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166 Cards in this Set
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CBC count
|
WBC, Hb, Hct, platelet
|
|
Normal Hemoglobin values
|
Male: 13-18 g/dL
Female: 12-16 g/dL |
|
Normal Hematocrit values
|
Male: 40-54%
Female: 38-47% |
|
MCV (normal value)
|
80-100 um^3
Hct / RBC count |
|
MCH
|
26-32 pg
|
|
MCHC
|
32-36%
|
|
corrected reticulocyte count
|
observed Hct/normal Hct
usually 0.5-1.5% |
|
normal adult hemoglobin
|
A: 97%
A2: 3% F: <1% |
|
Specific signs for iron deficient anemia
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koilonychias, pica, pagophagia, smooth tongue
|
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Specific signs for folate deficient anemia
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swollen, red tongue
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Specific signs for vitamin B12 deficient anemia
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swollen red tongue, icterus, gastric mucosal atrophy and NEUROLOGICAL FINDINGS
|
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Hemolytic anemia
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Jaundice
|
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normal WBC
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5-10,000/mm^3
|
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normal platelet count
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140,000-400,000/mm^3
|
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RDW
|
red blood cell distribution width
indicates the variability of RBC sizes normal: 11-15% |
|
Vitamin B12 deficiency neurological findings
|
numbness and paresthesias
peripheral neuropathy ataxia: muscular incoordination (stagger, etc) diminished vibratory sense gait abnormalities depressed deep tendon reflexes psychiatric abnormalities dementia |
|
Iron deficient lab assays
|
Serum iron
TIBC Fe/TIBC MOST IMPORTANT (pregnancy increases this) serum ferritin (increased by liver disease, inflammatory disease and cancer) |
|
Normal folate
|
1.8-16ng/mL
|
|
Normal Vitamin B12
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100-900 pcg/mL
|
|
Erythropoietin
|
0-19mU/mL
|
|
Usual oral iron dose
|
200mg/day elemental iron in 2 or 3 divided doses
|
|
Elemental iron in oral iron preparations
|
ferrous sulfate (20%)
exsiccated ferrous sulfate (30%) ferrous fumarate (33%) ferrous gluconate (12%) polysaccharide iron complex and carbonyl iron (100%) |
|
Counseling points to maximize absorption of iron
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1+ hours before meal on empty GI
No tea/milk Orange juice and Vit.C rich foods |
|
Parenteral products administration of iron
|
Iron dextran contains 50mg/mL iron and is administered 100 mg IV over 2-5 min.
ALL: Administer daily till dose reaches 1000mg, then reassess and give after 4 weeks if necessary Premedicate with APAP and diphenhydramine |
|
Adequate response to iron therapy
|
Hgb and Hct: 1-2 g/dL/2 weeks, then 0.5-1.5 g/dL/wk after
Hemoglobin: >2grams/3 weeks PRBC: 1 unit increases Hgb by 1g/dL and Hct by 3% |
|
Vitamin B12 anemia lab abnormalities
|
Dec. Vit. B12
High/normal methylmalonic acid/homocysteine, LDH, bilirubin Hypersegmented neutrophils Leukopenia and thrombocytopenia in sever cases Anti-IF antibodies may be present schilling test may indicate decreased absorption |
|
oral/sublingual treatment of Vitamin B12 deficient anemia
|
only for dietary deficiency
1-2 mg po daily for 1-2 weeks, followed by 1 mg po daily/weekly |
|
parenteral treatment of Vitamin B12 deficient anemia
|
Cyanocobalamin is PREFERRED -- 30mcg/day IM for 5-10 days, then 100-200 mcg/month (usually used as 100-1000mcg/day IM or SQ for 2-3 wks, then monthly.
