Study Pharm-HTN Flash Cards

 
Pile Management Card
Pharm-HTN

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Thrombolytics: Relative Contraindications
Severe uncontrolled HTN (> 180/110 mmHg)
Current use of anticoagulants in therapeutic doses, Recent trauma (<2-4 weeks, esp. head), Prolonged CPR (>10 min), Recent major surgery (<3 weeks), Non-compressible vasculature puncture
Recent internal bleed (<2-4 weeks), Active peptic ulcer, Pregnancy, History of chronic severe HTN
Thrombolytics: Absolute Contraindications
Previous hemorrhagic stroke at any time
Previous ischemic stroke within 1 year
Known intracranial neoplasm
Active internal bleed (does not include menses)
Suspected aortic dissection
The Open-Artery Theory
Early reperfusion of the infarct-related coronary artery results in myocardial salvage.
Acute Coronary Syndromes (ACS) ST-segment Elevation Treatment
ST-segment elevation-->MONA+BB-->
Fibrinolytic (UFH/LMWH) or PCI
Contraindications to GP IIb/IIIa Rx
Active or recent bleeding (4-6 weeks)
Severe hypertension (SBP >180-200 mm Hg; DBP >110 mm Hg)
Any hemorrhagic CVA (+/- intracranial neoplasm, AVM, or aneurysm)
Any CVA within 30 days–2 years
Major surgery or trauma within 4-6 weeks
Thrombocytopenia ( <100,000/mm3 )
Bleeding diathesis/warfarin with elevated INR
Avoid in patients with renal insufficiency or failure
Nitroglycerin Sublingual Patient Education
For patients with previous STEMI
Take one tablet and wait 5 minutes
If pain persists, call 911 and take a second tablet
If pain persists, take a third tablet (3 in 15 min)
Management of ACS: Agents to target thrombus and reperfusion
Heparin
Glycoprotein (GP) IIb/IIIa receptor inhibitors
Thrombolytics
Management of ACS: Routine Measures (MONA + BB)
Analgesics, nitrates, antiplatelets, and B-blockers
Bed rest, IV access, oxygen to maintain SaO2 >90%, serial ECGs and cardiac enzymes
modifiable risk factors for artherosclerosis and ischemic heart disease
Dyslipidemia, Hypertension, Cigarette smoking, Diabetes, Overweight/obesity, Physical inactivity, Atherogenic diet
Non-modifiable risk factors for artherosclerosis and ischemic heart disease
Age (men>45 years; women >55 years)
Gender
Family history of premature CHD (male first degree relative <55 or female <65)
Contraindications for ACEI and ARB
Pregnancy: ACEI and ARB can cause injury and death to the developing fetus when used in the second and third trimesters
Bilateral renal artery stenosis
History of angioedema to another ACEI
Do not start in volume depleted patients
ARB adverse effects
Side effects similar to ACEI (cough is less likely)
Less angioedema, cross-reactivity is possible
ACEI adverse effects
Cough (mediated by bradykinin accumulation), Hyperkalemia (hold if K+ >5.5 mEq/L), Worsen renal function (hold if SCr increases >1 mg/dL above baseline), Angioedema (rare, but life threatening), Hypotension (first dose), Rash
Non-dihydropyridines (CCB) Adverse Effects
Bradycardia, heart block
Worsen heart failure
Constipation (verapamil)
Dihydropyridines (CCB) Adverse effects
Edema
Headache
Dizziness
Tachycardia
what is the most effective lifestyle modification for HTN (how much decrease)
weight reduction 5-20 mmHG/ 10-kg weight loss
LVD <120/80
ACEI or ARB and β-blocker and aldosterone antagonist and thiazide or loop diuretic and hydralazine/isosorbide dinitrate (blacks)
STEMI <130/80
β-blocker (if stable) and ACEI or ARB
UA/NSTEMI <130/80
β-blocker (if stable) and ACEI or ARB
Stable angina <130/80
β-blocker and ACEI or ARB
High CAD risk (DM, CKD, CAD, PAD, AAA, Framingham >10%) <130/80
ACEI or ARB, or CCB, or thiazide
(If SBP >160, or DBP >100, then
start 2 drugs)
General CAD prevention <140/90
Any (If SBP >160, or DBP >100, then start 2 drugs)
Stage 2 HTN tx
two-drug combination for most

usually thiazide diuretic + ACEI, ARB, BB, CCB
Stage 2 HTN
SBP >160 or DBP >100 mm Hg)
Stage 1 HTN tx
thiazide diuretic for most

may consider ACEI, ARB, BB, CCB, or combination
Stage 1 hypertension
SBP 140–159 or DBP 90–99 mm Hg)
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