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82 Cards in this Set

  • Front
  • Back
prevalence of htn is ____ million people in US
____% of pts are aware that they have the disease
____% are treated
____-___% are controlled
70; 80; 70; 50; 60
htn is termed the "_____ _____" as most pts are asymptomatic
silent killer
sequelae of htn
end organ damage (kidneys etc), MI, stroke, sudden death
advantages to at home or self-measured BP
indentifies "White-coat htn"
assesses response to meds
improves adherence to tx
potentially reduces cost
follow up recommendations based on initial BP measurements
<120 <80 recheck ___ years
120-139 80-89 _____ changes
140-159 90-99 start ___ med
>160 >100 start ___ meds
2; lifestyle; one; two
evaluation components of htn pt
medical hx; physical exam; routine labs (renal fxn, electrolyte levels); optional tests (plasma renin activite 24 hour urnine for catacholemines)
examples of indentifiable causes of htn
renovascular dz, renal parenchymal dz, polycystic kidney, aortic coarctation, pheo, primary aldosteronism, cushing sydrome, hyperparathyroidism, exogenous causes (smoking, coke, meth, stress
cardiovascular risk in pts with htn
smoking, dyslipidemia, DM, age > 60, men, post-meno. women, fmhx, obesity
blood pressure determinants

BP is effected by ___ and ___
CO is effected by ___ and ___
SV is effected by ___ and ___
cardiac output and systemic vascular resistance
heart rate adn stroke volume
contractilit and volume
algorithum for tx htn
1. ____ changes
2. use of 2 drugs such as _____, _____, _____, _____, ____
lifestyle
diuretics, B-blockers, ace, arb, CCB
with initial drug choice there was no response or troublesome side effects you ______ another drug from a ____ class
sustitute; different
if there was an inadequate repsonse, but well tolerated you add _____ agent from _____ class
second; different
if htn still not controlled you continue ____ agents from ____ classes and consider _____ (if failing ___ meds)
adding; different; referral; three
MOA of diuretics
reduce volume
prevent Na reabsorption
areas where diuretics work
proximal tubule, loop of henle, distal tubule
meds that work in proximal tubule
carbonic anhydrase inhibitors
examples of carbonic anhydrase inhibitors are
acetazolamide (oral, IV)(glaucoma, altitude sickness)
dorzolamide (Trusopt) (ophtatlmic soln)
carbonic anhydrase inhibitors are ______ diuretics
weak
acetazolamide is excreted ____
renally
clinical uses for acetazolamide
glaucoma; urinary alkalinization, metabolic acidosis, altitude sickness
caution use of acetazolamide in pts with _____ allergy (anaphylaxis)
sulfa
group of diuretics that work in the loop of henle
loop diuretics
loop diuretics MOA
inhibit Na reabsorption in LOH and some in proximal tubule
loop diuretics are well and ______ absorbed
rapidly
examples of loop diuretics
Furosemide (Lasix)
Ethacrynic acid (Edecrin)
Bumetanide (Bumex)
Toresemide (Demedex)
all loop diuretics are sulfa based except
Ethancrynic acid (Edecrin)
adverse effects of loop diuretics
hypovolemia, metabolic acidosis, hypomagnesemia,
hypokalemia, hypocalcemia, ototoxicity, hyperuricemia
clincal uses of loop diuretics
acute pulmonary edema
hypercalcemia (bone malign)
maintenance in CHF
tx of htn with loop diuretics only if they have
acute pulmonary edema
hypercalcemia
CHF
Thiazides are _____ than loop diuretics
weaker
MOA of thiazide diuretics

require normal _____ fxn to be effective
block Na reabsorption in distal tube

renal
adverse effect of thiazides
hypokalemia, hypomagnesemia, HYPERcalcemia, hypertriglyceridemia, hyperglycemia, hyperuicemia
examples of thiazides
HCTZ, chlorthalidone (Hygroton), chlorothiazide (Diuril){injectable}, methyclohiazide (enduron), Indapamide (Lozol), metolazone (Zaroxolyn)
Max dose for thiazides is

if dose is >50mg/d efficacy is ____ increased, but ___ are
25mg q d

not; SE
clinical uses of thiazides
hypertension; CHF in combo with loop; nephrolithiasis
examples of K+ sparing diuretics
spironolactone (Aldactone)
triamterene
amiloride
Aldactone is a _____ antangonsit of ______
competative; aldosterone
Amiloride decreases activity of ___-___ antiport
Na-H
K+ sparing diuretics decrease the loss of ____
K+
adverse effects of PSD
HYPERkalemia
metabolic acidosis
antiandrogenic effects (esp. renal dysfxn_)
only osmotic diuretic used in US