Hydroxocobalamin is used as same dosage but is retained longer and not more efficacious. Nascobal (nasal cyanocobalamin gel) 500mcg once a week through one nostril. maintenance therapy AVOID WITHIN 1 HOUR OF DRINKING BEVERAGE. |
|
Monitor response to B12 therapy
|
Reticulocyte count, hgb,and hct
Check CBC and B12 in 1-2 mths Homocysteine and methylmalonic acid in 2-3 months Hypersegmented neutrophils may persist for 2 weeks. |
|
Clinical signs of folate deficient anemia
|
Elevated MCV, reticulocyte, folic acid level, homocysteine. Rule out B12 deficiency if MMA levels are high!!
|
|
ACD causes
|
IMPAIRED ERYTHROPOIESIS
Infections Autoimmune disorders Chronic kidney disease Malignancy Organ transplant rejection |
|
Clinical signs of ACD
|
MCV/MCHC elevated/normal
Erythropoetin decreased/normal Reticulocyte decreased/normal Erythroid hypoplasia Hgb/hct |
|
NCD for coverage of ESAs
|
Hgb level must be <10g/dL OR
Hct level must be <30% Solid tumors and hematological malignancies |
|
Epoetin Alfa to treat ACD
|
Initial dose: 50-150units/kg SQ or IV two or three times weekly
Renal: 50units/kg AIDS: 100units/kg Cancer w/ chemo: 150units/kg |
|
Darbepoetin (aranesp-amgen)
|
ACD
CKD: 0.45 mcg/kg IV/SQ weekly Malignancy: 2.25mcg/kg 200units epoetin/1 mcg darbepoetin |
|
Mircera (methoxy poly. glycol-epoetin beta; Roche)
|
ONLY FOR ANEMIA IN CKD
0.6ug/kg once every 2 wks IV/SQ till Hg>11g/dL, then continue at twice the starting dose every month |
|
ESA dosage changes for myelosuppressive chemotherapy
|
Start if Hgb<10g/dL and Hct<30%
Maintain dose if a mth after starting dose, the Hgb increased >1 but is still <10. Increase dose by 25% if a mth after starting therapy, the rise is <1 but is still <10. Decrease dose by 25% if there's a rise of >1g/dL over 2 wks and is >10g/dL. DISCONTINUE 8 WEEKS AFTER CHEMOTHERAPY ENDS START IRON SUPPLEMENT AT START OF EPO THERAPY IF FERRITIN <100ng/mL or TIDC <20% |
|
Adequacy of ACD therapy
|
Increase in Hgb >1 g/dL after 4 weeks of EPO or after 6 weeks with Darbopoetin
|
|
Causes of hemolytic anemia
|
G6PD (inherited) -antimalarials, antibacterials, etc.
Sickle cell disease Thalassemia Autoimmune diseases Hypersplenism |
|
Clinical signs of hemolysis
|
Peripheral blood smear: spherocytes, RBC fragments
Dec. Hgb and Hct Inc. Reticulocyte count, bilirubin, LDH +/- Coomb's test Dec. haptoglobin Jaundice and hemoglobinuria |
|
Peak Flow zones
|
>80% of personal best GOOD (green)
50-80% CAUTION (yellow) <50% EMERGENCY (red) |
|
Special modifcation for corticosteroidal MDI/Puffer
|
Use a SPACER! slightly extend neck when inhaling and gargle after each dose.
|
|
Special modification for anticholinergic MDI/Puffer
|
Use CLOSED MOUTH technique and CLOSE EYES
|
|
Autohaler
|
pirbuterol (Maxair)
|
|
Diskus
|
Salmeterol (serevent)
Fluticasone (flovent) Fluticasone/salmeterol (advair) |
|
Aerolizer
|
Formoteral (foradil)
|
|
Handihaler
|
Tiotropium (spiriva)
|
|
Flexhaler
|
Budesonide (pulmicort)
|
|
Which spacer device does not contain a valve?
