Cardiovascular Agents: Htn And Misc.

Front 1

What classes of drugs are used for hypertension?

Back 1

Diuretics, beta-blockers, calcium channel blockers, ACE-I's, Angiotensin II receptor blockers (ARBs).

Front 2

Description of the Renin-Angiotensin System

Back 2

BP drop to renal arteries stimulates renin. Renin activates renin-angiotensin system by cleaving angiotensinogen produced in liver to yield angiotensin I. ACE converts angiotensin I to angiotensin II, constricting blood cells, increasing secretion of antidiuretic hormone (ADH) and aldosterone, and causes reabsorption of sodium in the kidneys, leading to water retnetion, increased blood volume, and increased BP.

Front 3

Definition of metabolic syndrome

Back 3

Abdominal obesity, hypertension, insulin resistance, and a lipid disorder; increases risk of CVD.

Front 4

Diagnostic criteria for HTN

Back 4

Average of non-affected (absence of illness, etc) readings taken at an initial screening and two or more readings taken at each of two or more subsequent visits.

Front 5

Secondary causes of hypertension, s/s: Coarctation of aorta

Back 5

S/S: Delayed or absent femoral arterial pulses, decreased BP in LEs.

Dx: ECG, CXR, ECHO, doppler US

Front 6

Secondary causes of hypertension, s/s: Cushing's Syndrom

Back 6

S/S: Long-term steroid use; truncal obesity with purple striae, moon facies.

Dx: Morning plasma cortisol after 1 mg hour of sleep dexamethasone

Front 7

Secondary causes of hypertension, s/s: Pheochromocytoma

Back 7

S/S: Labilte HTN, tachycardia, HA, palpitations, pallor, sweating, tremors.

Dx: Spot urine for metanephrine

Front 8

Secondary causes of hypertension, s/s: Primary aldosteronism

Back 8

S/S: Muscle weakness, polydipsia, polyuria

Dx: Hypokalemia, excessive urinary potassium exretion, suppressed levels of plasma renin activity, elevated Na+ level.

Front 9

Secondary causes of hypertension, s/s: Chronic Kidney DIsease

Back 9

S/S: Abdominal or flank massess (polycystic kidneys)

Dx: Urinalysis, creatinine, renal ultrasound

Front 10

Secondary causes of hypertension, s/s: Renovascular disease

Back 10

S/S: Epigastric or renal artery bruits, atherosclerotics disease of aorta or peripheral arteries

Dx: REnal duplex US, renal ateriography

Front 11

Secondary causes of hypertension, s/s: Sleep apnea

Back 11

S/S: Fatigue, loud cyclic snoring

Dx: Polysomnography

Front 12

Secondary causes of hypertension, s/s: Hyperthyroidism

Back 12

S/S: Weight loss, fatigue, tachycardia

Dx: TSH, T4, free T4 index.

Front 13

Secondary causes of hypertension, s/s: Hypothyroidism

Back 13

S/S: Weight gain, fatigue

Dx: May be d/t decreased tissue metabolism leading to low production of vasodilating metabolites

Front 14

Secondary causes of hypertension, s/s: Hyperparathyroidism

Back 14

S/S: Renal stones, polyuria, constipation

Dx: Serum and urine calcium, urine phosphate, serum parathyroid hormone

Front 15

Treatment for Normal HTN

Back 15

None indicated unless TOD occurring

Front 16

Treatment and criteria for Prehypertension

Back 16

120-139/80-89mmHg

None unless TOD occurring

Front 17

Treatment and criteria for Stage 1 HTN

Back 17

140-159/90-99mmHg

Thiazide-type diuretics for most.

May consider ACEI, ARB, BB, CCB, or combination.

Front 18

Treatment and criteria for Stage 2 HTN

Back 18

160/100mmHg

Two-drug combination for most, usually thiazide-type and ACE or ARB (or BB or CCB)

Front 19

Types of Target Organ Damage

Back 19

LVH

Angina, hx of MI

Prior coronary revascularization

Heart failure

Stroke or TIA

CKD

PAD

Retinopathy

Front 20

Blood pressure target goals

Back 20

General population: below 140/90mmHg

Hx of CAD or high-risk for CAD: below 130/80

Front 21

Lifestyle Modifications to reduce HTN

Back 21

Lose weight if overweight

Limit ETOH <1oz/day for men, 0.5oz/day women)

Increase aerobic activity 30-45 min/day

Reduce Na intake to 2.4g Na or 6g NaCl

Eat more K+ (over 90mmol/day)

Maintain adequate dietary Ca+ and Mg+

Stop smoking

Reduce intake of saturated fat, cholesterol

Front 22

Which HTN patients are at risk for hyperkalemia?

Back 22

Renal insufficiency

ACEIs

Aldosterone antagonists

Front 23

List of compelling indications with HTN

Back 23

CKD: only use ACEI, ARBs

DM: ACEI, ARB, CCB

HF: Don't use diuretic or CCB; may use aldosterone antagonist

High risk for CAD: Only BB, ACEI, CCB

Post-MI: BB, ACEI, ARB

Recurrent Stroke prevention: Only diuretic, ACEI

Front 24

Patient education for all anti-HTN meds:

Back 24

Do not d/c w/o instruction, d/t REBOUND HTN;

Avoid taking cough/cold/allergy meds that contain sympathomimetics that can elevate BP; may cause suddent orthostatic hypoTN

Drink plenty of water

Front 25

Patient education for alpha-1 blockers: doxazosin (cardura)

Back 25

Potential for syncope. FIRST-DOSE SYNCOPE. Avoid driving and other hazardous tasks. May produce priaprism. May worsen angina. Most common rxn is ortho hypoTN.

Front 26

Patient education for alpha-2 antiadrenergics: clonidine (catapres), methyldopa (pregnant chicks)

Back 26

Drowsiness common, take at bedtime.

Use caution w/ machinery/driving.

No ETOH or other CNS depressants.

Use hard candy or frequent mouth care to reduce dry mouth.

REBOUND HYPERTENSION w/ abrupt d/c.

TCAs decrease effect.

Caution w/ BB as it can cause bradycardia.

Methyldopa: POSITIVE COOMBS TEST (hemolytic anemia). Don't use w/ lithium/MAOIs.

Front 27

Patient education for direct vasodilators: hydralazine (apresoline)

Back 27

Urine exposed to air may darken.

Take hydralazine with meals.

Notify provider if unexplained prolonged fatigue/fever, muscle or joint aches, or chest pain.

Hydralazine: lupis-like syndrome. Use w/ caution in pt's w/ CAD.

Front 28

Patient education for renin inhibitors: aliskiren (tekturna) 150-300mg

Back 28

Do not use w/ ACEI, ARBs.

Not as effective in blacks, like ACEIs and ARBs.

Diarrhea may occur .

Like all RAS drugs, DO NOT USE WITH PREGNANCY.

Don't use w/ furosemide, (decreases f. effect).