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Ch. 46: HTN
drugs for hypertension
| Question | Answer |
|---|---|
| What BP is classified as prehypertension? | 120-139/80-89 |
| What BP is classified as Hypertension? | 140/90 |
| T/F: you should take BP when pt is tense. | F: have them sit and relax for 5 mninutes |
| What is the first way to Hypertension? | lifestyle modification. low salt/exercise. the goal is to have a BMI <25 |
| What is the ideal BMI in a hypertensive pt? | BMI<25 |
| What are the 2 classifications of HTN? | Primary (no known cause - 95%) Primary (underlying cause. If you treat the underlying cause, the BP will drop) |
| What are some consequences that can occur in a pt with uncontrolled HTN? | heart muscle remodeling/hypertrophy Renal failure increased risk for stroke eye damage (retinopathy)- get an eye exam each yr. |
| Signs and symptoms of HTN: | SILENT KILLE. if symptoms occur -> headache, dizziness |
| What are some diagnostic tests you might look at in a pt with HTN? | BUN/Creatinine Eye exam urinalysis (protein) H&H electrolytes Cholesterol EKG!!!!!!!!!!!!!!! (routinely done annually after 40) |
| What is the first line hypertensive in a pt without diabetes? what about a pt with diabetes? | without: HCTZ diuretic With: ACE inhibitor |
| what should be done if a pt is on 3 antihypertensive meds and still has uncontrolled HTN? | investigation of causes |
| how long must someone's BP be controlled before they can be weaned off their meds? | 1 year, then they are weaned off one at a time |
| what is special when considering HTN and African Americans? | A.A. tend to respond BEST to Calcium channel blockers and diuretics AA. typically need LARGER DOSES of ACE inhibitors and ARBs |
| What is special when considering HTN and the elderly? | Diuretics and beta blockers tend to decrease mortality |
| What is the drug of choice in chronic HTN in pregnancy? | Methyldopa |
| what are the 5 types of drugs used for CHF? | Diuretics ACE inhibitors ARBS RAAS blockers Digoxin Vasodilators |
| What should ALL CHF pts be on? | Diuretic ACE inhibitor Beta Blocker |
| American College of Cardiology and the American Heart Association classify Heart failure. How? | A:high risk for HF.No heart disease.NO s/s of HF.B:Structural heart disease.No symptoms of HF.C:structural Heart disease.No symptoms of HF.D:advanced heart disease.Marked s/s of HF at rest with maximal medical therapy. Specialized interventions needed |
| NY heart association classification of Heart Failure: | I: Asymptomatic II: symptomatic with moderate exertion III: symptomatic with minimal exertion IV: symptomatic at rest |
| Which/why are diuretics are used in CHF? | Thiazide or Loop (depending on amt of diuresis needed) decreases preload, periph/pulmonary edema |
| what is the first run diuretic for CHF? | HCTZ unless more diuresis is needed then loop |
| s/s pulmonary edema | Pink frothy sputum!! crackles dyspnea decreased O2 sat Increased resp rate |
| Why are ACE inhibitors used for CHF? | decrease morbidity, mortality and remodeling |
| why are ARBS used for CHF | ARBs are used if ACE inhibitors cause a cough |
| What classification of drug is Digoxin? | Beta Blocker |
| what does Digoxin do? | it is a positive inotrope (enhances contractility) which increases CO does NOT reduce symptoms does NOT prolong life DOES improve CO -> increased perfusion |
| what is the therapeutic range for Digoxin? | 0.5-0.8 |
| what is the biggest risk for Digoxin? | toxicity -> narrow therapeutic range (0.5-0.8) |
| what lab do you need to watch with Digoxin? | K+!! (toxicity of digoxin can lead to lethal dysrhythmias) |
| when there are lower levels of K+ while a pt is on digoxin, what is the risk? | when there is decreased K+, there is elevated digoxin -> toxicity |
| what drug may shorten the lifespan in women? | Digoxin |
| what are some side effects of Digoxin? | n/v fatigue |
| when would you NOT administer digoxin? | apical pulse <60 |
| what are some other inotropes? | dopamine dobutamine (only approved for CHF) |
