Shared Flashcard Set

Details

Therapeutics Exam 1 Lynch
Therapeutics Exam 1 Lynch
33
Pharmacology
Graduate
08/17/2010

Additional Pharmacology Flashcards

 


 

Cards

Term
140/90
Definition
blood pressure goal for general CAD prevention
Term
130/80
Definition
blood pressure goal for patients with
high CAD risk (DM, chronic kidney disease, CAD, carotid artery disease, peripheral artery disease, or abdominal aortic aneurism)
stable angina
post MI
>10% Framingham score
Term
120/80 (after initial goal of 130/80
Definition
blood pressure goal for patients with LVD
Term
HCTZ
beta blocker (may mask the signs of hypoglycemia, beta 1 specific are preferred)
ACEi or ARB
Definition
first line therapy for hypertensive patients with diabetes
Term
ACEi or ARB but not ACEi and ARB together
Definition
therapy used in patients with microproteinuria or gross proteinuria
Term
CrCl <60ml/min
SrCr >1.5
gross proteinuria
Definition
kidney disease can be diagnosed based on these three levels
Term
ACEi or ARB
do not use if SrCr is >2.5 for males and >2 for females
do not use if K>5
loop diuretics may be needed later in the disease (CrCl <30 generally)
Definition
therapy used for hypertensive patients with kidney disease
Term
ACEi or ARB may decrease incidence
HCTZ or beta blockers may increase incidence
Definition
therapy for hypertensive patients with metabolic syndrome (prediabetic or at high risk for T2DM)
Term
use beta blocker (B1) or alpha-beta blocker + ACEi (ARB if not tolerated)
aldosterone antagonists should be added if stage 3 or 4 HF or EF <40%
loop diuretics if fluid overload occurs (peripheral edema, positional shortness of breath)
thiazides may be added if additional control is needed
hydralazine/isosorbide dinitrate has added benefits in blacks
contraindicated: non-DHP, clonidine, alpha blockers
Definition
therapy for hypertensive patients with HF
Term
beta blocker (B1 preferred) + ACEi (ARB if not tolerated (patients should be hemodynamically stable before added a beta blocker)
aldosterone antagonists may add benefit
thiazides may add additional benefits if tolerated
non-DHP may be used rather than beta blockers if contraindicated (unless HF is also present)
Definition
therapy for hypertensive patients post MI
Term
beta blocker (B1 preferred) is 1st choice
long acting DHP CCB may be added
long acting non DHP may be used instead of beta blocker if absolutely necessary
use combination of beta blocker and non DHP very cautiously (heart block)
Definition
therapy for hypertensive patients with ischemic heart disease (stable angina or angina pectoris)
Term
thiazide +/- ACEi (ARB if not tolerated)
do not lower BP precipitously after a stroke (BP goal of 160/100 until stable)
Definition
therapy for secondary stroke prevention
Term
non selective beta blocker
Definition
therapy for migraine, thyrotoxicosis, and essential tremor
Term
DHP CCB
Definition
therapy for Reynaud's phenomenon
Term
beta blocker or non DHP CCB
use extreme caution with the combination of both classes
Definition
therapy for patients with atrial tachyarrhythmia (atrial fibrillation, atrial flutter)
Term
resistant hypertension
Definition
hypertension not at goal despite concurrent use of 3 or more drugs from different classes (ideally one of them is a diuretic)
20-30% of patients with hypertension will have this
Term
older age
high baseline blood pressure
obesity
excessive dietary salt intake
chronic kidney disease
diabetes
left ventricular hypertrophy
black race
female sex
residence in the southeast US
Definition
patient characteristics of resistant hypertension
Term
140/90
Definition
goal BP for hypertension in pregnancy
Term
1) methyldopa
2) labetolol or DHP CCB
avoid ACEi, ARB, renin antagonists, loop diuretics
thiazides - may continue if used prior to pregnancy
Definition
1) first choice of drug for hypertension during pregnancy
