thera 4 test 2 HTN

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coal
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268495
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thera 4 test 2 HTN
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2014-03-30 19:32:25
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thera test HTN
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thera 4 test 2 HTN
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thera 4 test 2 HTN
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  1. MAP equation
    1/3SBP + 2/3DBP
  2. pulse pressure
    SBP - DBP
  3. blood pressure classifications
    • normal <120/80
    • prehypertenxive 120-139/80-89
    • stage 1 140-159/90-99
    • stage 2>160/100
  4. risk factor for CVD
    • HTN
    • smoking
    • obesity
    • physical inactivity
    • dyslipidemia
    • DM
    • microalbuminuria or GFR < 60 ml/min
    • >55 men, >65 women
    • family history of premature CVD (m < 55, w < 65)
  5. target organ damage from HTN
    • heart
    • stroke TIA
    • nephropathy
    • PAD
    • retinopathy
  6. thiazide AE
    • decrease Na,K,Mg, total water
    • increase Ca, uric acid, glucose, lipids
    • photosensitivity
  7. which thiazide is not affected by lipids
    indapamide
  8. which thiazide work at low CrCl
    metolazone, indapamide
  9. who do we avoid thiazides in
    • low CrCl < 30ml/min
    • gout
    • hyperlipdemia
    • DM
  10. what is most effective for HTN in pts with renal impairment
    loops
  11. K-sparing diuretics
    • spironolactone
    • eplerenone
    • triamterene
    • amiloride
  12. K-sparing aldosterone antagonists
    • spironolactone
    • eplerone
  13. K-sparing that work in the distal tubule
    • amiloride
    • traimterene
  14. spironolactone AE
    • gynecomastia
    • alopecia
  15. place in therapy for K-sparing diuretics
    combination with TZD's to reduce effect on potassium
  16. drug of choice for diuresis in pts w/cirrhosis
    spironlactone
  17. diuretic to avoid in renal insufficiency
    k-sparing
  18. drug interactions with k-sparing drugs
    • digoxin
    • lithium
    • nsaids
    • hypoglycemic agensts
  19. SE of ACE inhibitors
    • cough
    • hyperkalemia
    • angiodema
    • rash
    • taste perversion
  20. which ACEI are not dosed QD
    • captopril TID
    • enalapril BID
  21. who do we avoid ACEI in
    • bilateral renal artery stenosis
    • pregnancy
  22. ACEIs & ARBs drug interactions
    • NSAIDs
    • lithium
    • K-sparing diuretics
  23. NDH CCB
    • verapamil
    • diltiazem
  24. dihydropyridines CCB
    • nefedipine
    • felodipine
    • amlodipine
  25. who do we avoid CCBs in
    HF
  26. what do NDHP target
    rate control
  27. what do DHP target
    BP control by vasodilation
  28. AE of beta blockers
    • xfatigue
    • bronchospasm
    • sezual dysfunction
    • glucose metabolism
    • increased lipids
    • depression
  29. alpha 1 blockers
    • prazosin
    • terazosin
    • doxazosin
  30. AE of alpha 1 blockers
    orthostatic hypotension
  31. central alpha 2 agonists
    • methyldopa
    • clonidine
    • guanfacine
  32. which central alpha 2 agonist causes hepatotoxicity
    methyldopa
  33. vasodilating agents
    • hydralazine
    • minoxidil
  34. which vasodilation agents are used in pregnancy and HTN crisis
    hydralazine
  35. AE of hydralazine
    • HA
    • tachycardia
    • SLE like symptoms
  36. AE of minoxidil
    • tachycardia
    • pericardial effusion
    • hirsutism
  37. Tx initiation for general nonblack
    • thiazide
    • CCB
    • ACEI or ARB
  38. Tx initiation for general black
    • thiazide
    • CCB
  39. Tx initiation for >18 yo with CKD
    ACEI or ARB
  40. Tx of heart failure
    • ACEI
    • diuretics
    • beta blockers
    • ARBs
    • spironolactone
  41. Tx o MI
    • beta blockers
    • ACEI
    • splerenone
  42. Tx of DM 1 & 2
    • ACEI
    • ARB
    • beta blockers
    • diuretics
  43. Tx of Chronic renal disease
    • ACEI
    • ARB
  44. Tx of secondary stroke prevention
    • diuretics
    • ACEI
  45. monitoring drug therapy with antihypertensives
    • if goal is not reached q/I a month = increase dose or add a second drug from another class
    • if goal is not reached w/2 drugs - add and titrate a 3rd drug
  46. drugs not to combine
    • ACEI + ARB
    • beta blocker + diltiazem or verapamil
    • ACEI/ARB + k-sparing diuretics
    • combo of centrally acting agents
    • clonidine + beta blocker
  47. what do we use in hypertensive emergency
    • sodium nitropursside
    • fenoldapam
    • nicardapine
    • nitroglycerin
    • labetalol
    • hydralazine
    • enalaprilat
  48. goal BP in hypertensive urgency
    160/110
  49. BP control in hypertensive emergency
    reduce 25% from initial, usually within hours
  50. HTN emergency, sodium nitroprusside avoid in
    • CVA
    • hepatic/renal dysfunction
  51. HTN emergency,  fenoldopam avoid in
    glaucome
  52. HTN emergency, nicardapine avoid in
    • heart block
    • CHF
  53. HTN emergency, nitroglycerin avoid in
    • renal damage
    • CNS damage

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