| what is dobutamine? what is it approved for? | positive inotrope. only approved for CHF |
| What is dopamine used for in the heart? | it is a positive inotrope |
| what are inodilators? what is 1 example? | increase contractility AND dilation(->decrased afterload) Milrinone |
| nitroglycerine, nesiritide and Sodium nitroprusside are what class of drug? | vasodilators |
| what does Sodium nitroprusside do? arteries or veins? | vasodilator for arterioles AND veins |
| major side effect for vasodilators? | hypotension *(headaches) |
| Lab value: total cholesterol | <200 |
| Lab value: LDL | <100 |
| another name for VLDL | triglycerides |
| Lab value: triglyceride | <150 |
| lab value: HDL | >40 |
| lifestyle modifications for Coronary Artery Disease: | Lower Saturated Fat |
| 4 food examples that are high in saturated fat | dairy products red meat organ meat fried food |
| Stages of Coronary Artery Disease: | (1) Damage to endothelium (2) production of fatty streaks (3) build up of fibrous plaque (4) complicated lesion |
| Cholesterol Screening should be done how often? | every 5 years after age 20 |
| how can you raise HDL? | exercise and smoking cessation |
| What are the risk factors for coronary artery disease? | age (men>45, women>55) family history HTN smoker (at least once in the past month) low HDL |
| What is the treatment of choice if lifestyle modification doesn't work? | Statins |
| What is the drug that is most effective for lowering LDLs? | Statins |
| what do Statins do? | lower LDL may elevate HDL may reduce triglycerides |
| how are statins tolerated? | a lot of people don't tolerate them well. |
| if a pt is at high risk for an MI or has had one what drug will they be on? | a statin |
| what are Statins indicated for? | elevated cholesterol primary (prevention) CVA Secondary (prevention of recurrence) CVA if a diabetic has total cholesterol >135 |
| Side effects of Statins: | headache rash n/v flatulence myopathy (reason for noncompliance) hepatotoxicity (monitor LFTs!!!!!!!) |
| What labs should you monitor if your pt is on a statin? | LFTs! it is hepatotoxic BUN/Creatinine -> if >10x normal limit, STOP statin! |
| are statins safe for pregnancy? | NO category x |
| What the dosing for statin? | Daily at night (because night is when cholesterol is synthesized |
| What does Niacin do? | raises HDLl |
| how do people tolerate Niacin? | BADLY! it is a wonderful drug if the pt can tolerate it |
| what are some side effects of Niacin? | FLUSHING & ITCHING (reason for noncompliance) GI disturbances hepatotoxicity Elevated BG Elevated Uric acid sweat |
| Who should be cautioned before taking Niacin? | Diabetics (elevate BG) Gouty pts (elevated uric acid) |
| What are teh 2 Bile-Acid Sequesterants? | Welchol and Zetia |
| What do Bile-Acid Sequesterants do? | decrease LDL (primarily in conjunction with statin) |
| Welchol is what type of drug? | Bile-Acid Sequesterant |
| What is an advantage to Welchol? | it does not affect the absorption of other meds |
| What is the mechanism of action in Welchol? | decreases LDL by increasing uptake and breakdown of LDL |
| what is the major side effect of Welchol? | constipation. other than that it is tolerated very well |
| Who should be cautioned before using Welchol | diabetics -> increases BG |
| What is the mechanism of action for Zetia? | decreases LDL and triglycerides by inhibiting cholesterol absorption in the small intestine |
| what is an advantage to Zetia? | it is well tolerated with no major GI problems |
| What drug is the most effective for lowering VLDLs? | Fibric Acid derivatives (Fibrates) |
| who commonly will be on a Fibrate? why? | Alcoholic (to lower triglycerides alone) |
| what is a risk associated with Fibrates? | increased risk for bleeding in pts on anticoagulants (lower the dose of these anticoagulants) |
| Lopid is what kind of drug? | Fibrate |
| what are the side effects of Lopid? | Rashes GI disturbances other than that,it is tolerated pretty well |
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