it's used in the reduction of ______ and ______ pressure
mannitol

intraocular adn intracranial
osmotic diuretics work in the
proximal tubule
examples of combo diuretics
(thiazides and PSD)
triamterene (Diazide, Maxzide)
spironolactone (Aldactizide)
diuretics work well in ____ groups of pts

they are ______ ($)
all; cheap
problems with diuretics
limitied dosing; fluid/elect. imbalance, decreased glucose control, hypertriglyceridemia (thiazides only)
BB reduce BP by have an negative ______ and _____ effect
chronotropy; inotropy
examples of BB
propranolol(Inderal)
atenolol(Tenormin)
Metroprolol(Lopressor)
problems with BB
asthma
DM
CHF (- chronotropic)
angiotensinogen is converted into angiotensin I by
Renin (kidney)
(has no other physiological effect)
angiotensin I is coverted into angiotensin II (involved in vasoconstriction, cardiac fxn, inotropy) by

which then leads to ______ and release of _______ which then loops back to ______
ACE; vasoconstriction; aldosterone; renin
ACE inhibitors are an effective _____ line therapy; has less effect in ______
first; black
problems with ACEs are
cough; renal dysfxn (limited decreased glomerulo filtration); HYPERkalemia
examples of ACES
captopril (Capoten) [only ACE dosed BID for htn)
Enalapril (Vasotec), Lisinopril (Prinivil)[dual elimination], Benazepril (Lotensin), Quinapril (Acupril), Ramipril (Altace), Fosinopril (Monopril), Trandolapril (Mavik)
ARBS (angiotensin II blockers)

similar to ACES except no _____
cough
examples of ARBS
Losartan (Cozaar), Valsartan (diovan), Irbesartan (Avapro), Candesartain (Atacand), Telminsartan (Micardis), Olmesartan (Benicar)
Direct Renin Inhibitors inhibit ______ production, decreaes ______, improves _____ suppression
renin; PRA; RAS
example of direct renin inhibitor
ALiskiren
alpha-1 antagonists work on _________, are a good _____ line agent, beneficial to persons with ________
vasodilation; second; hyperlipidemia
problems with alpha-1 antangonists
first dose hypotension, syncope, relfex tachycardia
examples of alpha 1 blockers
prazosin (Minipress)
terazosin (Hytrin)
doxazosin (Cardura)
Alpha-Beta blockers, at higher doses alpha blocking effects ___________, use same precautions as _______
dominate; BB
examples of ABB
Labetolol (Trandate)
Alpha 2 agonist are an effective ________ line therapy
second
Problems with A2A are
depression, sedation, sexual dysfxn, rebound effects with abrupt discontinuation
examples of A2A
clonidine (Catapress) (po IV, topical)
methyldopa (Aldomet) (PO, IV)[only one safe in pregnancy]
examples of direct vasodilators
dilates __________ and _________ as well
hydralazine (Apresoline)
Minoxidil (PO only)
arterioles; veniole
direct vasodilators are used as _______ or ________ line
3rd or 4th
Problems with vasodilators
water retention (LLE)
reflex tachy
examples of CCB
Verapamil (Calan)
Diltiazem (Cardizem)
Dihydropyridines
CCB work in ______ channels in _______ muscle and have a negative ________ effect
calcium; cardiac; ionotropic
verapamil and diltiazem are not commonly used in htn unless ________
other cardiac problems exist
SE CCB
constipation
dihydropyridines are ___ and ___ acting. _______ acting prep work well in htn
long; short; long
problems with dihydropyridines are
relfex tachy
peripheral edema
examples of dihydropyridines are
nifedipine (procardia, adalat) (sutained release)
felodipine (Plendyl)
Nicardipine (Cardene)
Isradipine (Dyancirc)
Amlodipine (Norvasc)
Nisoldipine (Sular)
examples of combo therapies
BB and Diur (tenoretic)
ACE diur
ARB and Diur(diovan/hct)
CCB and ACE (Lotrel)
first line for DM
ace or ARB (delay nephropathy)
time frame for switch of meds
6 weeks
htn emergency require ________ BP reduction to prevent _______ ____ damage
immediate, end organ
HTN urgencies benefit from reducing BP within ______
hours
drugs used for HTN emergency
vasodilators(nitroprusside, nicardipine, nitro, enalaprilat), adrenergic inhibitors (labetalol, atenolol, phentolamine)
starting doses in elderly persons should be _____ than those used in younger adults

SBP is _______predictor of events than DBP
lower; better