Non Pharm Management Of Htn

Front 1

necessity of non pharm intervention (7)

Back 1

1) elevated bp is a common and important risk factor for cv and renal diseases
2) 27% of americans have htn
3) 31% of americans have prehypertension
4) estimated that 1/3 of bp related deaths from chd occur in normal indivdiuals
5) once recommend treatment for prehypertensive patients if lifestyle modifications
6) in non ntn and pre HTN patients, dietary change that lower bp may: prevent htn from developing and lower the risk of htn related complications
7) small reducation in bp can have a big impact

Front 2

what areas do you put non pharm in soap

Back 2

1) assessment
2) plan
3) patient education

Front 3

what are the nonpharm treatments for htn- 6

Back 3

1) weight loss
2) adopt of DASH DIET
3) limit na intake
4) inc aerobic physical activity
5) limit etoh intake
6) encourage smoking cessation

Front 4

benefits of weight loss for bp

Back 4

1) weight is directly associated with bp. weight loss lowers bp
2) reductions similar for HTN and on HTN subjects
3) modest weight loss +/- na restriction can: prevent htn 20% in overweight, pre HTN patients, lead to decreases in number of meds and or dose

4) does not prevent a rise in bp over time

Front 5

weight loss recommendation
a) overweight/ obese
b) non overweight persons

Back 5

a) lose wt until attain bmi < 25 kg/ m2

b) maintain desirable bmi < 25 kg/ m2

Front 6

what is emphasized in DASH diet- 7

Back 6

- fruits
- veggies
- low fat dairy products
- whole grains
- poultry
- fish
-nuts

Front 7

what is not emphasized in DASH diet - 5

Back 7

- sat and total fat
- cho
- red meat
- sweets
- sugar containing beverages

Front 8

adopting a dash diet

a) rich in what nutrients
b) effect on bp
c) how long does it take to see effect?
d) effect on pop

Back 8

a) K, Mg, Ca, Fiber
b) reduceds sbp by 5.5 mmhg and dbp by 3 mmhg vs control diet
c) 2 weeks
d) blacks more than whites, htn more than non htn patients

Front 9

dash diet not recommended in patients with

Back 9

- stage 3 and 4 ckd
- gfr < 60 ml/min/ 1.73 m2

- high in K, P, protein

Front 10

name other diets other than dash to reduce htn

Back 10

1) vegetarian
2) omniheart trial

Front 11

vegetarian diet

a) effect on bp
b) contributing factors- 5

Back 11

a) associated w/ bp reduction. lowers bp than nonveg in industrialized countries

b) contributing factors
- reduced wt
- inc K
-low to moderate etoh intake
- high fiber
- no meat

Front 12

omni heart trial consists of what kind of diets- 3

Back 12

diets rich in:
- rich in carbs- 58% of total calories
- rich in protein- 50% frm plant sources
- rich in unsat fats- mostly monounsat

Front 13

omni heart trial

a) overall assess of 3 diets
b) effect on bp
c) effect of carb substitution

Back 13

a) overall diet
- reduce in sat fat and cho
- rich in fruit, vegs, fiber, P, and other minerals

b) each diet reduced sbp b/t 5-10 mmHg

c) substitution of carbs (10% of total calories) with either protein or unsat fats led to further bp red

Front 14

effect of dietary salt on bp?

Back 14

- inc in dietary salt, bp inc

Front 15

effect of dietary na restriction on bp for gender, ethnicity and htn status

Back 15

- significant lowers bp across genders, ethnicity and htn

Front 16

effect of reduction of na from 3.3 g to 1.5 g results in what effect on s and d bp

Back 16

S: red sbp by 2 mmHg (non-HTN) and 5 in mmHg (htn)

D: red dbp by 1 mmHg (non-HTN) and 2.7 mmHg (HTN)

Front 17

reduced na intake + weight loss can prevent HTN by ?

Back 17

20%

Front 18

t/f not everyone responds to na restriction the same

Back 18

true

Front 19

dietary na restriction has greater effects in patients who have?

Back 19

less responsive RAAS

Front 20

dietary na restriction is more pronounced effect in bp for what pop- 5

Back 20

- blacks
-htn patients
- ckd patients
- diabetes

Front 21

if you put dietary na restriction in soap note, what is the reco you would make

Back 21

-reduce 2.4 g/d or Na or 6 g/d of NaCl

Front 22

if you put dietary na restriction in soap note, what patient counseling tip would you put?

Back 22

- choose foods low in salt
- limit amt of salt added to food
- minimize processes foods

Front 23

effect on k on bp

Back 23

- increase K assocaited w/ red bp in htn and non HTN subjects

Front 24

what is the effect of inc K by 2g/d on s and d bp

Back 24

- dec sbp by 4.4 mmHg (HTN) and 1.8 mmHg (non-HTN)
- dec dbp by 2.5 mmHg (HTN) and 1 mmHg (non-HTN)

Front 25

blacks or whites benefit more from inc K intake

Back 25

blacks

Front 26

the effect of K on bp are dependent on Na intake - t/f , if so, how?

