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64 Cards in this Set
- Front
- Back
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According to the JNC VII Guidelines, what is Normal BP?
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<120 &
<80 ie, if DBP is 81 = Pre-HTN or if SBP is 121 |
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According to the JNC VII Guidelines, what is HTN, Stage II BP?
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>/= 160
OR >/=100 |
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According to the JNC VII Guidelines, what is Pre-HTN BP?
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<140 (120-139)
OR <90 (80-89) |
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According to the JNC VII Guidelines, what is HTN, Stage I BP?
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<160 (140-159)
Or <100 (90-99) |
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Way to measure:
Pump up to? When Systolic? When Diastolic? |
Pump up to: 30mmHg beyond pulse vanish
When Systolic: 2 consecutive beats heard When Diastolic: no audible pusle |
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Common etiology of Kidney related HTN in young men?
WOmen? |
Renovascular Dz in:
Men: Renovascular HTN Women: Fibromuscular Hyperplasia--occlude Renal A. |
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What are Initial Rx for Stage 1, (<160 Or <100)
Best Drug? other options? |
1 Rx
Thiazide Diuretics for Most --may consider ACEs, ARBs, BB, CCBs or Combos --Not This and Next are Tx options AFTER Pt is NOT at Goal BP after having tried Lifestyle Mods |
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What are Initial Rx for Stage 2, (160+ Or 100+)
Best Drug? other options? |
Combo Tx:
2-Rx combo for most -Usually: 1 Thiazide-Type DUs AND 2. ACEI -----or ARB, or BB, or CCB NOTE: DO NOT Give K+ SDUs with an ACE, as AE of ACEs is HyperKalemia... THo for HTN, recommended DU is THiazide, which is a K Waster---so okay in this lecture |
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If not at goal after Tx for Stage 1 or Stage 2 HTN, what then
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Optimize dosages or add additional drugs until goal is achieved
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List some components of Lifestyle Mod for HTN?
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Weight Reduction
DASH Eating Plan Dietary Na Reduction Aerobic Physical Moderate ETOH note: 5-10mmHg/10 Kg |
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What is Dougherty's mnemonic for HTN Drugs?
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AAA BC DD
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What are the 3 As
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1. Alpha-1 Blockers/ Centrally Acting Alpha 2-AGONISTS
2. ACEs 3. ARBs |
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What are BC drugs?
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B- Beta Blocker
C- CCBs |
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What are the DD drugs?
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Diuretics
Dilators |
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What is effect/MOA for Alpha-Blockers in HTN Tx?
Name 3 Drugs/ their endings? |
Vascular Sm. mm. Relax
---Alpha-1 Receptors in Most ----also Urinary/Prostate/Fat --the Zosins 1. Prazosin 2. Terazosin 3. Doxazosin |
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AEs of Alpha-Blockers
"zosins" |
Postural HypoTN
Dizzy Sex Dysfxn |
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Compelling reason to use a Zosin Alpha Blocker?
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in HTN with PT with BPH
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What is MOA for Centrally Acting Alpha-2 AGONISTs?
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Rely on Autoreceptor Feedback by Alpha-2 Receptors on Pre-Synaptic N.
AND!! on Extrasynaptic Space on Postsynaptic N. --(out of the cleft) --NE Binds and reduces further release--ie sense that the Nerves NT is already in synapse |
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What is prototype drug that is Centrally Acting Alpha-2 AGONIST that reduces sympathetic output?
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Clonidine
--short duration ----emergent tx ---Rebound HTN w/o tapering |
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In add to needing to taper clonidine (a-2 agonist) what drug interaction exists?
Other AEs? |
TCAs dec anti-HTN effects of c
of clonidine other AEs: HypoTN, dry mouth, impotence, sedation, rebound HTN |
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WHat is another centrally acting alpha-2 agonist to reduce Symp Output?
Indication for use? |
MEthyldopa
--used in Preggers with Chronic HTN |
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What is AE of ACEs:
in preggers? anyone? |
Teratogenic in Preggers
Cough due to Bradykinin Buildup |
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3 MOAs for ACEs?