|
Inspirease
|
|
Pathophysiology of OAG vs CAG
|
open-ended: high IOP resulting in optic nerve damage
close-ended: mechanical blockage causing episodes of high IOP |
|
Disease progression of OAG vs CAG
|
OAG: may not be noticeable in the optic disk or visual fields for years
CAG: high IOP >40mmHg causes opti c nerve damage; Very high IOP >60mmHg may result in permanent vision loss within a matter of hours to days |
|
Treatment goal and therapy for Open anged Glaucoma
|
Not recommended till disease progression is VISIBLY NOTICEABLE
Goal is to reduce IOP by 20-30% Nonselective B-blockers, prostaglandin analogs, brimonidine (alpha 2 agonist) and the combination of timolol and dorzolamide. trabeculoplasty or iridotomy may be needed |
|
B-blockers
|
Lowers IOP by reducing aqueous humor production
Contraindications: uncontrolled asthma heart disease and bradycardia Interactions: Theophylline, Methacholine, alpha and beta agonists Instill 1-2 times daily Monitor IOP, HR, fundoscopic exam, and visual field testing |
|
Non-selective b blockers
|
levobunolol (betagan)
metipranolol (optipranolol) timolol (timoptic/timoptic XE) |
|
Selective b blockers
|
Betaxolol (betoptic S)
Carteolol (also has ISA) |
|
Adrenergic Agonists
|
Alpha 2: Apraclonidine (iopidine)
Brimonidine (alphagan P) Nonspecific: Dipivefrin (Propine) |
|
Dipivefrin
|
Proprine
Nonspecific Adrenergic agonist Contraindicated in depressed patients esp. those on MAOIs Dose 2-3 times daily Monitor IOP and fatigue level |
|
Cholinergic Agonists
|
Pilocarpine (Isopto carpine and pilocar)
Carbachol (isopto carbachol |
|
Cholinergic Agonist MOA, etc
|
Causes miosis, constricts ciliary muscle, and lowers IOP
1-2 drops up to 6x daily and HS for the gel dosage form Monitors IOP, funduscopic exam, and visual field testing |
|
Carbonic Anhydrase Inhibitors
|
Brinzolamide (Azopt)
Dorzolamide (Trusopt) Acetazolomide |
|
Carbonic Anhydrase Inhibitors MOAs, etc.
|
Decrease production of aqueous humor
Interactions: other carbonic anhydrase inhbitors, and salicylates 2-3 times daily dosing Contraindicated in hepatic, renal, and diabetic patients. Monitor for sulfa allergy! |
|
Treatment for CAG
|
Prevent surgery and vision loss by rapidly reducing IOP
Pilocarpine + hyperosmotic agen + a secretory inhibitor |
|
1st line of therapy for glaucoma
|
B blockers, Brimonidine, Carbonic Anhydrase inhibitors, and prostglandin analogs
|
|
Which conjuctivitis subtypes cause mucous/serous discharge?http://www.flashcardexchange.com/mycards/add/1250300
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Serous: Allergic and Viral
Muco-perineal: Bacterial |
|
OTC and Prescription allergic conjunctivitis treatment
|
OTC: opthalmic lubricants/irrigant, cold compresses, alpha adrenergic agonists (vasoconstrictors)
Prescription: antihistamines, NSAIDS, and Mast cell stabilizers |
|
Viral conjunctivitis treatment
|
cold compresses
topical vasoconstrictors NO corticosteroids Ocular irrigants |
|
Hyperacute bacterial conjunctivitis treatment
|
Gonococcal: Ceftriaxone 1g IM QD OR Cefixime 400mg QD OR Azithromycin 2g QD
Chlamydial: Azithromycin 1g QD OR Doxycycline 100mg BID for 7 days |
|
Acute bacterial conjunctivitis treatment
|
Broad spectrum topicals
Aminoglycosides Sulfacetamide 10% solution Fluoroquinolones Azithromycin |
|
Self-care assessment
|
Discharge?
