RX PREP HYPERTENSION

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created 2 months ago by vodaosu88
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1

What's the BP goals for HTN according to ACC/ AHA guidelines?

card image
  1. Normal or elevated BP - lifestyle interventions
  2. Stage 1 Hypertension - treatment depends on risk (any patient with clinical ASCVD)

You can assume the ASCVD-risk for those without clinical ASCVD is >10% for those with conditions like diabetes, over 65 Y/O, many risk factors! Treatment necessary as well!

3. Stage 2 hypertension - drug treatment

2

What's goal BP?

  • BP <130/80 mmHg for all patients
3

What's the first line BP treatment for

  • Non-black
  1. Thiazide
  2. CCB
  3. ACEI or ARB
4

What's the first line BP treatment for

  • Black
  1. Thiazide or
  2. CCB
5

What's the first line BP treatment for

  • CKD Stage 3 or albuminuria* (eGFR <60 mL/min/1.73 m2 or urine albumin >300 mg/day)
  • ACEI or ARB
6

What's the BP treatment for

  • stage 2 HTN and average BP >20/10 mmHg above goal?
  • Start 2 drugs
    • Pick from the four preferred drug classes first
    • Do not use ACEI and ARB together
7

What are some 7 key drugs that can increase BP?

  1. Amphetamines and ADHD drugs
  2. Cocaine
  3. Decongestants (e.g. pseudoephedrine, phenylephrine)
  4. Erythropoiesis-stimulating agents
  5. Immunosuppressants (e.g. cyclosporine)
  6. NSAIDs
  7. Systemic steroids
8

What's the brand name of

  • Lisinopril/HCTZ
  • Zestoretic
    • tip: the brand names of many diuretic combinations end in HCT, -id or -etic)
9

What's the brand name of

  • Losartan/HCTZ
  • Hyzaar
    • tip: the brand names of many diuretic combinations end in HCT, -id or -etic)
10

What's the brand name of

  • Olmesartan/HCTZ
  • Benicar HCT
    • tip: the brand names of many diuretic combinations end in HCT, -id or -etic)
11

What's the brand name of

  • Valsartan/HCTZ
  • Diovan HCT
    • tip: the brand names of many diuretic combinations end in HCT, -id or -etic)
12

What's the brand name of

  • Benazepril/amlodipine
  • Lotrel
13

What's the brand name of

  • Valsartan/amlodipine
  • Exforge
14

What's the brand name of

  • Olmesartan/amlodipine
  • Azor
15

What's the contraindication of

  • Thiazide?
  • Contraindicated with sulfa allergy
16

What are ADRs of

  • Thiazide?
  • Low K, Na, Mg
  • Increased Ca, UA, BG, LDL/TG
17

What's the starting dose and counseling of

  • Thiazide?
  • Take early in the day
  • Start at 12.5 mg daily
18

Do NOT start thiazide if CrCl<<___

  • Not effective if CrCl <30 mL/min
19

Name DDI with thiazide?

  • NSAIDs, lithium
20

MoA of

  • DHP CCBs (end in “-pine”)
  • Vasodilatory side effects
21

T/F.

  • Nifedipine IR is a preferred drug for pregnancy?

FALSE

  • Do not use nifedipine IR
  • Pregnancy: nifedipine ER
22

Preferred CCB for Heart failure?

  • Amlodipine or felodipine
  • Do not use Diltiazem or Verapamil in HF
23

What are the AEs of

  • Non-DHP CCBs (diltiazem, verapamil)
  • Bradycardia
  • Constipation (especially verapamil)
24

What's the major DDI with CCB?

  • ALL have CYP3A4 drug interactions
25

T/F.

  • ALL CCB can cause gingival hyperplasia

TRUE

  • Also phenytoin and cyclosporine
26

What is Clevidipine?

  • Milky-white lipid emulsion
  • 2 kcal/mL (propofol provides 1.1 kcal/mL)
27

What's the rare AEs of Clevidipine?

  • Hypertriglyceridemia with prolonged use (rare)
28

What's the counseling point for Clevidipine?

  • Change bottle and tubing after 12 h
29

What's the contraindication for Clevidipine?

  • Contraindicated with soybean, soy or egg allergy
30

What are the contraindications for

  • ACEI and ARBs?
  1. Angioedema
  2. B/L renal artery stenosis
  3. Pregnancy (BBW)
  4. Do not use within 36 h of Entresto (ACEIs)
31

What are the AEs for

  • ACEI and ARBs?
  • Cough (ACEIs), increased K, renal impairment
32

What are the DDI for

  • ACEI and ARBs?
  • lithium
33

When to use

  • Beta-blockers?
  • Not first-line (unless HF, MI, IHD)
34

What are AEs of

  • Beta-blockers?
  • decreased HR, fatigue, dizziness, depression
35

What's the conversion from

  • Metoprolol tartrate IV:PO
  • 1:2.5
36

What the brand name for Clonidine used for BP?

  • Catapres
37

What the brand name for Clonidine patch used for BP?

  • Catapres-TTS
38

What the brand name for Clonidine used for ADHD?

  • Kapvay - for ADHD
39

What's the AE of Clonidine?

  • Anticholinergic ADRs
40

The only antihypertensive drug that comes in patch form is___?

  • Clonidine (Catapress)
41

What's the name for Guanfacine IR used for BP?

  • Tenex
42

What's the name for Guanfacine ER??

  • Intuniv - for ADHD
43

Patient 1: 58 Y/O male presents to the ER with headache, blurred vision and BP 188/122 mmHg. An ECG, head CT, CXR and BMP have no notable abnormalities

What kind of BP crisis is this? Management?

Urgency: kidneys/heart/brain ok!

  • Decreased BP gradually over 1-2 days
  • PO drugs: captopril, labetalol, clonidine, hydralazine
44

Patient 2: 58 Y/O male presents to the ER with SOB, decreased UO, and BP 188/122 mmHg. CXR with pulmonary edema; BMP with a SCr of 2.4 mg/dL (baseline: 1.2 mg/dL)

What kind of BP crisis is this? Management?

Emergency: kidneys/heart/brain failing!

  • Decreased BP by 25% in first hour
  • IV drugs: nitroprusside, NTG, nicardipine, labetalol