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1. Dec Angio II =less TPR
2. Dec. Angio II = less Aldo = less Volume 3. Reduced Dest of Bradykinin = Vasodilation |
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Which ACEs are Prodrugs?
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ALL "prils" except Captopril
--Note: BQREL - prils are Primary Renal Elim --MOX-pril is Hepatic rest are mixed: CFPT |
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What AE is 4.5x riskier in blacks?
K+ AEs? 2 COntraindications for ACEs? |
Angioedema/Anaphylaxis worse in blacks
HyperKalemia--additive with K+ SDUs Contra: Preggers and Renal A. Stenosis |
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What is the suffix for ARBs?
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"sartans"
- |
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What does Aliskiren do?
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Inhibits action of Renin Directly
--ie, upstream of ACEs --newer drug for HTN ---being studied for other uses |
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Regarding Beta Receptors, what do you wish to do with Tx for HTN?
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Block Stimulation of beta-1s
and NOT beta-2s ---similar to blocking Alpha-1s , but agonizing Alpha-2s is good too. B1 found in Heart, Kidney and Fat B2 in Lungs, Bladder, Eye and Vessels==relaxative for all |
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What do drugs that block B1 in heart, kidney and fat do?
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dec rate and force of contraction
dec renin secretion dec lipolysi |
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When are BB a compelling Rx for HTN patients??
When bad? |
When they also have STABLE HF
Bad for Asthmatics/COPDers if using non-selective BB that block relaxative effects of B2 stimulation probably not good in DM --can mask the Sx |
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What do all BB end in?
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ol
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What do the BB with B1 selectivity end in?
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olol if A-M
any olol N-Z are NOn selective and Carvedilol is a-1 and non-selective BB |
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Renal effects of BB?
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Block B-receptors in JG complex
-reduces renin secretion: =dec Angio II =dec Systemic Vasc Res. |
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AEs of BB?
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Bronchospasms
Brady, HF Sex Dysfxn Excercise Intolerance CNS toxicity--depress/insom,fatigue inc VLDL and dec HDL --prolong HypoGlyc--bad in DM AV Block, Obstructive Airway Dz |
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What do CCB do?
Force? Vessels? Cardiac Vessels? HR? Peripheral Vasc Resis? |
Relax Myocardial and Vasc. Sm. mm.
--reduces contractility and dec PVR and increases Cardiac Perfusion --slows conduction in SA and AV nodes = dec HR |
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2 Sub cats for CCB Agents?
Which is better for Cardiac? Which is better for dec PVR? |
Nondihydropyridines
= cardiac selective Dihydropyridines --end in "pine" Vascular Selective |
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What are the 2 Non-dihydropyridines?/non-"pines"
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Verapamil
Diltizaem watch for constipation in Verapamil |
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Which CCB will you use in HTN?
name some? Which is most effective (i think) |
The Pines:
ie Nifedipine, Amlodipine, Vaso Dil high to lowest 1. Nifedipine > Diltiazem > Verapamil |
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What is another major benefit for the Pines?
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Inc. Coronary Blood Flow
--(in spite not being the cardiac selective) |
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AEs of Verapamil and Diltiazem
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COnstipation--most with Verap
AV Block--sinus brady Flushing Headache HypoTN Precip/Exacerbate HF |
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AE of the Pines (dihydropyridines
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Peripheral Edema
Flushing/H/Syncope/HypoTN Dizy, Palps CNS: fatique, vertigo weak Hearth Burn Sx--relaxed eso sphincter |
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What is MOA for Thiazide Diuretics?
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Ibx NaCl Transporter in DCT--5% of Na R there
--modest/low ceiling DUs |
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Regarding Loop DUs and Thiazides, which is better/more effective in:
1. Efficacy of DU alone 2. Anti-HTN 3. Ca+ Excretion affected 4. Effective in Low GFR |
1. Loops
2. Thiazides--!!!! 3. Loops Increase, Thiazides Decrease it (good) 4. Loops. thiazides ineffective |
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MOA for Nitrates/Dilators?