Bilateral/unilateral? Symptom duration? Age? Trauma? Contact lens? medication use? pain/photophobia/blurry vision? |
|
Physiological consequences of asthma
|
Increased work of breathing, decreased CaO2 w/ organ system stress, and heart failure
|
|
Symptoms of asthma
|
Wheezing, dry hacking cough, tachypnea, tachycardia, pale/cyanotic skin
|
|
Beta 2 adrenergic agonists
|
Ephedrine, epinephrine, metaproterenol, terbutaline, albuterol, levalbuterol, salmeterol, formoterol, arformoterol, and pirbuterol
|
|
Albuterol
|
Proventil, Ventolin
Lasts4-6 hours |
|
Salmeterol
|
Serevent
Lasts 8-12 hours |
|
What ACT score indicates an asthma that could be better controlled?
|
< or = 19
|
|
Inhaled albuterol MDI
|
90mcg/puff
ASTHMA MEDICALLY SUPERVISED 4-8 puffs every 30 min up to 4 hours then every 1-4 hours as needed FOR COPD: every 20 min up to 4 hours SELF-CARE PRN 2 puffs 3-4 times a day as needed |
|
Nebulizer albuterol
|
5mg/mL
ASTHMA MEDICALLY SUPERVISED 2.5–5 mg every 20 min for 3 doses, then 2.5–10 mg every 1–4 h as needed, or 10–15 mg/h continuously FOR COPD: 2.5-5mg diluted with NSS to a total of 3mL SELF CARE PRN 2.5 mg diluted with NSS to a total of 3ml 3-4 times a day PRN over 5-15 min |
|
SQ epinephrine for acute exacerbation
|
1mg/mL
0.3-0.5 mg every 20 min for 3 doses |
|
Salmeterol DPI
|
50mcg every 12 hours
|
|
Formoterol DPI
|
12mcg every 12 hours
|
|
Inhaled ipratropium for asthma
|
MDI: 8 puffs every 20 minutes PRN up to 3 hours
self-care: 2-3 puffs every 6 hours Nebulizer: 0.5mg every 20 min for 3 doses then PRN medically supervised self-care 0.25mg every 6 hours |
|
Anticholinergic side effects (ipratropium)
|
Cough
dry mouth unpleasant taste may worsen narrow angle glaucoma |
|
Methylprednisolone IV for acute exacerbations
|
60–80 mg in 3 or 4 divided doses for
48 h, then 30–40 mg/day until PEF reaches 70% of personal best |
|
DPI budesonide
|
ICS
Low-dose:180-600 medium-dose:600-1200 high-dose:>1200 |
|
Montelukast
|
10mg daily in the evening
|
|
Cromolyn
|
MDI: 2 puffs QID
Nebulizer: 20-40mg QID |
|
Omalizumab
|
Steps 5&6 if patients are allergic
SQ every 2-4 weeks |
|
Target theophylline serum concentration for treating acute asthma exacerbations and chronic therapy
|
exacerbations: 12-15mg/L
Chronic, stable: 5-12mg/L Pick a lower range for a patient that has never been on theophylline |
|
Common drug and disease interactions with theophylline and the antileukotrienes
|
CYP3A4 inducers such as aminoglutethimide, carbamazepine, nafcillin, nevirapine, phenobarbital, phenytoin, and rifamycin
|
|
Anti-inflammatory comparisons of activity (highest to lowest)
|
Corticosteroids
Antileukotrienes Cromones Omalizumab |
|
When to obtain steady-state trough and peak serum theophylline concentrations
|
Trough: obtain just before next dose (identifies lowest dosing interval serum concentration)
