Term
| Approximately what % of the US adult population has HTN? |
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Definition
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Term
True or false?
Incidence of HTN is relatively equal across both sexes |
|
Definition
|
|
Term
| Are hypertension control rates improving or decreasing? |
|
Definition
improving -
2003 data shows 2/3 of htn patients received treatment |
|
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Term
| What are some major risk factors for HTN? |
|
Definition
1) african-american race
2) smoking, ETOH
3) type A personality
4) dyslipidemia
5) diabetes
6) genetics
7) physical inactivity
8) increased sodium intake
9) age
10) obesity |
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Term
| in terms of etiology - what percentage of patients are idiopathic? |
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Definition
|
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Term
| What are some secondary etiological concerns of HTN? |
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Definition
| renal dysfunction, medications, phenochromocytoma, endocrine disorders, sleep apnea |
|
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Term
| what does total peripheral resistance (TPR) indicate in regard to arteriole muscle? |
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Definition
| arteriole smooth muscle tone |
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Term
| according to JNC-7 classification, what BP indicates stage 1? what about normal, prehypertension and stage 2? |
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Definition
stage one = (140-159/90-99 mmHg)
normal = (<120/<80 mmHg)
pre = 120-139/80-89 mmHg
stage 2 = >160 / >100 mmHg |
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Term
| name some of the most serious consequences of HTN |
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Definition
premature CV disease (ischemic heart disease/ coronary artery disease), angina, myocardial infarction, stroke
heart failure, end-organ damage |
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Term
| Rate of mortality doubles w/ ___ mmHG sys and ___ mmHg diast |
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Definition
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Term
True or false?
most patients will reach systolic BP goal once they reach diastolic BP goal. |
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Definition
False,
reverse
- most reach DBP once they reach SBP |
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Term
| What lifestyle modification provides the greatest approx SBP reduction? |
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Definition
| weight reduction (BMI less than 25kg/m2) |
|
|
Term
| What lifestyle modification is likely to produce the least amount of change in SBP? |
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Definition
|
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Term
| According to JNC7, what are some of the initial treatments of HTN? |
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Definition
| diuretics, ace-inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers |
|
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Term
| What is the primary mechanism of diuretics? |
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Definition
| reduce C by increasing fluid excretion by the kidneys -> decreases the circulating fluid volume that the heart pumps |
|
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Term
| What is the typical name ending of beta blockers? |
|
Definition
"-olol"
ex. metoprolol, atenolol |
|
|
Term
| what is the primary mechanism for calcium channel blockers? |
|
Definition
| dilate arterioles to cause a decrease i TPR |
|
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Term
| ACE inhibitors primarily function by inhibiting the angiotensin-coverting enzyme which prevents the formation of the __________ (a vasocontrictor) |
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Definition
|
|
Term
| What is the typical name ending for angiotensin receptor blockers? |
|
Definition
"-sartan"
ex. iosartan, valsartan |
|
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Term
| name some agents that may increase bp or hr |
|
Definition
1) cough/cold preparations
2) NSAIDs
3) Caffeine
4) appetite suppressants/weight loss
5) herbals/energy boosters |
|
|
Term
| the majority of patients require how many agents for treatment of HTN? |
|
Definition
|
|
Term
| Which type of diuretics should initially be used for most patients? |
|
Definition
|
|
Term
| According to the AHA statement in 2007, what changes occurred regarding thiazide diuretics? |
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Definition
| thiazide diuretic may not be preferred initial agents |
|
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Term
| name steps in the role of pharmacist working with HTN patient |
|
Definition
screen for risk factors
lifestyle modification
reinforce silent killer
education
patient assistance programs
compliance aids
counsel on the good use of OTC agents |
|
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Term
| What is the rationale behind the detailed recommendations for HBPM? |
|
Definition
offers benefit over office BP measurement
patient actively involved in his/her own care |
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|
Term
| epidemiological studies on heart failure shows that it is the leading cause of ________ in persons > 65 |
|
Definition
|
|
Term
| What are some risk factors for HF? |
|
Definition
HTN
myocardial infarction
coronary artery disease
diabetes
dilated cardiomyopathy
valvular heart disease
arrhythmias
cardiotoxic drugs
etoh, smoking |
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Term
| HF impairs the hearts ability to act as a ____ |
|
Definition
|
|
Term
True or false?
there is no single diagnostic test for HF |
|
Definition
|
|
Term
| What are some compensatory responses to maintain adequate CO? |
|
Definition
| increased HR and contractility, increased preload, vasoconstriction to increase blood flow to organs, ventricular remodeling and hypertrophy |
|
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Term
| Which side is affected when the blood backs up into pulmonary circulation = forces fluid into the lungs? |
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Definition
|
|
Term
| which side is affected with blood backs up into peripheral circulation? |
|
Definition
|
|
Term
| What are some common signs on a physical exam that indicates left or right side? |
|
Definition
| dyspnea, fatigue, edema, rales, weight gain |
|
|
Term
| what are some objective measures to determine right or left side? |
|
Definition
|
|
Term
| describe BNP as objective measure of LVEF |
|
Definition
| brain naturioletic peptide ->release by vent when the are over streatched -> rule out other disease that includes SOB, also use as a baseline for treatment |
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|
Term
| NYHA functional class - class IV indicates what? |
|
Definition
| occurrence of symptoms at rest |
|
|
Term
| in AHA.ACC functional class, why can the patients not return to previous stages? |
|
Definition
| to prevent ventricular hypertrophy and remodeling. |
|
|
Term
|
Definition
| 3rd sound due to abnormal vent filling |
|
|
Term
| jugular venous distention is a sign of ___ side HF |
|
Definition
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|
Term
| Stage C or AHA/ACC functional class is the largest class ... what is stage C? |
|
Definition
| means past or current symptoms of HF associated with underlying structural disease |
|
|
Term
| How does digoxin help in treatment of HF? |
|
Definition
| improves symp/inc contractility/toxicity |
|
|
Term
| How do ACE inhibitors help treat HF? |
|
Definition
| improves the ventricular remodeling if routinely used |
|
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Term
| according to principles of therapy, stage D would indicate special treatments such as? |
|
Definition
| heart transplant or hospice |
|
|
Term
| What are some non-pharmacological therapies? |
|
Definition
dietary sodium and fluid restriction
weight loss if appropriate
regular exercise
abstinence from etoh and tobacco
influenza and pneumococcal vaccinations |
|
|
Term
| What are some rx meds known to exacerbate HF? |
|
Definition
1) glitazones
2) pregabalin
3) rx strength NSAIDs
4) corticosteroids
5) cilostazol
6) amphetamines
and possibly metformin |
|
|
Term
| What are some OTC agents that can contribute to HF? |
|
Definition
| NSAIDs Cough/cold preps salt substitutes food labels herbals |
|
|
Term
| what is the pharmacist's role in HF? |
|
Definition
| educate patients and families, lifesstyle mods, risk factor management, vaccinations, adherence to meds |
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