Htn Therapy

Front 1

CAD prevention
a.) BP goal
b.) medications

Back 1

CAD prevention
a.) <140/90 mm Hg
b.) thiazides, ACE, ARB, dihydro, combo

Front 2

Peripheral artery disease
a.) category
b.) BP goal
c.) medications

Back 2

Peripheral artery disease
a.) High risk CAD
b.) <130/80 mm Hg
c.) thiazides, ACE, ARB, dihydro, combo

Front 3

Abdominal aortic aneurysm
a.) category
b.) BP goal
c.) medications

Back 3

Abdominal aortic aneurysm
a.) High CAD risk
b.) <130/80 mm Hg
c.) thiazides, dihydro, ACE, ARB, combo

Front 4

Carotid disease
a.) category
b.) BP goal
c.) medications

Back 4

Carotid artery disease
a.) high risk CAD
b.) <130/80
c.) thiazides, dihydros, ACE, ARB, combo

Front 5

Framingham 10-y Risk > 10%
a.) category
b.) BP goal
c.) medications

Back 5

Framingham 10 yr risk >10%
a.) high risk CAD
b.) <130/80
c.) thiazides, dihydros, ACE, ARB, combo

Front 6

Kidney disease
a.) BP goal *
b.) medications

Back 6

Kidney disease
a.) <130/80, lower if proteinuria:creatinine 500-1000
b.) ACE or ARB

Front 7

Diabetes
a.) BP goal
b.) medications

Back 7

Diabetes
a.) <140/80
b.) ACE or ARB

Front 8

Angina
a.) category
b.) BP goal
c.) medications

Back 8

Angina
a.) CAD
b.) <130/80
c.) Beta blockers

Front 9

NSTEMI/STEMI
a.) category
b.) BP goal
c.) medications

Back 9

NSTEMI/STEMI
a.) CAD
b.) <130/180
c.) beta blockers

Front 10

LV dysfunction
a.) category
b.) BP goal
c.) medications

Back 10

LV dysfunction
a.) heart failure
b.) <130/80
c.) beta blocker

Front 11

Chronic use = plasma volume returns to normal

Back 11

a.) Thiazides

Front 12

Decreased systemic vascular resistance

Back 12

a.) thiazides

Front 13

Hypercalcemia

Back 13

a.) thiazides

Front 14

indicated for pts with normal renal function (CrCl>30mL/min)

Back 14

a.) thiazides

Front 15

indicated for pts with CrCl<30mL/min

Back 15

loop

Front 16

hypocalcemia

Back 16

loop

Front 17

tinnitus

Back 17

loop

Front 18

need k supplementation

Back 18

loop

Front 19

hyperkalemia
a.) drugs (3)
b.) diseases (2)
c.) misc. drugs (2)

Back 19

hyperkalemia
a.) k-sparring diuretics, ACE/ARB, direct renin inhibitors
b.) diabetes, renal disease
c.) NSAIDs, K supplements

Front 20

gynecomastia & irregular menses

Back 20

k-sparring

Front 21

increased lithium levels (2)

Back 21

diuretics, ACE-I

Front 22

angioedema

Back 22

ACE-I

Front 23

Acute renal failure

Back 23

ACE-I

Front 24

bilateral renal artery stenosis

Back 24

C/I in ACE-I

Front 25

SCr increase 30-35%

Back 25

d/c ACE-I

Front 26

monitor within 4 weeks of starting therapy or increasing dose

Back 26

ACE-I

Front 27

use of ARB in ACE-I induced angioedema

Back 27

if mild (no shortness of breath) and has compelling indications

Front 28

Isolated systolic HTN
a.) definition
b.) which drug treats this

Back 28

a.) systolic >140; diastolic <90
b.) dihydropyridine CCB

Front 29

ADR: peripheral edema (1)

Back 29

DHP (alpha 1 blockers cause regular edema)

Front 30

ADR: Tachycardia (3)

Back 30

DHP CCB (especially IR nifedipine), alpha 1 blockers, renin inhibitor; also beta blockers if abruptly discontinued

Front 31

ADR: bradycardia (3)