Peaks: product-specific (identifies highest dosing interval serum concentration) |
|
Proactive measurements for patients taking medium or high doses of inhaled corticosteroids
|
Calcium 100-1500 mg/day
Vitamin D 400-800 units/day May need to add bone-sparing therapy (i.e. bisphosphonate) |
|
Signs of COPD
|
Dec. FEV1 and FVC1
FEV1/FVC <70% barrel chest/(enlarged)right heart failure, ankle swelling, bullae PaO2<60 w/ or w/o PaCO2>45 |
|
Symptoms of COPD
|
chronic cough
chronic sputum production persistent dyspnea (air hunger) |
|
GOLD COPD goals of therapy
|
relieve symptoms
prevent disease progression improve exercise tolerance improve health status prevent and treat complications prevent and treat exacerbations reduce mortality |
|
Tips for COPD therapy
|
Vaccines: Influenza for ALL COPD, pneumococcal for all patients >65 and <65 if <40% FEV1 and Novel H1N1 for <65
Avoid beta blockers Oxygen therapy if PaO2<55 or SaO2<88% Pulmonary rehabilitation is recommended for stages 2, 3, and 4 of COPD (2months) |
|
inhaled iptatropium for COPD
|
exacerbations: Neb: 0.5mg every 20 min for 3 doses then PRN; self care 0.25mg every 6 hours
MDI:8 puffs every 20min PRN up to 3 hours; self care 2-3 puffs every 6 hours maintenance: MDI: 2 inhalations QID (max 12 inhalations/day) |
|
Corticosteroid indication for COPD exacerbation
|
Prednisone/equivalent 30-40mg/day for 7-10 days
|
|
When to add antibiotics for an acute COPD exacerbation
|
If mechanically ventilated AND if evidence of infection (inc. dyspnea, sputum volume, sputum purulence)
|
|
Difference between SBP and DBP
|
SBP/DBP
SBP =CO =during cardiac contraction DBP =TPR =during cardiac filling |
|
RAAS changes in blood pressure
|
Renin is released by catecholamines, dec. renal artery pressure, and dec. Na or Cl delivered to kidneys. ACE converts ANG1 to ANG2 which vasoconstricts, stimulates aldo synthesis, sympathetic outflow, and Na retention.
Also in heart and brain. |
|
Baroreceptor reflex
|
Baroreceptors sense dec. bp and trigger sympathetic stimulation:
NE: alpha1-constriction alpha2-neg. feedback EPI: beta1-inc. heart contractility and CO and inc. renin by kidneys beta2-inc. smooth muscle relaxation |
|
Bradykinin
|
Vasodilator
Broken down by ACE so there's a balance. Impaired in HTN patients |
|
Secondary causes of HTN
|
obstructive sleep apnea, thyroid disease, and parathyroid disease
Inc. Na+ retention in CKD, primary aldosteronism, and renal artery stenosis (due to dec. renal perfusion) Inc. sympathetic NS activity in pheochromocytoma |
|
JNP BP classifications
|
Pre-HTN 120-139 OR 80-89
STAGE 1 140-159 OR 90-99 STAGE 2 >160 OR >100 |
|
Complications in patients with HTN AND LVH
|
there's a 3x increased risk of CV events in these patients than normal HTN patients due to incomplete filling of the left ventricle by via upregulation of RAAS system.
