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HTN
40
Health Care
Undergraduate 1
03/09/2015

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Term
HTN treatments:
ARBs
Definition
-Lower BP
-Renal protective ability
-Used when ACE inhibitors are not tolerated
-Preferred for people with DM
-Indications for monotherapy include" heart failure, CKD.
Term
HTN:
ACE Inhibitors
Monitoring
Definition
-BP, Electrolytes and renal function are measured and monitored
-Continuing K+ levels are monitored 2/2 potential rapid rise in K+
-Monitor for changes in renal function
Term
Loop Diuretic Names and Dosing
Definition
-Furosemide/Lasix: 20-40 mg BID
-Torsemide/Demadex: 5-10mg daily
-Bumetanide/Bumex: 0.5-2mg BID
Term
Thiazide Diuretic Names and Dosing
Definition
-Hydrochlorothiade: 12.5-50mg QD
-Chlorthalidone/Clorpres: 12.5-25 mg QD
-Metolazone/Zaroxolyn: 2.5-5mg QD
-Indapamide/Lozol: 1.25-2.5mg QD
Term
HTN:
Diuretic Loop
Monitoring
Definition
-Used when GFR falls <30
(Since low GFR allows more time for Na and water absorption, thiazide type diuretics are some what ineffective)
Term
HTN:
Diuretics
Thiazide Use
Definition
-First Line for uncomplicated HTN.
-Often used w/ ACE or ARB
-Can use as monotherapy and combination for CHF, recurrent stroke prevention and DM
Term
HTN:
Diuretics
Thiazide Names
Definition
-Hyzaar (ARB + HCTz)
-Prinizide (ACE + HCTz)
-Aldactazide (K+ sparing diuretic + HCTz)
Term
Rx Tx HTN
Types of Diuretics
Definition
-Choice depends on baseline renal function and serum K+.
-Not usually a first line HTN choice for DM.
1. Thiazide
2. Loop
3. K+ sparing
4. Carbonic anhydrase inhibitors
Term
Standard treatments for HTN
Definition
-Pharmacotherpy + Lifestyle change
-MNT, Activity, Moderate Alcohol intake and wt reduction
Term
Goals for HTN
Definition
130/80
(possibly lower with Nephropathy)
Term
HTN Management:
Drug Classes for DM
Definition
Thiazide Diuretics
Beta Blockers
ACE Inhibitors
ARBs
Term
HTN Management:
Drug Classes for other classes
Definition
Calcium channel blockers
Central acting agonists
Alpha receptor blockers
Alpha + Beta Blockers
Vasodilators
Term
Regulating HTN:
Systemic responses
Definition
-Regulate BP: Autonomic Nervous system + Renin-angiotension-aldosterone system (RAAS)
Term
Regulating HTN:
RAAS
Definition
-Responsible for progression of DM, CVD and renal disease.
-Thru RAAS inhibition, BP is Lowered and albunimuria can be reversed
-RAAS inhibition can also decrease CVD and slow DM progression.
Term
HTN Definition
Definition
-Product of Cardiac output (CO) + Total peripheral resistance (TPR), where CO is the product of stroke volume and Heart rate.
-Occurs due to the bodies inability to maintain homeostasis b/t CO and TPR
Term
HTN goals
Definition
ABC:
A= A1c
B= BP no higher than 130/80
C= cholesterol
Term
HTN Rx
K+ sparing diuretics
Definition
-Only type that increase serum K+
-Clinically combined with HCTz to balance serum K+
(alone, they do little to lower BP)
Term
HTN rx
ARBs, Precautions
Definition
**do NOT use during:
-pregnancy
-renal artery stenosis
-renal or hepatic dx
-angiodema, CHF, severe HTN/CHF
-Daily BP checks
-Fluid Volume and Na depletion should be corrected prior to dosing
Term
HTN rx
ARBs, Side Effects
Definition
-Dizziness, Drowsiness, Diarrhea, Dyspepsia
-HyperK+, Headache, URI
-Cough risk lower than with ACE
Term
HTN rx
ARBs, Dosing Info
Definition
-Take everyday
-Take same time each day
-Start w/ Low dose, then titrate higher, as needed, adding a thiazide diuretic
-Usually better than increasing ARB dosing too high
Term
HTN Rx
ARBs Names/Dosing
Definition
-Candesartan/Atacand: 8-32 mg QD
-Aprosartan/Teveten: 600 mg QD
-Irbesartan/Avapro: 150-300 mg QD
-Losartan/Cozaar: 25-100 mg QD
-Olmesartan/Benicar: 20-40 mg QD
-Telmisartan/Micardis: 20-80 mg QD
-Valsartan/Diovan: 80-320 mb daily
Term
Diuretics
Patient instructions
Definition
-Taken in am with/out food
-Monitor foods high in K+
-Look for s/s of low K+: muscle cramping, fatigue
-BP monitor daily for change
-Rise slow when sitting or lying down
Term
HTN in Children
Interventions
Definition
-Lifestyle Therapy
- >/90th % for age
-Weight control + Physical activity
-If targets not reached in 3-6 months, pharmacologic therapy
-If wt >/95th %: pharmacologic therapy should be started immediately.