Back 31

non-DHB CCB, beta-blocker, alpha 2 agonists

Front 32

flushing

Back 32

dihydros

Front 33

Avoid grape-fruit juice

Back 33

dihydros

Front 34

first degree heart block

Back 34

non-CCB (like labetalol in HTN crisis)

Front 35

Constipation

Back 35

non-CCB

Front 36

negative inotropic effects (2)

Back 36

non-CCB, beta blockers

Front 37

anorexia

Back 37

non-CCB

Front 38

3A4 drug reactions (2)

Back 38

non-CCB, renin inhibitor

Front 39

mask symptoms of hypoglycemia

Back 39

beta blockers

Front 40

first dose syncope

Back 40

alpha 1 blocker

Front 41

postural hypotension/orthostasis

Back 41

alpha 1 blocker

Front 42

Recurrent stroke prevention/ischemic stroke
a.) goal
b.) first line (2)

Back 42

Recurrent stroke prevention/ischemic stroke
a.) <130/80
b.) ACE & thiazide combo

Front 43

Isolated systolic hypertension
a.) first line
b.) alternative
c.) avoid (2)

Back 43

Isolated systolic hypertension
a.) diuretics
b.) dihyropyridines
c.) centrally acting agonists or alpha blockers

Front 44

Combo therapy
a.) RAAS inhibitors
b.) Dihydropyridines
c.) Beta-blockers

Back 44

Combo therapy
a.) RAAS inhibitors + diuretics or DHP CCB
b.) Dihydropyridines + diuretics or already on BB
c.) Beta blockers + diuretics or dihydros

Front 45

BP goals for elderly with CAD
a.) 70-80 years old
b.) >80 years old

Back 45

BP goals for elderly with CAD
a.) 70-80 years old: >135/75
b.) >80 years old: >140/80

Front 46

Very elderly with no compelling indications
a.) BP goal
b.) keep above
c.) drug therapy

Back 46

Very elderly >80 with no compelling indications
a.) 140-145
b.) >130/65
c.) lower thiazide diuretic; can use CCB, ARB, or ACE

Front 47

Chronic HTN in pregnancy
a.) goal
b.) first line
c.) drug therapy

Back 47

Chronic HTN in pregnancy
a.) <160/100
b.) NON-PHARM
c.) labetalol

Front 48

hyperuricemia (3)

Back 48

thiazides, loop, k-sparring

Front 49

Diuretics
a.) drug interactions (3)
b.) monitoring (4)
c.) counseling points (4)

Back 49

Diuretics
a.) NSAIDs, steroids, lithium
b.) BP, basic metabolic panel, weight, uric acid
c.) SODIUM RESTRICTION! don't take at night, eat hard sugarless candy if dry mouth, monitor ADRs

Front 50

Thiazides
a.) ADRs (4)

Back 50

Thiazides
a.) HYPERcalemia, sun sensitivity, hypercalcemia, hypo Na, K, Mg

Front 51

Loop
a.) ADRs (5)

Back 51

Loop
a.) TINNITUS, hypocalcemia, hypo Na, K, Mg, hyperuricemia, sun sensitivity

Front 52

K-sparring diuretics
a.) ADRs (4)

Back 52

K-sparring diuretics
a.) gynecomastia, irregular menses, HYPERKALEMIA (eplerenone), hyperuricemia

Front 53

ACE-inhibitors
a.) Why is it first line in DM?
b.) ADRs (4)
c.) absolute contraindications (2)
d.) d-d rxns (3)
e.) monitoring and when (4)

Back 53

ACE inhibitors
a.) because it slows the progression of diabetic neuropathy and reduces risk of cardiac events
b.) cough, hyperkalemia, angioedema, acute kidney failure
c.) bilateral renal artery stenosis, pregnancy
d.) NSAIDs, potassium supplements, lithium
e.) basic metabolic panel within 4 weeks starting therapy. If SCr increases 30-35% from baseline, D/C drug! angioedema, cough, BP

Front 54

ARBs
a.) why is it first line in DM?
b.) when to give ARB if pt has ACE angioedema (2)

Back 54

ARBs
a.) slows progression of diabetic neuropathy, reduces risk of cardiac events
b.) pt has compelling indication, rxn was mild-moderate (no SOB)

Front 55

Dihydropyridines
a.) ADRs (4)
b.) alternative for
c.) MOA
d.) form preferred
e.) monitoring (3)
f.) patient education (3)

