
Q

What does the AHA/ACC suggest a person do when in hypertensive crisis?

A

Consult doctor immediately

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41
Q

What are thiazides categorized as? How do they work?

A
  1. Diuretics

2. rid your body of sodium and H2O

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42
Q

What does CCBs stand for?

A

Calcium Channel Blockers

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43
Q

What does ACEIs stand for?

A

Angiotensin Converting Enzyme Inhibitors

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44
Q

What does ARBs stand for?

A

Angiotensin Receptor Blocker

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45
Q

What drugs are recommended to be prescribed to the general non black population for HTN initially (JNC 8)?

A
  1. Thiazides
  2. CCBs
  3. ACEIs
  4. ARBs
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46
Q

What drugs are recommended to be prescribed to the general black population for HTN initially (JNC 8)?

A
  1. Thiazides

2. CCBs

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47
Q

What drugs are recommended to be prescribed to CKD patients for HTN (JNC 8)?

A
  1. ACEIs

2. ARBs

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48
Q

If initial treatment does not achieve BP goal by ___ , the treatment is changed.

A

one month

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49
Q

If initial treatment does not achieve BP goal__1__ or _2___ should be done.

A
  1. up titrate current medication

2. add therapy

50
Q

Which HTN medications should not be prescribed at the same time?

A
  1. ACEIs and ARBs

2. HF clients

51
Q

Are ACEIs and ARBs ever prescribed together?

A

Occasionally

52
Q

When is it okay to be prescribed ACEIs and ARBs together?

A

In HF clients

53
Q

Who would prescribe an ACEIs and ARBs together? Who would not?

A

A HF physician

54
Q

Who would not prescribe an ACEIs and ARBs together?

A

NPs

55
Q

Why would a heart failure physician prescribe an ACEI and ARB together?

A

ACEIs are one of the initial drugs used to treat heart failure

56
Q

When would a heart failure patient NOT be prescribed an ACEI initially?

A

If the client is in fluid overload

57
Q

If a heart failure patient is in fluid overload what medication is prescribed initially? (generic name and brand name)

A

furosemide (Lasix)

58
Q

If a heart failure patient is NOT in fluid overload what medications would be prescribed initially?

A
  1. ACEIs

2. Beta-blockers

59
Q

If after initial treatment if an additional medication therapy is already added and BP goal is still not achieved what should be done?

A

Refer to a HTN specialist

60
Q

What are examples of thiazides?

A
  1. hydrochlorothiazide

2. chlorthalidone

61
Q

What HTN medication is first line? Why?

A
  1. thiazides
  2. cheap
  3. minimal side effects
  4. old and well studied
62
Q

Why would you initially start a general non black or CKD patient off on a ACEIs rather than an ARBs?

A

cheaper

63
Q

What generation are ARBs?

A

second

64
Q

What is the major side effect that happens with ACEIs? What should a prescriber do if a patient has this side effect? Why?

A
  1. cough
  2. switch them to an ARBs
  3. bc ARBs don’t cause cough as a side effect
65
Q

Should a provider start by prescribing thiazides or CCBs to the general black population?

A

They can start with either

66
Q

What are the positives to each initial medication prescribed to the general black population?

A
  1. thiazides: cheap

2. CCBs: studies on black men have have shown these clients have more resistant HTN (r/t genetic makeup)

67
Q

In patients with CKD why would we start with ACEIs and ARBs? why not thiazides?

A
  1. ACEIs and ARBs can be renal protective

2. Thiazides are harsh on kidneys

68
Q

What does renal protective mean?

A

Supports kidney function

69
Q

In CKD patients what lab values will be monitored?

A
  1. BUN

2. Creatinine

70
Q

What could occur in CKD clients prescribed HTN medications? Which ones run a higher risk of this?

A
  1. electrolyte imbalance

2. Thiazides and CCBs

71
Q

Which electrolyte should we be monitoring for imbalances in CKD patients prescribed HTN medications?

A

potassium

72
Q

Is it possible for a patient to to have HTN that cannot be controlled? What causes this?

A
  1. Yes

2. Certain conditions cause this

73
Q

If a prescriber has tried to control a patients HTN without success what should they do?

A

Test for the conditions that cause HTN that cannot be controlled

  1. Renal Artery Stenosis patients
  2. Pheochromocytoma patients
74
Q

Which conditions cause HTN that cannot be controlled?

