Hosam Mohamed-
<120; <80
What is the SBP & DBP for "Normal Patients" ?
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120-129; <80
What is the SBP & DBP for " Prehypertension"?
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130-139; 80-89
What is the SBP & DBP for "HTN- Stage 1"?
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>140; >90
What is the SBP & DBP for "HTN-Stage 2"?
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if >20/10mmHg
When do we start a Stage 2: HTN patient on 2 different medications?
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need ASCVD risk; may or may not start medication; more aggressive treatment/follow up
What are the clinical guidelines for a Stage 1: HTN patient?
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pulmonary disease, valvular heart disease, ED, PAD/PVD, heart block/ bradycardia
Which disease states do we avoid Beta-blockers in? (5)
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b, c
Which disease states do we avoid non-DHP CCBs?
a) Pulmonary disease
b) heart failure
c) valvular heart disease
d) erectile dysfunction
e) PAD/PVD
f) Heart block/ Bradycardia
g) Pregnancy
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d
Which disease states do we avoid aldosterone antagonists?
a) Pulmonary disease
b) heart failure
c) valvular heart disease
d) erectile dysfunction
e) PAD/PVD
f) Heart block/ Bradycardia
g) Pregnancy
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g
Which disease state do we avoid ACEIs and ARBs?
a) Pulmonary disease
b) heart failure
c) valvular heart disease
d) erectile dysfunction
e) PAD/PVD
f) Heart block/ Bradycardia
g) Pregnancy
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ACEI or ARB + thiazide; ACEI or ARB + CCB
What are the preferred medication combos for HTN?
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ACEI + ARB
Which medication combo do we avoid in HTN?
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carbonic anhydrase inhibitors, osmotic diuretics
Which diuretics are not useful for HTN?
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acetazoldamide, dorzolamide
What are the carbonic anhydrase inhibitors? (2)
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mannitol
What is the Osmotic diuretic?
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f; must combine w/ other BP medication
Potassium-sparing Diuretics are effective as standalone therapies. T/F?
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significant CKD w GFR< 40 ml/min
When do we avoid Potassium-sparing diuretics?
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increased risk of hyperkalemia; we are blocking aldosterone; less Na+ uptake into the cell; less excretion of potassium
Why are Potassium-sparing diuretics a bad combo in RAAS or aldosterone antagonists? Why?
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treatment-resistant, ckd; GFR <30ml/min, hyponatremic patients
Which types of patients are Loop Diuretics reserved for? (3)
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primary aldosteronism, heart failure, resistant HTN
Spironolactone & Eplerenone are preferred agents in patients who possess what conditions? (3)
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low Na+ diet, Caucasians, patients w low renin levels
Which patients have a better response to ACEI/ARBs? (3)
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african americans, chronic NSAID users
Which patients have an attenuated response to ACEI/ARBS? (2)
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pregnancy, bilateral renal artery stenosis
When do we NOT use ACEI/ARBS? (2)
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aliskiren, increased lithium serum concentrations, potassium-sparing diuretics, direct renin inhibitors
Which DDI's should we watch out for when prescribing ACEI/ARBs?
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increase in SrCr of at least 30%
How do we monitor for renal artery stenosis in patients on ACEI/ARBs?
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c
There are no renal dose adjustments in _______.
a) thiazides
b) ACEi
c) ARBs
d) Aliskiren
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false; less than 1%
The cross-reactivity of ACEI and ARBs is high. T/F?
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6 weeks
If you stop an ACEi for angioedema cross-reactivity, how long should you wait before starting an ARB?
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on a thiazide, volume-depleted, elderly; risk of hypotension
Starting doses for ACEI/ARBs should be reduced by 50% in patients who are what? Why?
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don't crush up oral pellets; take with milk or water
Counseling points for Aliskiren (2) ?
