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At what BP should medication be started?
140-160 S, 90-100 D
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At what BP should a second antihypertensive be added?
>160 S or >100 D
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Causes of secondary hypertension
- Aldosteronism,
- Renal disease,
- Thyroid disease,
- Medications
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Classes of antihypertensives
- Angiotensin/ renin related,
- calcium channel blockers,
- diuretics,
- adrenergic related vasodilators
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Inexpensive ACE inhibitor
lisinopril
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side effect of ACE inhibitors
- dry cough,
- hypotension episode after first dose,
- hyperkalemia,
- angioedema,
- rash
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Contraindications for ACE I / ARB
- Renal artery stenosis,
- woman of childbearing age, allergy to ACE inhibitors
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Suffic for ACE I inhibitors
-pril
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suffix for AngiotensinII receptor antagonists
-sartan
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Typical dose of losartan
25 mg QD - 50 mg BID
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risk factors for hyperkalemia with ACE/ARB
- DM,
- NSAID use,
- Beta blockers,
- Advanced age,
- volume depletion,
- chronic renal insufficiency
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drug interactions of ACE/ARB
- lithium levels may rise,
- Can raise risk of hypersensitivity to allopurinol
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Suffix for dihydroperidines
-ipine
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indicationsFor dihydroperidine CCBs
- essential HTN, especially systolic,
- angina pectoris
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adverse effects of dihydroperidine
Peripheral edema
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most common dihydropyridines
Amlodipine
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typical amlodipine dose
5-10 mg QD
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Diltiazem does what?
slows conduction through AV node
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Adverse effects of loop diuretics
- Electrolyte imbalance,
- dehydration,
- hypotension,
- ototoxicity,
- hyperglycemia
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Contraindications for spironolactone
- anuria,
- renal insufficiency,
- hyperkalemia,
- patient’s taking amiloride or triamterene
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Adverse effects of methyldopa
- Somnolence,
- dry mouth,
- depression,
- rebound hypertension when discontinued
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indications for nitroglycerin
- Prophylaxis and treatment of angina pectoris,
- In IV form:
- CHF w/acute MI, BP control during surgery
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adverse effects of nitroglycerin
- Headache,
- reflex tachycardia,
- orthostatic hypotension,
- topical allergic reaction
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interactions with nitroglycerin
- ETOH can cause severe hypotension,
- Aspirin increases serum concentration,
- CA+ channel blockers can cause orhostatic hypotension,
- Viagra can cause hypotension
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Hydralazine used as second line for what
People who can’t tolerate or didn’t have therapeutic results with ACE inhibitors
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adverse effects of hydralazine
- Reflex tachycardia,
- increased blood volume,
- peripheral neuritis,
- headache,
- constipation,
- blood dyscrasias,
- lupus-like syndrome
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First line treatment for diabetic patient
- ACEI or ARB;
- -thiazide or CCB if Af Amer
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first line treatment for pts with heart failure
ACEI / ARB
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First line treatment for stroke patient
ACEI / ARB
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First line treatment for coronary disease
BB + ACEI or ARB
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ACE inhibitors and ARBs contraindicated in
Pts with renal artery stenosis, women of childbearing age
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Typical dose of lisinopril
10-40 mg QD
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Typical dose of enalapril
5-20 mg BID
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typical dose of benazepril
5-40 mg QD
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Typical dose of losartan
25 QD - 50 mg BID
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Typical dose of valsartan
80 QD - 160 BID
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Risk factors for hyperkalemia on ACEI or ARB
- DM,
- GFR <60,
- trimethoprim,
- hypovolemia,
- NSAID S,
- K sparing diuretic
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Example of a renin inhibitor
Aliskerin
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examples of dihydroperidine CCBs
Amlodipine, felodipine, nifedipine
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examples of non dihydroperidine CCBs
- diltiazem (30-90 mg q 6 hrs)
- verapamil (40 mg TID - 120 mg QID)
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best CCB for acute A fib
Diltiazem 30-90 mg q 6 h
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Creatinine clearance must be what threshold to treat with thiazide diuretic
CrCl >30 mL/ min
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spironolactone drug interactions
Avoid triamterene. Interacts with ACEI and salicylates
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Typical dose of metoprolol
50 mg BID
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typical dose of atenolol
25-50 mg QD
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Indication for sotalol
acute arrythmia
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clonidine is useful for
Alcohol and opioid withdrawal
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examples of vasodilators
Nitroglycerin, hydralazine
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vasodilator for hypertensive crisis
Hydralazine
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vasodilator for pulmonary hypertension
Sildenafil
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Examples of ACEI, with typical doses
- Lisinopril 10-40 mg QD
- Enalapril 5-20 mg BID
- benazepril 5-40 mg QD
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example of loop diuretic
Furosemide, bumetanide, torsemide
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Hypertensive urgency
SBP>180 and/or DBP>110
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Drugs for hypertensive crisis, with doses
- Nitroglycerine 5-10 mcg/min max 100,
- Nicardipine 5-15 mg/hr
- labetolol 20-80 mg q 15 min
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treat eclampsia
Hydralazine, labetolol
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hypertensive crisis in acute renal failure
Nicardipine
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