A
  1. Renal Artery Stenosis

2. Pheochromocytoma

75
Q

What is Pheochromocytoma?

A

Tumor on the adrenal glands

76
Q

As a NP, if you are unable to get a patients blood pressure under control what is important to do? Why?

A
  1. Refer sooner than later

2. Avoid complications

77
Q

Example Patient:

  1. Diabetes: No
  2. CKD: No
  3. Age: 60+
  4. Race: non black
  5. What should their BP goal be?
  6. Which HTN medications could you prescribe?
  7. Would you prescribe the medication alone, in combination, or with other drugs?
A
  1. < 150 and < 90
  2. Thiazide, CCB, ACEI, ARB
  3. alone OR in combo
78
Q

Example Patient:

  1. Diabetes: No
  2. CKD: No
  3. Age: 60+
  4. Race: black
  5. What should their BP goal be?
  6. Which HTN medications could you prescribe?
  7. Would you prescribe the medication alone, in combination, or with other drugs?
A
  1. < 150 and < 90
  2. Thiazide, CCB
  3. alone OR in combo
79
Q

Example Patient:

  1. Diabetes: No
  2. CKD: No
  3. Age: < 60
  4. Race: non black
  5. What should their BP goal be?
  6. Which HTN medications could you prescribe?
  7. Would you prescribe the medication alone, in combination, or with other drugs?
A
  1. < 140 and < 90
  2. Thiazide, CCB, ACEI, ARB
  3. alone OR in combo
80
Q

Example Patient:

  1. Diabetes: No
  2. CKD: No
  3. Age: < 60
  4. Race: black
  5. What should their BP goal be?
  6. Which HTN medications could you prescribe?
  7. Would you prescribe the medication alone, in combination, or with other drugs?
A
  1. < 140 and < 90
  2. Thiazide, CCB
  3. alone OR in combo
81
Q

Example Patient:

  1. Diabetes: Yes
  2. CKD: No
  3. Age: any age
  4. Race: non black
  5. What should their BP goal be?
  6. Which HTN medications could you prescribe?
  7. Would you prescribe the medication alone, in combination, or with other drugs?
A
  1. < 140 and < 90
  2. Thiazide, CCB, ACEI, ARB
  3. alone OR in combo
82
Q

Example Patient:

  1. Diabetes: No
  2. CKD: Yes
  3. Age: any age
  4. Race: any race
  5. What should their BP goal be?
  6. Which HTN medications could you prescribe?
  7. Would you prescribe the medication alone, in combination, or with other drugs?
A
  1. < 140 and < 90
  2. ACEI, ARB
  3. alone OR with other drugs
83
Q

Example Patient:

  1. Diabetes: Yes
  2. CKD: Yes
  3. Age: any age
  4. Race: any race
  5. What should their BP goal be?
  6. Which HTN medications could you prescribe?
  7. Would you prescribe the medication alone, in combination, or with other drugs?
A
  1. < 140 and < 90
  2. ACEI, ARB
  3. alone OR with other drugs
84
Q

What does SPRINT study stand for?

A

Systolic Blood Pressure Intervention Trial

85
Q

How many participants were included in the SPRINT study?

A

9,361

86
Q

What factors were considered when choosing participants for the SPRINT study?

A
  1. Age
  2. BP
  3. Number of cardiovascular disease risk factors
87
Q

What were the SPRINT study’s participant requirements:

  1. Age
  2. BP
  3. Number of cardiovascular disease risk factors
A
  1. 50+
  2. systolic > 130
  3. 1+
88
Q

How many SPRINT study participants were 75+ ?

A

28%

89
Q

How many SPRINT study participants had CKD?

A

28%

90
Q

Who monitored the SPRINT study?

A

An independent Data & Safety Monitoring Board

91
Q

What was the responsibility of the The SPRINT study’s independent Data & Safety Monitoring Board?

A

To perform interim analyses of:

  1. Study results
  2. Adverse events
92
Q

What was was the SPRINT study’s independent Data & Safety Monitoring Board looking for when performing their responsibility?

A

Any indication that one treatment group’s results were superior to the other group

93
Q

Did the SPRINT study’s
independent Data & Safety Monitoring Board find any indication that one treatment group’s results were superior to the other groups?

If so, WHEN were indications identified and WHAT were they?