2) alternative agents for hypertension during pregnancy
Term
pre-eclampsia
Definition
typically occurs post week 20 in primigravid women
BP >140/90 appearing post week 20 in the presence of proteinuria
Term
delivery
if not delivery then bed rest, limited activity, close monitoring
drug therapy prior to delivery with goal DBP of 95-105 mmHg
IV hydralazine commonly used
Definition
treatment of pre-eclampsia
Term
BP >180/120
Definition
BP of hypertensive urgency
Term
captopril, clonidine, or labetolol
avoid precipitous BP reduction (avoid immediate acting DHP)
Definition
treatment of HTN urgency
Term
HTN emergency
Definition
those with evidence of acute organ target-organ damage and markedly elevated BP (>180/120)
require immediate hospitalization
lower MAP by 25% in minutes to hours (avoid precipitous drops in BP)
Term
MI or unstable angina
head trauma, CNS changes, stroke
abdominal pain, bruising, bloating
Definition
examples of target organ damage in HTN emergencies
Term
1) 160/100
2) 140/90
Definition
1) goal BP 2-6 hours after a HTN emergency
2) goal BP 24-48 hours after a HTN emergency
Term
sodium nitroprusside (may be dangerous in patients with kidney disease)
may be given instead IV hydralazine or IV beta blockers
Definition
1st choice agent for HTN emergencies
Term
Systolic Hypertension in the Elderly Program (SHEP)
Definition
Design: patients with isolated systolic BP >60 yo
Drugs: chlorthalidone 12.5mg qd, then chlorthalidone 25mg qd, then add atenolol 25mg.
Results: drug therapy reduced the incidence of cardiovascular events and stroke
(beginning of the evidence that thiazides decrease morbidity and mortality)
Term
Veterans Affairs Cooperative Study Group on Antihypertensive Agents
Definition
Drugs: Randomized to: 1) placebo, 2) HCTZ 12.5-50mg qd, 3) atenolol 25-100mg/d 4) clonidine 0.2-0.6mg/d 5) captopril 25-100mg/d 6) prazosin 4-20 mg/d 7) diltiazem SR 120-360 mg/d
Results: Race and age differences existed in response to drugs. HCTZ was the best in older blacks, captopril was the worst. This is the beginning of prejudice against ACEi in black patients. HCTZ was least effective in young whites.
Term
Hypertension Outcomes Prevention Evaluation (HOPE)
Definition
Drugs: ramipril 2.5-10mg/d vs. placebo
Results: ACEi reduces the rates of death, MI, and stroke
(made ACEi a first line therapy)
Term
FACET and ABCD
Definition
These two trials both compared DHP CCB to an ACEi in patients with diabetes. While patients receiving CCB had some small benefit, those receiving ACEi had lower rates of coronary events and death.
Term
Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trail (ALLHAT)
Definition
1) Completed in 2002, comparing chlorthalidone, amlodipine, and lisinopril as well as comparisons of hyperlipidemia treatment modalities. Outcome: thiazides are superior to ACEi or CCB in preventing coronary outcomes, and should be considered first line therapy for HTN.
2) The doxazosin vs. chlorthalidone arm was stopped. Those receiving doxazosin had 25% more cardiovascular events and were twice as likely to be hospitalized for congestive heart failure as those receiving chlorthalidone.
(alpha blockers aren't used as 1st line therapy b/c of this trial)
Term
ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET)
Definition
1) established that telmisartan reduces morbidity and mortality in a broad cross section of patients at high risk for heart and vascular events, to an extent similar to that of the ACEi ramipril. In addition, it demonstrated that telmisartan is somewhat better tolerated than ramipril.
2) the combination of ramipril and telmisartan resulted in increased incidence of renal failure and dialysis that either agent alone.
3) the results of this trial is that many clinicians feel that ACEi/ARB combo should no longer be used
Supporting users have an ad free experience!