Back 55

Dihydropyridines
a.) TACHYCARDIA (bc inhibits vasoconstriction in heart, especially IR nifedipine), PERIPHERAL EDEMA (bc inhibits vasoconstriction in periphery), flushing, headache
b.) isolated systolic hypertension (diuretic first line)
c.) inhibits vasoconstriction in heart and periphery (thus peripheral edema)
d.) long acting products bc short acting (IR nifedipine) increases sympathetic tone, leading to increased morbidity/mortality
e.) BP, HR (bc reflex tachycardia), peripheral edema
f.) avoid > qt grapefruit juice, dont chew/crush long acting product, monitor for peripheral edema

Front 56

non-dihydro CCB
a.) ADRs (5)
b.) indication (2)
c.) precautions (2)
d.) monitoring (3)

Back 56

non-dihydro CCB
a.) NAB FC: negative inotropic effects (verapamil>diltiazem), anorexia, bradycardia, first degree heart block (dose related), constipation
b.) for patients with atrial fibrillation and tachycardia
c.) those on beta blockers; 3A4 inhibitors
d.) BP, HR, constipation

Front 57

beta blockers
a.) first line for (2)
b.) ADRs (6)
c.) cardioselective drugs (3)
d.) relative C/I (5)
e.) alternative place in therapy
f.) monitoring (2)
g.) patient education (2)

Back 57

beta blockers
a.) MI, angina
b.) B2EGS M: bradycardia (negative inotropic effects like non-DHP), bronchospasm, exercise intolerance, glucose intolerance, sexual dysfunction, MASKS HYPOGLYCEMIA except sweating
c.) atenolol, metoprolol, nebivolol
d.) peripheral vascular disease (because causes vasoconstriction in periphery), asthma & COPD (bronchospasm), diabetes (masks hypoglycemia), sleep apnea
e.) add on to non-compelling indications
f.) HR & BP
g.) DO NOT ABRUPTLY STOP (bc causes tachycardia, angina, death), can mask hypoglycemia

Front 58

Misc. beta blockers
a.) have ISA (2)
b.) cause peripheral vasodilation (2)
c.) CNS effects (2)
d.) extensive first pass (2)
e.) excreted renally (2)

Back 58

Misc. beta blockers
a.) pinodolol, acebutelol
b.) carvedilol, labetolol (pregnancy)
c.) propanol, metoprolol
d.) propanol, metoprolol
e.) atenolol, nadolol

Front 59

Alpha 1 blockers
a.) indicatoin
b.) ADRs (4)
c.) why not use monotherapy?
d.) monitoring (2)
e.) patient education (2)

Back 59

alpha 1 blockers
a.) for patients with BPH
b.) FPET: first dose syncope (happens 1-3 hours after dose), postural hypotension/orthostasis (take low dose at bedtime), edema (chronic use), tachycardia (like DHP)
c.) increased risk of stroke & heart failure (doxazosin)
d.) BP & orthostasis
e.) take at bedtime, rise slowly from supine/seated position

Front 60

regular edema

Back 60

alpha 1 blockers (DHP causes PERIPHERAL edema)

Front 61

central alpha 2 agonists
a.) indication
b.) ADRs (7)
c.) why shouldn't you abrupt d/c?
d.) alternative therapy
e.) tablet to patch counseling
f.) monitoring (2, general)

Back 61

celtral alpha 2 agonists
a.) resistant HTN (like direct vasodilators)
b.) DAS2H2 B: depression, ANTICHOLINERGIC EFFECTS (clonidine), sexual dysfunction, skin rash, hemolytic anemia, hepatic dysfunction, bradycardia
c.) causes rebound HTN (clonidine)
d.) alternative to pregnancy HTN (methyldopa) because lots of safety & efficacy data (labetalol first line)
e.) continue taking tablets 24-48 hours after putting on first patch
f.) BP & ADRs

Front 62

hemolytic anemia

Back 62

alpha 2 agonist (methyldopa)

Front 63

anticholinergic ADR
a.) symptoms
b.) drug

Back 63

a.) sedation, dry mouth
b.) alpha 2 agonist (clonidine)

