Term
| How is MAP defined mathematically? |
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Definition
MAP= CO * TPR
CO= SV * HR
TPR= PVR+ RVR (peripheral and renal) |
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Term
| How does the progression of HTN manifest in terms of CO and SVR? |
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Definition
1) Early HTN- Increased CO and relative increase in SVR
2) Established HTN- Decreased CO and increased SVR
3) Late- Decreased CO (25%) and markedly elevated SVR (25-30%) |
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Term
| What are the basic pharmacological goals in treating HTN? |
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Definition
1) Reduce SVR
2) Preserve CO
3) Improve arterial compliance
4) Maintain organ perfusion |
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Term
| How is treatment of essential HTN (1-2) handled? |
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Definition
Lower BP to 140/90 (130/80 for DM or chronic renal disease)
to lower morbidity and mortality |
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Term
| When should you avoid Thiazide-like diuretics? |
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Definition
Watch out for hypokalemia
1) NIDDM (induced glucose intolerance)
2) Hyperlipidemia (increases lipids)
3) Gout (Hyperuricemia) |
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Term
| How do thiazide diuretics lower BP initially and chronically? |
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Definition
1) Initially, increased sodium excretion leads to water excretion and decreased IV volume
2) Chronically, PVR decreases. |
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Term
| Why might you prescribe Aldosterone antagonists to treat HTN? |
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Definition
| K+ sparing action for severe HF (class IV) in combination with Ace-i and Loop diuretic. |
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Term
| How do beta blockers treat HTN? |
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Definition
1) Slows heart rate and reduces force of contraction
2) Inhibit renin release at JG cells |
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Term
Why might you use a beta blocker with ISA?
What about a cardioselective beta blocker? |
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Definition
Best to use cardioselective, low lipid solubility and long half-life
1) Peripheral vascular disease and Diabetes
2) Asthma (don't hit beta 2) or HTN (don't want to hit |
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Term
| What is the drug of choice for HTN with BPH? |
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Definition
ALLHAT study
Alfuzosin or Tamsulosin (Alpha-1 blockers) |
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Term
| Why are ACE-i less effective in treating HTN in the elderly and African American populations? |
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Definition
Less renin.
This is where you use THIAZIDES! |
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Term
| Why might you choose an ARB (SARTAN) instead of an ACE-i to treat HTN? |
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Definition
Cough from ACE-i (ARB doesn't inhibit bradykinin breakdown)
Use in low doses |
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Term
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Definition
| Renin inhibitor! Only approved 1. |
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Term
| What is the most common side effect of calcium channel blocker use? |
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Definition
| Ankle Edema from vasodilation (dihydropyridine especially). |
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Term
| How do Methyl-dopa and Clonidine work and why might you prescribe them? |
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Definition
Central A-2 stimulation in venral medulla to prevent NE release and lower BP
Methyl-dopa is ONLY USED IN PREGNANCY
Clonidine is RAPID and used in emergencies |
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Term
| How does Hydralazine treat HTN? |
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Definition
Peripheral Vasodilator used in African Americans for long-term outpatient therapy for HTN (Second line)
They can cause reflex tachycardia. |
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Term
| How does Reserpine treat HTN? |
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Definition
Bad SE!
Prevent physiological release of NE from postganglionic sympathetic terminals, so decreases PVR |
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Term
| What drug should all patients with HTN and CKD receive? |
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Definition
RAAS inhibitor (ACEI, ARB or renin inhibitor)
**add aldosterone antagonist or renin inhibitor to avoid "renin escape"** |
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Term
| How do treatment protocols differ for HTN emergencies and urgencies (DP>120 mmHg)? |
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Definition
Emergency means organ involvement (CNS, Cardiac, Renal)
1) Reduce BP by 30% or to 105 DBP in minutes to an hour
Urgency means no organ
1) Reduce BP during 1-24 h |
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Term
What anti-HTN agents are safe for use in chronic renal disease?
What about for recurrent stroke prevention?
HF? |
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Definition
1) ACE-i and ARB (NOT diuretic)
2) ACEI or diuretic
3) Any of them. |
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Term
| How should you handle HTN in diabetic patients? |
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Definition
Remember, their kidneys are sensitive to BP and proteinuria is risk factor for renal and CVD!
1) Early- prevent CVD with tight BP control, including NON-pharmacological methods
- Aim for 130/85
2) Use ACE-I first, and if it doesn't work, add a Thiazide |
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Term
| How should you handle HTN in Ischemic Heart Disease?? |
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Definition
Beta Blockers and long-acting CCB
**IF unstable angina, use beta blocker or ACE-i
** Post-MI, use ACEI + Beta blocker + Spironolactone |
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Term
| How should you handle HTN in Heart Failure?? |
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Definition
1) Asymptomatic: ACE-I or Beta blocker
2) Symptomatic ventricular dysfunction: Add Diuretic, ARB and Spironolactone |
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Term
| How should you handle HTN in Asthma?? |
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Definition
Beta blocker NOT SAFE
Use low-dose Thiazide (watch out for alkylosis in COPD or chronic hypercapnia) |
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Term
| How should you handle HTN in Pregnancy?? |
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Definition
1) Acute reduction with i.v. infusion of labetalol or hydralazine
Don't use nefedipine |
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