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Integrated Drug Structure, Function, and Therapeutics Winter Term > Hypertension Therapeutics - Dr. Singh > Flashcards

Hypertension Therapeutics - Dr. Singh Flashcards

1
Q

What are the blood pressure goals for a diabetic person age 40?

A

< 140/90

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2
Q

What are the blood pressure goals for someone age 65, without diabetes?

A

< 150/90

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3
Q

What are the blood pressure goals for someone age 70 with diabetes?

A

< 140/90

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4
Q

What are the blood pressure goals for someone with chronic kidney disease, any age?

A

< 140/90

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5
Q

How are the JNC -7 and 8 guideline different?

A

There is no cutoff for the elderly w/o diabetes/kidney disease (still 140/90 is goal in JNC -7). The BP goals for diabetes and kidney disease patients in JNC-7 were also more aggressive. JNC-8 more lenient.

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6
Q

What is a hypertensive crisis?

A

180/120

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7
Q

What is resistance hypertension?

A

4 or more drugs for BP, regardless of BP
OR
3 different classes of BP meds, one of them being a diuretic, for 140/90

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8
Q

How do you manage hypertension in pediatric populations?

A

95 percentile

all classes, no ACE’s and ARBS for sexually active girls

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9
Q

How do you manage hypertension for a pregnant woman?

A

Not ACE’s, not ARBs

Methyldopa (beta blockers, except for atenolol)

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10
Q

What does the mean arterial pressure tell us?

A

It tells us about organ perfusion. It is a measure of SBP x 1/3 plus DBP x 2/3. If the number is below 70, then we need to worry about organ perfusion.

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11
Q

What increases stroke volume?

A

Contractility and preload

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12
Q

What decreases stroke volume?

A

Afterload

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13
Q

What did the ACCORD trial find?

A

That intensive and non-intensive treatments in diabetes patients had the same results, except in non-fatal stroke (where intensive therapy was more useful)

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14
Q

What is a difference in the JNC-8 guidelines compared to CHEP guidelines?

A

CHEP is more severe for diabetes (130/80) and more severe for the elderly (after age 80, it is 150/90)

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15
Q

Do beta-blockers have a big place in anti-hypertensive therapy?

A

No.

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16
Q

What are the different recommendations based upon white or African American race?

A

Non-African American: Thiazide, ACE, ARB, CCB

African American: Thiazide, CCB

17
Q

When is the main time that we use loop diuretics?

A

To get rid of fluid

18
Q

in small white females, hyponatremia is often seen as a side effect of which medication?

A

Thiazide diuretics

19
Q

As GFR decreases, what lab value goes up?

A

There is a bump in SrCr. After kidneys normalize, SrCr goes down.

20
Q

How do you manage hypertension for someone with chronic kidney disease?

A

ARBs

21
Q

How do you manage hypertension for someone who has had a stroke?

A

ARBs

22
Q

If someone has had angioedema with an ACE inhibitor, what medication should they try next?

A

Not an ARB - same risk!

23
Q

How do you manage hypertension for someone with chronic kidney disease?

A

ACE I’s

24
Q

How do you manage hypertension for someone who has had a stroke?

A

ACE I’s

25
Q

If someone has had angioedema with an ACE inhibitor, what medication should they try next?

A

Not an ARB - same risk!

26
Q

How do you manage hypertension for someone with T2DM with nephropathy?

A

ARBs

27
Q

What do CCB cause on smooth muscle?

A

They inhibit contraction, and so cause relaxation of smooth muscles.

28
Q

What are the non-dihydropyrides, and when are they contraindicated? Which is a more potent vasodilator? Which has a side effect of constipation? What enzyme do they inhibit?

A

Verapamil and diltiazem. They can worsen heart failure. Diltiazem is a more potent vasodilator, and verapamil can cause constipation. Inhibit 3A4 metabolism.

29
Q

What did the ALLHAT trial find?
Lowering of systolic BP
Lowering of DBP

A

Basically, that thiazides should be drug of choice for HTN
SBP - chlorthalidone lowered the most
DBP - amlodipine lowered the most
Less stroke in chlorthalidone group vs lisinopril
Chlorthalidone better in black vs. non-black population overall
Chlorthalidone was better in both black and non-black populations in new-onset heart failure.
Decreased rates of combined cardiovascular disease and stroke vs. lisinopril.

30
Q

What are the dihydropyridines? How do you change the dose when taking simvastatin?

A

Amlodipine and nifedipine. There is 3A4 inhibition, so cannot take a dose of simvastin higher than 20mg with 10mg amlodipine daily.

31
Q

What did the ACCOMPLISH trial find?

A

They found that benazepril and amlodipine were better than benazepril and HCTZ, but they should have used chlorthalidone.

32
Q

When would you use a beta-blocker? SE’s problems? CI’s?

A

Heart failure, MI, coronary artery disease. SE’s should get better over time (empower patient)
Should not use beta-blocker for bradycardia, uncontrolled asthma or COPD (reactive component), cariogenic shock, or heart block

33
Q

What did the LIFE trial find?

A

losartan superior to atenolol

Integrated Drug Structure, Function, and Therapeutics Winter Term (18 decks)

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