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heart failure w/ reduced EF, stable ischemic heart disease, Acute coronary syndrome, diabetes, CKD
What are Compelling Indications for ACEI & ARB use? (5)
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angioedema, pregnancy, rash
Which AE's do we discontinue ACEi/ARBs? (3)
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methyldopa, nifedipine, labetalol
Which Medications do we use in pregnancy? (3)
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b, f
Which medications do we AVOID in Valvular Heart disease?
a) methyldopa
b) beta blocker
c) Losartan
d) Alpha blocker
e) ARB
f) non-DHP CCB
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b
Which medication is the treatment of choice in Thoracic Aortic Aneurysms?
a) methyldopa
b) beta blocker
c) Losartan
d) Alpha blocker
e) ARB
f) non-DHP CCB
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c
Which medication is the treatment of choice for gout?
a) methyldopa
b) beta blocker
c) Losartan
d) Alpha blocker
e) ARB
f) non-DHP CCB
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d
Which medication is the medication of choice for Benign Prostatic Hyperplasia?
a) methyldopa
b) beta blocker
c) Losartan
d) Alpha blocker
e) ARB
f) non-DHP CCB
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b, e
Which medication is used for Afib?
a) methyldopa
b) beta blocker
c) Losartan
d) Alpha blocker
e) ARB
f) non-DHP CCB
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ACEi or ARB + BB
What is the HTN-medication combo for Caucasians?
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CCB + diuretic
What is the HTN-medication combo for African Americans?
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d
Which diuretic is used in Heart failure patients?
a) osmotic
b) thiazide
c) potassium sparing
d) loop
e) AA/MRAs
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dofetilide, sotalol, droperidol
A patient on thiazide diuretics + _____ = increased risk of arrythmias. (3)
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lithium
A patient on thiazide diuretics + _____ = lithium toxicity
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digoxin
A patient on thiazide diuretics + ______ = digoxin toxicity
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increases; electrolyte
Combining diuretics ________ risk of various _________ abnormalities.
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decrease efficacy
NSAIDs _________ of thiazides.
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c
Which thiazide may have some effect on Ca++ blockade?
a) HCTZ
b) chlorothalidone
c) indapamide
d) metalozone
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d,e
Which diuretics do we have to watch K+ & SrCR?
a) osmotic
b) thiazide
c) potassium sparing
d) loop
e) MRAs
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e
Which ACEi is the only "true once daily"?
a) Captopril
b) Enalapril
c) Lisinopril
d) Moexipril
e) Trandolapril
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a
Which ACEi do we watch for Sulfa allergies?
a) Captopril
b) Enalapril
c) Lisinopril
d) Moexipril
e) Trandolapril
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a, c
Which ACEi is NOT a prodrug?
a) Captopril
b) Enalapril
c) Lisinopril
d) Moexipril
e) Trandolapril
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b
Which is the only available via IV?
a) Captopril
b) Enalapril
c) Lisinopril
d) Moexipril
e) Trandolapril
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a
Which is required to be taken 2-3x/ day?
a) Captopril
b) Enalapril
c) Lisinopril
d) Moexipril
e) Trandolapril
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d
Which is required to be taken with food to increase absorption?
a) Captopril
b) Enalapril
c) Lisinopril
d) Moexipril
e) Trandolapril
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SBP-DBP; 40-60
The formula for Pulse Pressure? Normal range?
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structure changes/ Afib
High pulse pressure =
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poor heart function, low CO
Low pulse pressure =
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(SBP x 1/3) + (DBP x 2/3) ; 70-100
MAP formula? Normal range?
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increased risk of blood clots, CVA, HF
High MAP =
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low perfusion to brain/kidneys
Low MAP =
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Mean arterial pressure
-average pressure throughout the cardiac cycle
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pulse pressure
- a measure of arterial wall tension
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elevated bp, 4th heart sound, av nicking, cardiomyopathy, carotid bruits
Signs of Hypertension (5)
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headache, fatigue, dizziness, facial flushing
Symptoms of HTN (4)
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2-3 measurements over 2-3 visits
Diagnosis of HTN?
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false
CVD risk is equal in White-Coat HTN and Masked-HTN. T/F?
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b
Do we treat a patient who has White-Coat HTN with a normal BP reading at home?
a) yes
b) no
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sleep deficits, heavy drinking, physical inactivity, smoking, perceived health
Incidence-impacting factors? (5)