Back 26

-true
- effects on bp greater in high Na intake subjects
- effects on bp lower in low na intake subjects

Front 27

average intake of K for women and men

Back 27

adult women: 2.1-2.3 g/d

adult male: 2.9- 3.2 g/d

Front 28

reco for increased K intake to lower bp ?

Back 28

- > 4.7 g/d in most patients
- < 4.7 g/d in pat with impaired K excretion

Front 29

what drugs (4) and disease (5) impair K excretion

Back 29

drugs
- acei
-arb
- nsaid
- K sparring diuretics

diseases
- dm
-cri
- esrd
- severe HF
- adrenal insuff

Front 30

reco for increasing physical activity

Back 30

- regular aerobic physical activity: brisk walking, bike riding, swimming

- 30 mins /day on most days of the week. AHA min reco is 3 days/ wk

Front 31

alcohol relationship w/ bp

Back 31

alcohol has a dose dependent relationship w/ inc bp

Front 32

how many drinks does it take to reduce bp and chd risk

Back 32

less than or equal to 2 r

Front 33

reco for moderate alcohol intake-3

Back 33

- less than or equal to 2 drinks in men and less than or equal to 1 drink in women

- do not recommend patients to start drinking

- only reco to reduce amt

Front 34

how is a drink defined

Back 34

-12 oz of regular beer
-5 oz of wine (12% etoh)
-1.5 oz of 80 proof (40% etoh) distilled spirits

Front 35

cigarette smoking is dependent/independent risk factor for CHD?

Back 35

independent risk factor for CHD

Front 36

htn patients who smoke need to be counseled on ? (3)

Back 36

- risk and benefits of smoking cessation
- smoking cessation programs
- smoking cessation aids

Front 37

fish oil supplementation and effect on htn

a) dose
b) effect on bp
c) adr

Back 37

a) high dose of omega 3 fa > 3g/d

b) can dec sbp by 4 and dbp by 2.5 in HTN patients

c) adr: bleeding, belching, and fish taste, not routinely reco due to high dose

Front 38

other dietary factors that do not have enough info to have effect on bp- 8

Back 38

- fiber
- ca
- mg
- carb consumption
- protein intake
- fat intake
- cho
- vit c

Front 39

how many different antihypertensive drug classes are there

Back 39

10

Front 40

primary anti HTN agents-5

Back 40

- diuretics
- bb
- acei
- angiotensin II receptor blockers
- ccb

Front 41

alternative anti-HTN agents-5

Back 41

- alpha 1 blockers
- central alpha 2 agonists
- adrenergic inhibitors
- vasodilators
- direct renin inhibitors

Front 42

what drug class is the first line agent for most patients w/ HTN

Back 42

thiazide type diuretics
-based on the ALLHAT study

Front 43

explain the synergistic effect of diuretics

Back 43

- diuretics are very good agents to use in conjunction with other therapies to achieve bp goals
- pharmacodynamic synergy
- anti- htn may have a compenstaory inc in na and water retention, ie: acei/arb body will keep na,

Front 44

categories of diuretic agents

Back 44

- thiazide
- loop
- K sparing diuretics
- aldosterone antag

Front 45

name a thiazide diuretics

Back 45

hydrochlorothiazide (Hydrodiuril)

Front 46

gen: hydrochlorothiazide
brand?
class:

Back 46

gen: hydrochlorothiazide
brand: hydroDiuril
class: thiazide diuretic

Front 47

dosing of hydrochlorothiazide( Hydrodiuril)

Back 47

12.5- 50 mg po daily

Front 48

name a loop diuretic

Back 48

furosemide (lasix)

Front 49

gen: furosemide
brand:?
class:?

Back 49

gen: furosemide
brand: lasix
class: loop d

Front 50

dosing of furosemide (lasix)

Back 50

20-40 mg po bid

Front 51

name aldosterone antag (2)

Back 51

eplerenone (inspra)
spironolactone (aldactone)

Front 52

gen: eplerenone
brand:?
class:?

Back 52

gen: eplerenone
brand: inspra
class: aldosterone antag, diuretic

Front 53

gen: spironolactone
brand:?
class:?

Back 53

gen: spironolactone
brand: aldactone
class: aldosterone antag, diuretic

Front 54

dosing of spironolactone

Back 54

25-50 mg po daily or bid

Front 55

dosing of eplerenone

Back 55

50 mg po daily or bid

Front 56

thiazide moa- 4

Back 56

1) inhibit na and cl transport in the cortical thick ascending limb and the early distal tubule
2) less na is reabsorbed by this nephron site than by the thick ascending (loop). milder diuretic axn than loop diuretics.

