Term
|
Definition
-Lower BP
-Renal protective ability
-Used when ACE inhibitors are not tolerated
-Preferred for people with DM
-Indications for monotherapy include" heart failure, CKD. |
|
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Term
HTN:
ACE Inhibitors
Monitoring |
|
Definition
-BP, Electrolytes and renal function are measured and monitored
-Continuing K+ levels are monitored 2/2 potential rapid rise in K+
-Monitor for changes in renal function |
|
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Term
| Loop Diuretic Names and Dosing |
|
Definition
-Furosemide/Lasix: 20-40 mg BID
-Torsemide/Demadex: 5-10mg daily
-Bumetanide/Bumex: 0.5-2mg BID |
|
|
Term
| Thiazide Diuretic Names and Dosing |
|
Definition
-Hydrochlorothiade: 12.5-50mg QD
-Chlorthalidone/Clorpres: 12.5-25 mg QD
-Metolazone/Zaroxolyn: 2.5-5mg QD
-Indapamide/Lozol: 1.25-2.5mg QD |
|
|
Term
HTN:
Diuretic Loop
Monitoring |
|
Definition
-Used when GFR falls <30
(Since low GFR allows more time for Na and water absorption, thiazide type diuretics are some what ineffective) |
|
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Term
HTN:
Diuretics
Thiazide Use |
|
Definition
-First Line for uncomplicated HTN.
-Often used w/ ACE or ARB
-Can use as monotherapy and combination for CHF, recurrent stroke prevention and DM |
|
|
Term
HTN:
Diuretics
Thiazide Names |
|
Definition
-Hyzaar (ARB + HCTz)
-Prinizide (ACE + HCTz)
-Aldactazide (K+ sparing diuretic + HCTz) |
|
|
Term
Rx Tx HTN
Types of Diuretics |
|
Definition
-Choice depends on baseline renal function and serum K+.
-Not usually a first line HTN choice for DM.
1. Thiazide
2. Loop
3. K+ sparing
4. Carbonic anhydrase inhibitors |
|
|
Term
| Standard treatments for HTN |
|
Definition
-Pharmacotherpy + Lifestyle change
-MNT, Activity, Moderate Alcohol intake and wt reduction |
|
|
Term
|
Definition
130/80
(possibly lower with Nephropathy) |
|
|
Term
HTN Management:
Drug Classes for DM |
|
Definition
Thiazide Diuretics
Beta Blockers
ACE Inhibitors
ARBs |
|
|
Term
HTN Management:
Drug Classes for other classes |
|
Definition
Calcium channel blockers
Central acting agonists
Alpha receptor blockers
Alpha + Beta Blockers
Vasodilators |
|
|
Term
Regulating HTN:
Systemic responses |
|
Definition
| -Regulate BP: Autonomic Nervous system + Renin-angiotension-aldosterone system (RAAS) |
|
|
Term
|
Definition
-Responsible for progression of DM, CVD and renal disease.
-Thru RAAS inhibition, BP is Lowered and albunimuria can be reversed
-RAAS inhibition can also decrease CVD and slow DM progression. |
|
|
Term
|
Definition
-Product of Cardiac output (CO) + Total peripheral resistance (TPR), where CO is the product of stroke volume and Heart rate.
-Occurs due to the bodies inability to maintain homeostasis b/t CO and TPR |
|
|
Term
|
Definition
ABC:
A= A1c
B= BP no higher than 130/80
C= cholesterol |
|
|
Term
HTN Rx
K+ sparing diuretics |
|
Definition
-Only type that increase serum K+
-Clinically combined with HCTz to balance serum K+
(alone, they do little to lower BP) |
|
|
Term
|
Definition
**do NOT use during:
-pregnancy
-renal artery stenosis
-renal or hepatic dx
-angiodema, CHF, severe HTN/CHF
-Daily BP checks
-Fluid Volume and Na depletion should be corrected prior to dosing |
|
|
Term
|
Definition
-Dizziness, Drowsiness, Diarrhea, Dyspepsia
-HyperK+, Headache, URI
-Cough risk lower than with ACE |
|
|
Term
|
Definition
-Take everyday
-Take same time each day
-Start w/ Low dose, then titrate higher, as needed, adding a thiazide diuretic
-Usually better than increasing ARB dosing too high |
|
|
Term
|
Definition
-Candesartan/Atacand: 8-32 mg QD
-Aprosartan/Teveten: 600 mg QD
-Irbesartan/Avapro: 150-300 mg QD
-Losartan/Cozaar: 25-100 mg QD
-Olmesartan/Benicar: 20-40 mg QD
-Telmisartan/Micardis: 20-80 mg QD
-Valsartan/Diovan: 80-320 mb daily |
|
|
Term
Diuretics
Patient instructions |
|
Definition
-Taken in am with/out food
-Monitor foods high in K+
-Look for s/s of low K+: muscle cramping, fatigue
-BP monitor daily for change
-Rise slow when sitting or lying down |
|
|
Term
HTN in Children
Interventions |
|
Definition
-Lifestyle Therapy
- >/90th % for age
-Weight control + Physical activity
-If targets not reached in 3-6 months, pharmacologic therapy
-If wt >/95th %: pharmacologic therapy should be started immediately.
