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PHRM 844 > Therapeutics of HTN pt. 2 > Flashcards

Therapeutics of HTN pt. 2 Flashcards

(60 cards)

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1
Q

what does the ALLHAT trial stand for

A

Antihypertensive and lipid lowering treatment to prevent heart attack trial

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2
Q

what is the subject population in the ALLHAT trial

A

42,418 pts age >55 yo with HTN and 1 additional CV risk factor

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3
Q

what were the medication arms in the ALLHAT trial

A

Chlorthalidone, lisinopril based therapy, amlodipine, doxazosin

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4
Q

what was the result of the ALLHAT trial

A

Chlorthalidone > amlodipine and lisinopril based therapy in preventing stroke, heart attacks, and HF
*doxazosin arm stopped early due to increased risk of HF

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5
Q

what are the key takeaways from the ALLHAT trial

A
  1. thiazide diuretics should be first line
  2. for pts who cannot take a diuretic, consider prescribing a CCB or ACEi
  3. most pts with high BP need more than one drug
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6
Q

what are the preferred combination therapies

A

ACEi/CCB, ARB/CCB, ACEi/diuretic, ARB/diuretic

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7
Q

what is acceptable combination therapy

A

CCB/diuretic

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8
Q

first line for HTN with stable ischemic heart disease

A

1.Beta blockers - reduce CV events and anginal Sx
2. ACEi/ARBs - reduce MI, stroke, CVD
3. Dihydropyridine CCBs can be used if still uncontrolled

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9
Q

therapy for HTN with HFrEF (HF with reduced Ejection Fraction)

A
  1. Follow most recent guidelines
  2. Avoid non-dihydropyridine CCBs due to no clinical benefit/worse outcomes in pts with HF
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10
Q

therapy for HTN with HFpEF (HF with preserved Ejection Fraction)

A
  1. Diuretics - fluid overloaded
  2. ACEi/ARB - elevated BP
  3. B blockers - elevated heart rate
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11
Q

therapy for HTN with CKD

A
  1. CKD stage 1 or 2 AND albuminuria (>300 mg/day or >300 mg/g albumin-creatinine ratio) - ACEi or ARBs
  2. CKD stage 3 or higher - ACEi or ARBs
  3. Post kidney transplantation - dihydropyridine CCBs are preferred due to improved GFR and kidney survival
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12
Q

therapy for HTN with cerebrovascular disease

A

For secondary stroke prevention - ACEi/ARB, thiazide, combo of above

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13
Q

when is it not useful to start therapy on pts with HTN with cerebrovascular disease

A

if BP is <140/90

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14
Q

therapy for HTN with diabetes

A
  1. all first line classes of antihypertensive meds are useful and effective
  2. in the presence of albuminuria, use ACEi or ARB
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15
Q

preferred agents for pregnant pts

A

methydopa, nifedipine, labetalol

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16
Q

CI agents in pregnant pts

A

ACEi, ARBs, direct renin inhibitors.
Thiazides aren’t CI, but not preferred.

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17
Q

therapy for black adult pts with HTN but w/o HF or CKD

A

initial antihypertensive tx should include a thiazide diuretic or CCB
(unless albuminuria)

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18
Q

diuretics in HTN - initial anti-hypertensive effects

A

diuresis -> reduced stroke volume -> increased peripheral vascular resistance

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19
Q

diuretics in HTN - chronic anti-hypertensive effects

A

stroke volume returns to normal -> decrease in peripheral vascular resistance

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20
Q

thiazide diuretics agents

A

hydrochlorothiazide (HCTZ), chlorthalidone, indapamide, metolazone

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21
Q

what are thiazides more effective than

A

more effective than loop diuretics if CrCl >30 ml/min

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22
Q

when do you take thiazides

A

in the morning to avoid nocturnal diuresis

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23
Q

what is the frequency of all thiazides

A

1/day

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24
Q

thiazides AEs

A

hypokalemia, hypomagnesemia, hypercalcemia, hyperuricemia, hyperglycemia, hyperlipidemia, sexual dysfunction, increase in TGs/cholesterol

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25
thiazide drug interactions
lithium toxicity with concurrent use
26
thiazide CIs
sulfa allergy, anuria
27
loop diuretics agents
furosemide, torsemide, bumetanide, ethacrynic acid
28
are loop diuretics first line for HTN and if not, what is it used for
NOT first line. It is preferred in HF for Sx management and more effective than thiazides with CrCl <30 ml/min.
29
What is the “high-ceiling” dose response curve relevant to loop diuretics?
- May need higher doses with severely reduced renal function or fluid overload - Switching to another loop diuretic or from PO to IV can help
30
When should pts take loop diuretics and why
Dose in the morning or afternoon to avoid nocturnal diuresis
31
What is the furosemide frequency
1 or 2 /day
32
What is torsemide frequency
1/day
33
What is bumetanide frequency
1 or 2 /day
34
Loop diuretics AEs
Hypokalemia, hypomagnesemia, hypocalcemia, hyperuricemia, ototoxicity
35
Loop diuretics CI
Sulfa allergy
36
What are the aldosterone antagonists
Spironolactone, eplerenone
37
Which aldosterone antagonist is preferred with resistant HTN
Spironolactone
38
What trial found that spironolactone is preferred with resistant HTN
PATHWAY-2 trial
39
What AE is specific to spironolactone
Gynecomastia and it develops in up to 10% of pts
40
What can you do if pt is experiencing gynecomastia from spironolactone
Can switch to eplerenone
41
When should aldosterone antagonist not be initiated
If potassium is > 5 mEq/L
42
When should aldosterone antagonists be initiated
Dose in the morning or afternoon to avoid nocturnal diuresis
43
What is spironolactone frequency
1 or 2 /day
44
What is eplerenone frequency
1 or 2 /day
45
When should aldosterone antagonists be held or dose reduced
If potassium is > 5.5 mEq/L or SCr increase >25%
46
Aldosterone antagonists AEs
Hyperkalemia, hyponatremia, gynecomastia in spironolactone
47
Aldosterone antagonists drug interactions
ACEI/ARBs/renin inhibitors/NSAIDs - increase risk of hyperkalemia
48
Eplerenone specific CIs
- Impaired renal function (CrCl <50 ml/min or SCr >2 in males or >1.8 in females - T2DM and proteinuria
49
Aldosterone antagonists CIs
Concomitant use w/ potassium sparing diuretics - risk of hyperkalemia
50
K sparing diuretics agents
Amiloride, triamterene
51
Caution with K sparing diuretics
Caution with pts with diabetes or CKD (GFR <45 ml/min)
52
What is K sparing diuretics effects
- Minimal BP effects - used in combination with thiazide to minimize hypokalemia
53
Amiloride frequency
1 or 2 /day
54
Triamterene frequency
1 or 2 /day
55
K sparing diuretics AEs
Hyperkalemia, increased uric acid, hyperglycemia
56
General diuretic monitoring
57
When do you not give diuretics
Do not give at bedtime
58
What is the first line diuretics for most HTN pts
Thiazides
59
Which diuretic should not be used as monotherapy for HTN
K sparing diuretics
60
What antihypertensive drug class should be avoided in patients with gout
Thiazide diuretics

PHRM 844 (13 decks)

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