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Flashcards in Resistant HTN Deck (84)
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1

What is resistant HTN?

When you have tried 3 different BP meds at max dose and are still hypertensive

2

Normal BP?

Under 120/80

3

Pre-HTN?

120-139 OR 80-89

4

Stage 1 HTN?

140-159 OR 90-99

5

Stage 2 HTN?

Over 160 OR over 100

6

What is the BP goal in average population?

140/90

7

What conditions turn the goal BP into 130/80?

Kidney disease, heart disease, or diabetes

8

What is the most common form of HTN?

Essential HTN

9

If your patient doesn't have essential HTN, what's the next most likely cause?

Renal HTN

10

If your patient has HTN, what do you do first?

Lifestyle modifications

11

Is weight reduction good for lowering BP?

Not so much...although it's good for overall health, weight reduction doesn't have a direct effect on lowering BP

12

How does exercise help lower BP?

It reduces vascular tone

13

If life style modifications didn't work and your patient has Stage 1 HTN, what is the 1st drug you should give?

Either a diuretic (thiazide-type) or beta blocker

14

If your patient has chronic kidney disease (stage 3 or lower) or diabetes, what should your first-line drug be for Stage 1 HTN?

ACEi or ARB

15

If your patient presents with Stage 2 HTN, what will you do?

Give 2 drugs...thiazide diuretic and and another drug (usually beta-blocker)

16

Which drug class shows decreased mortality in patients with CHF or CAD?

Beta blockers

17

So if your patient has CHF and CAD and is HTN, what do you give them?

Probably go with a diuretic and beta blocker, if they have CHF too, possibly consider ACEi as well

18

If the first drug you prescribed was a beta blocker for your HTN patient, and they still aren't at their goal, what should be the 2nd drug you add?

DIURETIC

19

Why is it so important to have diuretics on board to treat HTN?

Because a diuretic will decrease Na/Volume which will activate the RAA system, which then will let your ACEi/ARB come in and work more effectively to squash it
-Basically, diuretics make the other BP meds more effective

20

When would you prescribe a CCB for HTN and why?

In situations where the patient is allergic to other drugs...CCV don't have a benefit in mortality and are really only to be used as supplements once the other drugs have been tried

21

What stages of kidney disease can ACEi and ARB be used in?

Anything stage 3 or lower

22

Why can't ACEi or ARB be used in Stage 4 or Stage 5 kidney disease?

Because they block RAA and can block perfusion to the kidney resulting in a decrease in GFR in a kidney that already has a low GFR leading to acute kidney failure

23

What condition do you not give ACEi or ARB to a patient due to the risk of triggering acute kidney failure?

Bilateral renal artery stenosis

24

GFR in Stage 3 kidney disease?

Under 60

25

GFR in Stage 4 kidney disease?

Under 30

26

GFR in Stage 5 kidney disease?

Under 15 --> They need dialysis

27

What drug class is given more often to patients with HTN and Type I diabetes?

ACEi

28

What drug class if given more often to patients with HTN and Type II diabetes?

ARB

29

If your patient is taking an ACEi and gets a nasty cough, what do you do?

Switch them to an ARB

30

What are 2 AE of BB that you should address/keep an eye out for in your patients (especially because these might make them not take their meds)

1. Erectile dysfunction
2. Depression