Front 64

skin rash

Back 64

clonidine

Front 65

hepatic dysfunction

Back 65

alpha 2 agonist (2) methyldopa

Front 66

sexual dysfunction (2)

Back 66

beta blockers, alpha 2 agonists

Front 67

rebound hypertension

Back 67

clonidine when abruptly d/c

Front 68

refractory hypertension

Back 68

direct vasodilators

Front 69

direct vasodilators
a.) indication
b.) general ADRs (3)
c.) what do you always need to use
d.) monitoring (4)
e.) patient education

Back 69

direct vasodilators
a.) refractory and resistant HTN
b.) TACHYCARDIA, FLUID RETENTION, WORSENING ANGINA
c.) need to use in COMBO with beta blocker AND diuretic because direct vasodilators cause HUGE vasodilation and as a result reflex SNS response will occur
d.) HR, BP, edema, ADRs
e.) can cause hair growth (minoxidil/loniten)

Front 70

hypertrichosis

Back 70

minoxidil/loniten

Front 71

treatment for resistant HTN (2)

Back 71

alpha 2 agonists and direct vasodilators

Front 72

Hydralazine
*class
a.) specific ADRs (3)
b.) general ADRs (3)

Back 72

Hydralazine
*direct vasodilator
a.) Drug-induced lupus, peripheral neuropathy, headache
b.) FAT: tachycardia, worsening angina, fluid retention

Front 73

headache

Back 73

hydralazine and dihydros

Front 74

drug-induced lupus

Back 74

hydralazine

Front 75

peripheral neuropathy

Back 75

hydralazine

Front 76

minoxidil
a.) class
b.) main ADR (1)
c.) general ADRs (3)

Back 76

minoxidil
a.) direct vasodilator
b.) hypertrichosis
c.) FAT tachycardia, fluid retention, worsening angina

Front 77

diarrhea

Back 77

aliskiren/tekturna

Front 78

Direct renin inhibitor
a.) patients to avoid (1)
b.) ACE ADRs (4)
c.) unique ADRs (2)
d.) contraindicated (1)
e.) d-d rxn (2)
f.) monitoring (5)
g.) what decreases absorption?

Back 78

Direct renin inhibitor
a.) CKD patients on ACE/ARB
b.) angioedema, cough, hyperkalemia, rise in creatine kinase
c.) diarrhea, anemia
d.) pregnancy
e.) 3A4 (like non-CCB); decreases furosemide effect
f.) angioedema, cough, diarrhea, BP, basic metabolic panel (especially K and SCr)
g.) high fat food so take before or after a meal

Front 79

anemia

Back 79

direct renin inhibitors

Front 80

furosemide d-d rxn

Back 80

renin inhibitor

Front 81

NAB-FC

Back 81

*non CCB ADRs
Negative inotropic effect
Anorexia
Bradycardia
First degree heart block
Constipation (verapamil>diltiazem)

Front 82

B2EGS-M

Back 82

*beta-blocker ADRs
Bradycardia
Bronchospasm
Exercise intolerance
Glucose intolerance
Sexual dysfunction
Masks hypoglycemia

Front 83

PADS

Back 83

*relative contraindications to beta blockers
Peripheral vascular disease (because causes vasocontriction in periphery
Asthma/COPD (bronchospasm)
Diabetes (glucose intolerance)
Sleep apnea (bronchospasm)

Front 84

HELD C3

Back 84

*drugs >daily dosing
Hydralazine 10-75 mg BID-QID
Enalapril 2.5-40 mg 1-2xday
Losartan 25-100 mg 1-2xday
Diltiazem SR capsules 60-180 mg BID
Catapres 0.1-1.2 mg BID
Catapres TTS 0.1-0.3 mg once/week
Carvedilol 6.25-25 mg BID

Front 85

FPET

Back 85

*ADR for alpha 1 blockers
First dose syncope
Postural hypotension/orthostasis
Edema
Tachycardia

Front 86

FAT

Back 86

*direct vasodilators
Fluid retention
Angina (worsening)
Tachycardia

Front 87

DA(SH)2-B

Back 87

alpha 2 agonists
Depression
Anticholinergic effects
Sexual dysfunction
Skin rash
Hemolytic anemia
Hepatic dysfunction
Bradycardia