|
|
CKD in HTN patients
|
GFR < 60ml/min/1.73m^2 for >3mths with or w/o kidney damage
Kidney damage >3mths w or w/o abnormal. GFR Increases risk of CVD CKD target organ damange can be functional or structural!! Decreased GFR = functional damage! Elevated SCr indicated decreased filtration also! |
|
HTN patients with PAD
|
Should be treated as aggressively as CAD patient
ABI: SBP in ankle/SBP in brachial artery. <0.90 suggests PAD 1.00 is normal |
|
HTN patients with glomerulosclerosis
|
ACE inhibitors!!!! (DO NOT USE in patients w/ Renal artery stenosis)
inadequate blood flow into bowmans capsule which helps with filtration Look at fundoscopic findings of retinal vessels |
|
Physical exam to diagnose HTN
|
Retinopathy (grade 3 changes-exudates and hemorrhages)
neurological hemiparesis/hemiplegia (stroke/TIA) Neck (goiter, bruits-inc risk of CVD) Palpate pulses (PAD) |
|
Lab testing to diagnose HTN
|
Chem 7 (baseline Na and K, and SCr, glucose)
Fasting lipid panel CVC (hgb and hct) ECG (MI, etc) Urinalysis (proteinuria) |
|
Auscultatory measurements of bp
|
measure with bell
check right and left arm bp |
|
Follow up times for HTN
|
Normal: 2 years
Pre-HTN: 1 year Stage 1: 2 months Stage 2: 1 month; if >180/110, then 1 week KEEP IN MIND THAT OTHER RISK FACTORS REQUIRE SOONER FOLLOW-UP |
|
JNC 7 BP goals
|
General CAD prevention: <140/90
CKD, Diabetes, Angina: <130/80 LVD: <120/80 Lower SBP goal being considered in patients with >500mg/day of proteinuria |
|
Lifestyle modifications to manage pre-HTN or HTN
|
weight loss (most significant! 5-20mmHg decrease)
DASH 2.4gNa or 6gNaCl intake/day Physical activity Moderate alcohol intake |
|
DASH
|
Dietary Approaches to Stopping HTN
Change to diet rich in fruits, vegetables and low-fat dairy products Decrease bp by 5-6/3 in pre-htn and 11-12/5-6 in HTN patients |
|
HOPE study
|
ACE inhibitors are preferred over thiazide because it has more effects rather than just lowering bp because it is thought to prevent platelet aggregation on artherosclerosis
|
|
UK diabetic HTN study (UKPDS)
|
Captopril vs. atenolol
B-blockers don't need to be avoided in diabetics as commonly thought. In this study, b-blockers reduced risk for diabetes-related complications Diabetics have the same risk of having a stroke/MI as a person who has experienced these events! |
|
HOT trial
|
It is not hazardous to have a DBP of <80. In fact, AHA recommends that heart disease patients should have this goal.
|
|
CAMELOT
|
Supports lower BP goal in CAD patients
|
|
Thiazide diuretics
|
HCTZ, chlorthalidone (longest half-life), indapamine, metolazone
First line unless contraindicated (i.e. GFR<30) Primary MOA:arteriolar vasodilation to increase TPR 6.25-25mg reduction in target organ damage Adverse effects: hypokalemia, hyperuricemia, hyperglycemia, gypercholesteremia (last two are most likely temporary See patient in 1-2 weeks to check chem 7 for dehydration and hypotension (SBP<90-100) Interact with lithium, NSAIDs, and digoxin (lithium and NSAIDs common w/ all diuretics) Ethacrynic acid may be used for pt who needs diuretic but is allergic to thiazides |
|
Common side effects in most anti-HTNs
|
fatigue, headache, impotence, photosensitivity, and dehydration/hypovolemia
|
|
Loop diuretics
|
Furosemide, torsemide, bumetanide
Torsemide has longest half-life Primary MOA: inhibits Na and Cl reabsorption hypocalcemia (opposite of thiazide) Can use for GFR<30, preferred for pts with HF Interactions: Lithium, NSAIDs, and digoxin |
|
Aldosterone Antagonists
|
Spironolactone and Eplerenone
MOA: Blocks adlo receptor Check for hyperkalemia and gynecomastia (>risk in spironolactone) in 1-2 wks caution when using: spironolactone in pts with: SCr>2.5 and K>5.0 CONTRAINDICATED: Eplerenone in pts with GFR<30, SCr>2.0, and K>5.5 Metabolized by CYP3A4 so increase dose to 25mg MAX if used w/ fluconazole, erythromycin, verapamil, saquinavir, etc. interacts with potassium sparing diuretics |
|
Potassium sparing diuretics
|
Amiloride & triamterene
MOA: inhibit the sodium channel Mostly used in combo with thiazide diuretics to balance K level Common side effect is hyperkalemia Monitor Chem7 |
