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Ripley Rotation
Hypertension
38
Pharmacology
Post-Graduate
04/11/2011

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Cards

Term
Normal Blood Pressure
Definition
<120/
<80
Term
Prehypertension
Definition
120-139/
80-89
Term
Stage 1 HTN
Definition
140-159/
90-99
Term
Stage 2 HTN
Definition
>160/
>100
Term
Cardiovascular Risk Factors
Definition
HTN, Cigarette smoking, BMI >30kg/m2, Physical Inactivity, Dyslipidemia, DM, Microalbuminuria or GFR <60mL/min, >55 yo M or >65 yo F, Family HO of premature cardiovascular disease
Term
When to start Lifestyle Modification
Definition
Not at Goal BP (<140/90) or (<130/80 for patients with DM or CKD)
Term
Lifestyle modifications
Definition
Weight Reduction (BMI 18.5-24.9)
DASH diet (fruits,veges, and lowfat dairy)
Physical Activity (30 min most days)
Moderation of EtOH (2 drinks for men, 1 drink for women)
Sodium Restriction (<2.4g)
Term
B-Blockers MOA
Definition
Blocking B1 in heart causes: decrease HR and contractility, decreased renin secretion, decreased sympathetic outflow from CNS, altered baroreceptor function, increased synthesis of prostacyclin in smooth muscle cells, increased release of NE
Term
Angiotensin II receptor antagonist MOA
Definition
Block AT1 receptors in a competitive, but essentially irreversible manner because of their high affinity for the slow dissociation from the receptor.
Term
Thiazide Diuretic MOA
Definition
Distal tubule, competes for Cl binding sites on the Na & Cl symporter, causes ions to remain in the tubule lumin to be excreted. Increase K bc increased Na present for Na/K exchange pump. Loose: Na/K/Cl/H2O/Mg/halogens, retain uric acid/Ca
Term
Loop Diuretics MOA
Definition
Function at Ascending Loop of Henle. Bind to Cl binding sites of the Na/Cl symporter to decrease the gradient. Less water is retained from the collecting duct, leading to more dilute urine. Loss Na/K/Cl/Mg/Ca/H2O, retain uric acid
Term
K Sparing Diuretics MOA Type 1
Definition
Aldosterone increases Na/H20 reabsorption and enhances K excretion. Compete with the binding site of aldosterone. Main site of action is the distal tubule and collecting ducts. Loose Na/Cl/H2O, retain K
Ex: Spironolactone and Eplerenone
Term
K Sparing Diuretics MOA Type 2
Definition
Late distal tubule and collecting ducts. Directly interfere with Na entry through the Na-selective ion channels in the collecting tubule. Loose Na/Cl/H2O, retain K
Ex: traimterene and amiloride
Term
Intervals of r follow-up of BP based on initial measurements
Definition
Normal- 2 years
PreHTN- 1 year, lifestyle counseling
Stage 1- confirm in 2 months, lifestyle
Stage 2- confirm in 1 month, Refer if >180/110 or clinical symptoms
Term
Goals for Uncomplicated HTN
Definition
<140/
<90
Term
Goals for Diabetes
Definition
<130/
<80
Term
Goals for Renal Disease
Definition
<130/
<80
Term
Goals for CAD or high CAD risk
Definition
<130/
<80
Term
Goals for Heart Failure
Definition
<120/
<80
Term
Monitoring Thiazides
Definition
Na, K, Cl, CO2, BUN, SCr, glucose, BP
Term
Monitoring Loops
Definition
K, SCr, BP
Term
Monitoring Aldosterone Receptor Blockers
Definition
K, SCr, BP, questions about adverse effects, gynocomastia
Term
Monitoring B-blockers
Definition
BP, HR, EKG, questions about adverse events
Term
Monitoring CCB
Definition
NDHP: BP, HR, EKG, AE
DHP: BP, physical assesment, AE
Term
Monitoring ACE-I's
Definition
K, SCr, physical assessment, AE
Term
Monitoring ARB's
Definition
K, SCr, BP
Term
How do AHA guidelines differ from JNC-7
Definition
BB should be used only with compelling indications such as angina, HF, post-MI. Not for uncomplicated HTN
Term
Therapy in African Americans
Definition
Decreased response to BB, ACE-I, ARB
More responsive to Diuretics & CCB
Term
Appropriate tx in CVA
Definition
ACE-I & thiazide
Term
Appropriate tx in IHD
Definition
Stable Angina: BB or CCB
Unstable angina or post-MI: BB and ACE-I, then thiazide
Term
Appropriate tx in HF
Definition
Asymptomatic: ACE-I with BB if stable. Then thiazide
Symptomatic: ACE-I, BB, ARB, and aldosterone antagonists with loop diuretics.
Term
Appropriate tx in DM
Definition
Need ACE-I or ARB to reduce risk of renal failure (w/ verapamil or diltiazem if those cannot be tolerated).
ARB preferred over ACE-I for proteinurea patients. Use thiazide to make more effective. Use BB if CAD present
Term
Appropriate tx in COPD/Asthma
Definition
BB, Alpha-Beta Blockers may worsen asthma.
Use ACE, if cough occurs ARB is alternative. OTC cough/cold remedies may raise bp temporarly.
Term
Appropriate tx in dyslipidemia
Definition
High doses of thiazides/loops may increase TC, TG, LDL, but not normal doses.
BB may transiently increase TG and reduce HDL, but they are cardioprotective.
Alpha-blockers may decrease TC and increase HDL. ACE-I, ARB, CCA, central α2 agonists are lipid neutral.
Term
Appropriate tx in gout
Definition
elevated uric acid levels may reflect decrease in renal blood flow. Diuretics should be avoided in gout pts.
Diuretic induced hyperuricemia does not require treatment unless symptoms.
Term
Appropriate tx in CKD
Definition
GFR below 60ml/min (SCr over 1.5), or albuminuria.
Goal is to slow deterioration of renal function and prevent CVD.
ACE-I or ARB recommended, NKF also recommends loop diuretic. Monitor SCr, K
Term
Appropriate tx in LV hypertrophy
Definition
lean toward use of ACE-I.
No help from vasodilators
Term
Appropriate tx in pregnancy
Definition
increased risk to mother and fetus.
Use methyldopa, BB, vasodilators. No renin-inhibitors, ACE-I or ARBs due to fetal risk
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