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Nitrates release NO-->acts guanylyl cyc. --> inc. cGMP --> relax all sm. mm.
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Main 3 benefits of Dilators due to?
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1. Pronounced Dil of LARGE VEINS--dec preload
2. Preferential Dil of Large EpiCardial A. --redistribs coronary flow from normal to ischemic areas 3. Mild ArterIOLAR Dil: decreases Afterload in system |
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Special note for Nitrate Tx?
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need 8-12 hour nitrate free period/day
--else tolerance |
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AEs of Nitrates?
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Throbbing headace--common and severe--reduces with several days of Tx
HypoTN--dizy weak Rash TachyCardia---reflex sympa |
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Drug Interactions of Nitrates (Dilators for Dougherty's AAABCDD)?
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PDE Ihbibitors
---these guys prevent breakdown of cGMP by PDE and NOs from Nitrates inc cGMB = double wammy =profound Hypotension |
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What are commonly added to ACEs or ARBs
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CCBs or Thiazide DUs
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What are commonly added to Thiazide DUs
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BB or Aldosterone Antags (spironolactone)
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HTN With Elderly: due to:
inc. TPR dec Renin activity (renal dz) inc LVH what are 2 good Tx options what are Rx avoided |
Rx: CCBs or Thiazide DUs
NO Rx: ACEs/ARBs due to renal Dz |
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With Black folks and HTN, due to:
dec Renin activity inc. Volume inc PVR what are 4 Rx/regimens that good? |
Thiazides, CCBs, ACEs, ARBs, BB
--combos work best |
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for HTN Tx in Obese, due to:
dec renin act. inc Volume inc PVR (fat itself) inc LVH what are 4 good Rx? |
Same as blacks, but combo method NOT mentioned
so, Rx: Thiazides, CCB, ACEs, ARBS, or BB |
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for Diabetics with HTN, and nephropathy, what are best Rx options?
what should be avoided? |
ACEs, ARBs, Thiaz, CCB
~~ BB BB can mask Sx---prolly avoid in DM |
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With HTN Tx in CKD, due to:
inc plasma Volume inc RAA reflexes what are 3 best options? caveat to 1 of them? |
ACEs, ARBs, Loops
NO ACEs if CKD is due to reduced renal perfusion!!! |
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With HTN Tx in HF Pt with LVH due to :
dec EF what are 2 best Rx? |
with LVH give
ACE and CCB reduce volume and TPR with ACE and reduce contractility and HR with CCBs ---dihydropyridine "pines" remodel LVH for better |
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HTN Tx in CAD Pt or Post MI patient, what are best options?
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CAD: BB, ACEs, ARBs, Aldosterone Antags (spirono)
Post MI: BB, ACEs, Aldo Antatgs |
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What is avoided in CAD Pt?
(note, not mentioned in Post-MI) What is probably best 1st Rx in either CAD/POST MI or CHF? |
NO CCB in CAD -- don't know why
Best for all 3 is BB!!!!! |
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HTN in CHF Pt due to
dec EF what are 5 Rx options What is Avoided? |
Rx: BB (MI or CAD too)
Rx: BB, ACE/ARB, Thiz, Aldo Antag NO RX CCB |
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What two conditions are CCB not used for HTN Tx?
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CAD and CHF with reduced EF
tho it is used in LVH with reduced EF |
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BPH tx for HTN?
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Alpha Blocker
the Zosins for Alpha 1 block or Alpha 2 Agonist clonidine |
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Now go do Case Hx which are start on p 80 of Notes
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DO do these.
they're good + there are 2 that were oral so only on very Last couple slides of Narrated PPT |
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2 Final Cases---note in notes---so yes ignore last part of last card
Case Hx: 67, black, 142/94, normal HR, slight LVH put her on? |
Stage 1 HTN
ACE , CCB recom for LVH + since black = thiaz of BB ==best Rx: Thiazide or CCB |
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Case:: 43, 162/100, HR 86, white, mom has HTN, has headaches
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Stage II
-ACE or DU pretty normal + for headaches use CCB or BB to ease headach |