|
B-blockers
|
-lol
First line of therapy for angina, post MI, and systolic HF patients. MOA: competes with EPI for adrenergic receptor. (inhibits renin & is a neg. ionotrope,chronotrope) May cause fatigue, impotence, depression, bradycardia, and heart block (common in elderly), bronchospasm, may mask hypoglycemia but not sweating so monitor for this!! Transient hyperglycemia & hypercholesterolemia may occur but not a good reason to stop!! Taper patient off b/c it may cause rebound HTN or MI |
|
Nonselective b-blockers
|
propranolol
Bronchoconstriction occurs!! Avoid in asthmatics! |
|
Cardioselective b-blockers
|
Metoprolol, nebivolol, atenolol, and nadolol
|
|
FDA approved b-blockers for systolic HF and LV dysfunction
|
Metoprolol XL
Carvedilol (XL also) Bisoprolol |
|
ACE Inhibitors
|
-pril
BLOCKS ACE that dec. ANGII (vasoconstrictor) and blocks degradation of bradykinin (vasodilator) DOC for DM, CKD, post-MI, systolic HF patients In CKD patients: nondialysis: lower or d/c if K>5.5 In patients without CKD: lower or d/c if K>5.1 Often used in combo with diuretic. Monitor for hyperkalemia, increase in SCr of 0.5-1 Cough, angioedema(life-threatening, COUNSEL) CONTRAINDICATED for pts with renal artery stenosis, and pregnancy INTERACTIONS with potassium, potassium sparing diuretics, ARBs and NSAIDs |
|
ARBs
|
-sartan
MOA: blocks vasoconstrictor and ALDO-secreting effects ANGII DOC for DM or CKD patients Usually used in combo with thiazide diuretic Hepatically metabolized CONTRAINDICATED in patients with renal artery stenosis, and pregnant pts INTERACTS with potassium, potassium sparing diuretics, ARBs and NSAIDs |
|
Calcium channel blockers
|
Nondihydropyridines:
-Diltiazem -Verapamil Dihydorpyridines: -ipine MOA: Dec. calcium influx leading to arterial and venous vasodilation hepatically metabolized: most are CYP3A4 inhibitors Adverse effects: Constipation headache peripheral edema gingival hyperplasia bradycardia VERAPAMIL HAS GREATEST INTERACTIONS and is P-GLYCOPROTEIN INHIBITOR Interactions: grapefruite juice, digoxin, carbamazepine, cyclosporine, and theophylline |
|
Nondihydropyridines
|
Diltiazem and Verapamil
DO NOT USE IN PATIENTS WITH LVD or SYSTOLIC HF Have a greater negative ionotropic and chronotropic effect |
|
Dihydropyridines
|
-ipine
Greater peripheral vasodilatory effect |
|
Calcium channel blockers
|
Nondihydropyridines:
-Diltiazem -Verapamil Dihydorpyridines: -ipine Good for patients you won't see in 1-2 weeks b/c chem 7 isn't so necessary for these drugs. MOA: Dec. calcium influx leading to arterial and venous vasodilation hepatically metabolized: most are CYP3A4 inhibitors Adverse effects: Constipation headache peripheral edema gingival hyperplasia bradycardia VERAPAMIL HAS GREATEST INTERACTIONS and is P-GLYCOPROTEIN INHIBITOR Interactions: grapefruite juice, digoxin, carbamazepine, cyclosporine, and theophylline |
|
Nondihydropyridines
|
Diltiazem and Verapamil
DO NOT USE IN PATIENTS WITH LVD or SYSTOLIC HF Have a greater negative ionotropic and chronotropic effect |
|
Dihydropyridines
|
-ipine
Greater peripheral vasodilatory effect |
|
HF & HTN
|
ACEI/ARB and BB and LOOP
|
|
POST MI & HTN
|
ACEI/ARB and BB
|
|
HIGH CAD RISK *& HTN
|
thiazide Diuretic OR ACEI OR ARB & BB OR CCB
|
|
Secondary stroke prevention & HTN
|
ACEI and diuretic
|
|
General CAD prevention & HTN
|
ACEI/ARB, CCB, thiazide (if SBP>160 or DBP>100)
|
|
Stable Angina & HTN
|
BB and ACEI/ARB
Use CCB if BB contraindicated |
|
LVD & HTN
|
ACEI/ARB and BB
|
|
B-blockers that cause increased risk of bradycardia
|
verapamil
Diltiazem Digoxin |
|
Aliskiren
|
Tekturna
MOA: Direct renin inhibitor Metabolized via CYP 3A4 Can be used alone but combined with HCTZ to inc. RAAS w/ a dec. in diuresis. Side effects: hyperkalemia, angioedema, diarrhea (elderly and women are more susceptible), and cough |
|
Peripheral alpha 1 blockers
|
Indirect vasodilators: inc. Na and water retention
Doxazosin, Prazosin, Terazosin Side effects: somnolence, priapism, dizziness, first dose syncope Administer at bedtime Dosing titration restart is necessary if pt stops therapy for several days. |