3) initially produce natriuresis that dec plasma vl, but dec w/ chronic use

4) long term effects are throught to be due to direct relaxation of vascular smooth muscle

Front 57

what is more potent diuretic: thiazide or loop

Back 57

loop

Front 58

moa of loop d

Back 58

- block the na/k/chloride co transporter in the thick ascending limb of henle's loop
- most potent diuretics avail

Front 59

moa of K sparing diuretics

Back 59

- inhibit na channel in the late distal tubule and collecting duct
- causes a lack of exchange of K

Front 60

moa of aldosterone antag

Back 60

- competitively block aldosterone at receptor site
-not a true diuretic

Front 61

what are the ci for diuretics

Back 61

1) sulfa allergy
- can't use thiazide or loop
- use epicrynic acid

2) crcl <30 ml/min
- thiazides can't be used

3) Scr
- monitor when using aldosterone antag
- Eplerenone (>2 mg/dL in men and >1.8 mg/dL in women, t2dm with proteinuria)

-Spironolactone (>2.5 mg/dl in men and >2.0 in women)

4) hyperkalemia (K>5.0 meq/l)
- dnt use K sparing diuretics and aldosterone antag

Front 62

when using aldosterone antag what is the ci

Back 62

- watch for scr

- Eplerenone (>2 mg/dL in men and >1.8 mg/dL in women, t2dm with proteinuria)

-Spironolactone (>2.5 mg/dl in men and >2.0 in women)

Front 63

if clcr <30 what is the diuretic you can use

Back 63

metolazone is the only thiazide effective if crcl <30

Front 64

thiazide precautions- 3

Back 64

-hypokalemia
- gout (inc uric acid)
- hypercalemia

Front 65

loop precautions

Back 65

- hypokalemia
- hypocalcemia

Front 66

benefits of thiazide- 4

Back 66

1) most effect to dec bp
2) reduce sbp by 12-18 mmHg
3) only use in patients w/ crcl >30 ml/min
4) excellent to educe bp in blacks that are resistant to bb and acei

Front 67

benefits of loop d-1

Back 67

1) CrCl <30 ml/min. otherwise use thiazide.

Front 68

benefits of K sparing diuretics - 2

Back 68

1) weak antiHTN agents when used alone
2) useful for patients that have risk of hypoK w/ thiazide or loop (serum K <4)

Front 69

benefits of aldosterone antag- 2

Back 69

1) decent diuretic properties but main effect is an aldosterone receptor blocker

2) proven to reduce M&M
- stage III-IV hf
- post mi w/ lvd

Front 70

adr in thiazides-3

Back 70

hypo: K, Mg

hyper: Ca, uricemia, glycemia, lipidemia

sexual dysfunction

Front 71

adr in loop- 3

Back 71

hypo: K, Mg, Ca

hyper: uricemia, glycemia, lipidemia

ototoxicity

Front 72

K sparing diuretics adr

Back 72

hyperkalemia

Front 73

aldosterone antag adr- 3

Back 73

1) hyperkalemia
2) gynecomastia (spironolactone)
3) hypertriglyceridemia (eplerenone)

Front 74

patient counseling for diuretics- 3

Back 74

1) dose
- daily dosing: dose in morning
- bid dosing: dose in am and afternoon

2) signs and symptoms of hypokalemia
- muscle fatigue or cramps

3) monitor for signs of dizziness

Front 75

6 acei agents

Back 75

1) benazepril (lotensin)
2) captopril (capoten)
3) enalapril (vasotec)
4) fosinopril (monopril)
5) lisinopril (prinvil, zestril)
6) ramipril (altace)

Front 76

generic: benazepril
brand: ?
class: ?

Back 76

generic: benazepril
brand: lotensin
class: acei

Front 77

generic: captopril
brand: ?
class: ?

Back 77

generic: captopril
brand: capoten
class: acei

Front 78

generic: enalapril
brand: ?
class: ?

Back 78

generic: enalapril
brand: vasotec
class: acei

Front 79

generic: fosinopril
brand: ?
class: ?

Back 79

generic: fosinopril
brand: monopril
class: acei

Front 80

generic: lisinopril
brand: ?
class: ?

Back 80

generic: lisinopril
brand: prinvil, zestril
class: acei

Front 81

generic: ramapril
brand: ?
class: ?

Back 81

generic: ramapril
brand: altace
class: acei

Front 82

dosing of benazepril (lotensin)
max dosage?

Back 82

10-40 mg qd-bid
max: 40

Front 83

dosing of captopril (capoten)
max dosage?

Back 83

6.25-50 mg bid- tid
max: 450

Front 84

dosing of enalapril (vasotec)
max dosage?

Back 84

2.5-40 mg qd-bid
max: 40

Front 85

dosing of fosinopril (monopril)
max dosage?

Back 85

10-40 mg daily
max: 40

Front 86

dosing of lisinopril (prinvil, zestril)
max dosage?

Back 86

10-40 mg daily
max: 40

Front 87

dosing of ramipril (altace)
max dosage?

Back 87

2.5-10 mg qd-bid
max: 20