-ACE inhibitors are good |
|
|
Term
| HTN in Children and Adolescence: Definition |
|
Definition
-Average systolic or diastolic BP >/95th% for age, sex and Ht profile
-Measured on 3 days
-High Normal is >/90th-<95th% |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Stage I HTN
140-159 / 90-99
-Dx is from 2 BP readings on 2 separate visits
-Person seated position after 5-10 min rest. |
|
|
Term
|
Definition
Stage 2 HTN:
160/100 (or greater) |
|
|
Term
|
Definition
|
|
Term
HTN Meds
ACE Inhibitors
Names/Dosing |
|
Definition
-Benazpril/Lotensin: 10-40mg QD
-Captopril/Capoten: 12.5-50mg BID/TID
-Enalapril/Vasotec: 2.5-20 mg QD/BID
-Fosinopril/Monopril: 10-40mg QD
-Lisnopril/Prinivil/Zestril: 10-40mg QD
-Moexipril/Univase: 7.5-30mg QD
-Perindopril/Aceon: 4-8mg QD
-Quinapril/Accupril: 10-80mg QD
-Ramipril/Altace: 2.5-20mg QD
-Trandolapril/Mavik: 1-4mg QD |
|
|
Term
HTN rx
ACE Inhibitors
Precautions |
|
Definition
-NOT for pregnancy
-NOT bilateral renal artery stenosis
-Cause dilation of efferent arteriole in the renal circulation which can lower GFR, thus causing RF.
-Caution with renal or liver dysnfunction
-Caution w/ angiodema, CHF and elevated K+
-Often effective at lowering BP in Black ppl, yet also increase rick of angiodema. |
|
|
Term
HTN rx
ACE Inhibitors
Dosing |
|
Definition
1-3 x day, with/out food.
-Must be taken at same time daily
-Lower BP in 1 hour, yet max effect at 8 hours.
-Start low dose, then titrate.
-More beneficial if HCTz added, rather than increasing dose. |
|
|
Term
HTN rx
ACE Inhibitors
General Information |
|
Definition
-First line of defense for HTN or renal protection in pts with DM
-Can inhibit the progression of micro albuminurea to macro.
-Good w/ HTN and other disease states: HF, Post MI, Strokes, CKD. |
|
|
Term
HTN rx
ACE Inhibitors
Adverse Effects |
|
Definition
-Cough
-Fatigue, H/A, Dizziness, Drowsiness
-Hyper K+
-HypoTN, GI issues: D/N/V
-Skin Rash
-Taste changes
-Angiodema
-Neutropenia Agranulocytosis |
|
|
Term
HTN rx
ACE Inhibitors
Drug Interaction |
|
Definition
-Use with NSAIDS, K+ sparing and K+ supplements
-Monitor Lithium Levels |
|
|
Term
Diuretics
K+ Sparing
Names/Dosing |
|
Definition
-Amiloride/Midamor: 5-10mg QD
-Triamterene/Dyrenium: 37-75mg QD
-Spironolactone/Aldactone: 25-50 QD/BID
-Eplerenone/ Inspa: 50mg QD/BID |
|
|
Term
Diuretics
General Actions |
|
Definition
-All work on different areas of tbe Kidneys
-Taken every morning due to increased urination
-Loop and K+ sparing may be BID for co-conditions
-Take lower doses initially, then titrate for only HTN doses >25mg which aren't showing benefits |
|
|
Term
Diuretics
General Cautions |
|
Definition
-GOUT, Renal and Liver Disease
-Electrolyte Imbalances
-Thiazide: Sulfa allergies |
|
|
Term
Diuretics
General Side Effects |
|
Definition
-H/A
-Photo-sensitivity
-Dry mouth
-N/V
-Orhostatic-hyPOTN |
|
|
Term
Diuretic
Drug Interactions |
|
Definition
-Stem from electrolyte Imbalance
-NSAIDS can lower AntiHypertensive effect (Ibuprofin)
-Can increase lithium levels
-Increased Salt intake can decrease effects. |
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