-ACE inhibitors are good
Term
HTN in Children and Adolescence: Definition
Definition
-Average systolic or diastolic BP >/95th% for age, sex and Ht profile
-Measured on 3 days
-High Normal is >/90th-<95th%
Term
HTN:
Stage 1
Definition
Normal:
120/80
Term
HTN:
Stage 2
Definition
Pre-HTN:
120-139 / 80-89
Term
HTN:
Stage 3
Definition
Stage I HTN
140-159 / 90-99
-Dx is from 2 BP readings on 2 separate visits
-Person seated position after 5-10 min rest.
Term
HTN:
Stage 4
Definition
Stage 2 HTN:
160/100 (or greater)
Term
Blood Pressure:
Target
Definition
130 / 80
Term
HTN Meds
ACE Inhibitors
Names/Dosing
Definition
-Benazpril/Lotensin: 10-40mg QD
-Captopril/Capoten: 12.5-50mg BID/TID
-Enalapril/Vasotec: 2.5-20 mg QD/BID
-Fosinopril/Monopril: 10-40mg QD
-Lisnopril/Prinivil/Zestril: 10-40mg QD
-Moexipril/Univase: 7.5-30mg QD
-Perindopril/Aceon: 4-8mg QD
-Quinapril/Accupril: 10-80mg QD
-Ramipril/Altace: 2.5-20mg QD
-Trandolapril/Mavik: 1-4mg QD
Term
HTN rx
ACE Inhibitors
Precautions
Definition
-NOT for pregnancy
-NOT bilateral renal artery stenosis
-Cause dilation of efferent arteriole in the renal circulation which can lower GFR, thus causing RF.
-Caution with renal or liver dysnfunction
-Caution w/ angiodema, CHF and elevated K+
-Often effective at lowering BP in Black ppl, yet also increase rick of angiodema.
Term
HTN rx
ACE Inhibitors
Dosing
Definition
1-3 x day, with/out food.
-Must be taken at same time daily
-Lower BP in 1 hour, yet max effect at 8 hours.
-Start low dose, then titrate.
-More beneficial if HCTz added, rather than increasing dose.
Term
HTN rx
ACE Inhibitors
General Information
Definition
-First line of defense for HTN or renal protection in pts with DM
-Can inhibit the progression of micro albuminurea to macro.
-Good w/ HTN and other disease states: HF, Post MI, Strokes, CKD.
Term
HTN rx
ACE Inhibitors
Adverse Effects
Definition
-Cough
-Fatigue, H/A, Dizziness, Drowsiness
-Hyper K+
-HypoTN, GI issues: D/N/V
-Skin Rash
-Taste changes
-Angiodema
-Neutropenia Agranulocytosis
Term
HTN rx
ACE Inhibitors
Drug Interaction
Definition
-Use with NSAIDS, K+ sparing and K+ supplements
-Monitor Lithium Levels
Term
Diuretics
K+ Sparing
Names/Dosing
Definition
-Amiloride/Midamor: 5-10mg QD
-Triamterene/Dyrenium: 37-75mg QD
-Spironolactone/Aldactone: 25-50 QD/BID
-Eplerenone/ Inspa: 50mg QD/BID
Term
Diuretics
General Actions
Definition
-All work on different areas of tbe Kidneys
-Taken every morning due to increased urination
-Loop and K+ sparing may be BID for co-conditions
-Take lower doses initially, then titrate for only HTN doses >25mg which aren't showing benefits
Term
Diuretics
General Cautions
Definition
-GOUT, Renal and Liver Disease
-Electrolyte Imbalances
-Thiazide: Sulfa allergies
Term
Diuretics
General Side Effects
Definition
-H/A
-Photo-sensitivity
-Dry mouth
-N/V
-Orhostatic-hyPOTN
Term
Diuretic
Drug Interactions
Definition
-Stem from electrolyte Imbalance
-NSAIDS can lower AntiHypertensive effect (Ibuprofin)
-Can increase lithium levels
-Increased Salt intake can decrease effects.
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