|
Centrally acting alpha 2 agonists
|
Clonidine & Methyldopa
Decreased sympathetic outflow & TPR. Pt should already be on a diuretic before starting this b/c it causes Na and water retention Common side effects: constipation, drowsiness, depression, and dry mouth |
|
Clonidine vs. Methyldopa
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Methyldopa is DOC for pregnant women!
Clonidine: abrupt withdrawal may cause hypertensive crisis. Adverse effects are dose dependent |
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Postganglionic Adrenergic Neuron Blockers
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Reserpine (nasal stuffiness & depression)
Guanethidine Guanadrel |
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direct vasodilators
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Hydralazine
Minoxidil |
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LV dysfunction & HTN
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DO NOT USE DILTIAZEM OR VERAPAMIL
ACEI/ARB BB DIuretics AA-add-on only if pt has HF alpha blockers-only use if pt not on goa with other therapy |
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STEMI & HTN
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ACEI
ARB: only if patient has a cough due to ACEI or intolerant to it BB AA: add-on for pts with LV and MI Dihydropyridine CCBs: inc. mortality if LV is present |
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Stable Angina, UA, NSTEMI
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ACEIs/ARBs
BBs Non-DHP CCBs (only if BB is contraindicated. DO NOT USE IF LV DYSFUNCTION IS PRESENT) |
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Bronchospastic airways (asthma, etc)
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Cardioselective agents
|
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Pregnancy & HTN
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METHYLDOPA or HYDRALAZINE ONLY
DO NOT USE ACEIs, ARBs, OR TEKTURNA! |
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Renal insufficiency & HTN
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Potassium-sparing diuretics and AAs
MONITOR FOR HYPERKALEMIA CLOSELY |
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Gout & HTN
|
THIAZIDES (monitor for uric acid buildup)
If 3 or more gout attacks, avoid diuretic |
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Angioedema & HTN
|
ARBs and ACEIs
|
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African-Americans
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Diuretics or CCBs are best
ACEI angioedema is 2-4x more frequent with blacks then caucasians |
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SHEP and HYVET
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Same BP goal in elderly as other populations
|
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Hypertensive Urgency Vs Hypertensive Emergency
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Both: SBP>180 OR DBP>120
Urgency: lower BP w/in hours to days Emergency: lower right away, within hours! |
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Hypertensive urgency causes
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Nonadherence, suboptimal treatment of HTN, or use of illicit drugs (avoid BBs in these pts)
|
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Hypertensive urgency management
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Reduce BP w/in hours
Pt should be re-evaluated w/in 3-4 days Sodium nitroprusside, nicardipine HCL, Fenoldopam mesylate, Nitroglycerin, Hydralazine hcl, labetalol HCl, and Esmolol HCl |
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HTN in hospitalized patients
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May be higher than 140/90 b/c of acute illness, pain, stress, steroids, or other meds
|
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Normal adult iron level
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Males: 75-175ug/dl
Females: 65-16ug/dl |