A
  1. Yes
  2. Before the study was planned to be completed
  3. Indications that participants being treated for target systolic BP of < 120 had better health outcomes
94
Q

The SPRINT study’s
independent Data & Safety Monitoring Board found that the subjects treated for target systolic BP of < 120 had what outcomes?

A

Reduced:

  1. cardiovascular events
  2. overall risk of death
95
Q

Were the SPRINT study’s independent Data & Safety Monitoring Board’s findings clear?

A

Yes, very clear

96
Q

What did independent Data & Safety Monitoring Board advise to happen to the SPRINT study after identifying their findings?

A

That the study be stopped early

97
Q

The independent Data & Safety Monitoring Board advised on how to proceed with The SPRINT study once their findings were identified. Why were these recommendations made?

A

So participants in the groups NOT being treated for target systolic BP of < 120 could be treated using new info and avoid complications

98
Q

Did the SPRINT study accept the recommendations on how to proceed with the study based on the findings identified by the independent Data & Safety Monitoring Board?

A

Yes

99
Q

The SPRINT study determined that __1__ systolic BP resulted in reduced __2__ and reduced__3___.

A
  1. lower
  2. cardiovascular events
  3. overall risk of death
100
Q

The SPRINT study determined that lowering the systolic BP to the target of < 120 reduced cardiovascular event occurrence by how much?

A

25%

101
Q

Did The SPRINT study determine that lowering the systolic BP to the target of < 120 reduced cardiovascular event occurrence in participants with CKD?

A

Yes

102
Q

Did The SPRINT study determine that lowering the systolic BP to the target of < 120 reduced overall risk of death in participants who had CKD?

A

Yes

103
Q

The SPRINT study’s findings helped to form what?

A

2017 AHA & ACC high BP clinical guidelines

104
Q

Once The SPRINT study was completed and its findings were published did any follow up research occur?

If so/not, what was done?

A
  1. Yes

2. A new study was formed

105
Q

The study that was formed based on The SPRINT study’s findings was referred to as ____.

A

The SPRINT MIND trial

106
Q

The SPRINT MIND trial used _____ derived from The SPRINT study to form its hypothesis.

A

preliminary results

107
Q

The SPRINT MIND trial hypothesized that:

Adults with increased risk for __1__ but without __2___ treated to a systolic BP target less than __3___ as compared to __4__ MAY reduce the risk of ___5___, and ___6___.

A
  1. CVD
  2. DM
  3. 120
  4. 140
  5. MCI
  6. Dementia
108
Q

What does MCI stand for?

A

mild cognitive impairment

109
Q

When was The SPRINT MIND trial’s hypothesis presented?

A

June 25, 2018

110
Q

What was The SPRINT MIND trial’s hypothesis presented at?

A

The Alzheimer’s Association International Conference

111
Q

Where was The SPRINT MIND trial’s hypothesis presented?

A

Chicago

112
Q

The SPRINT MIND trial’s findings concluded that:

Among ambulatory adults with ___1___, treating to an systolic BP goal of less than 120 vs. 140 __2__ [did/did not] result in a significant reduction in the risk of ___3____.

A
  1. HTN
  2. did not
  3. probable dementia
113
Q

How were the findings of the SPRINT MIND trial presented?

A

They were published

114
Q

When were the findings of the SPRINT MIND trial presented?

A

Jan. 28, 2019

115
Q

Where were the findings of the SPRINT MIND trial presented?

A

The Journal of the American Medical Association

116
Q

Once The SPRINT MIND trial was completed and its findings were published did any follow up research occur?

If so/not, what was done?

A
  1. No

2. A new hypothesis was created based on The SPRINT MIND trial’s findings

117
Q

As a follow to the The SPRINT MIND trial it was up hypothesized that:

Due to __1___ and ___2__ the study may have been __3___ for this __4___.

A
  1. early study termination
  2. fewer than expected cases of dementia
  3. underpowered
  4. endpoint
118
Q

The hypothesis created following The SPRINT MIND trial’s conclusion could be used for what?

A

Follow up research in future studies

119
Q

What information could be found using the hypothesis created following The SPRINT MIND trial’s conclusion?

A

It could prove the The SPRINT MIND trial’s hypothesis is actually significant or it is not.

120
Q

What is important to do as a practitioner/prescriber to get the best results for your clients?

A

Keep up to date on new study findings.

Pharmacology Spring 2021 (22 decks)

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