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Clinical Pharmacology > HTN: Special Populations > Flashcards

Flashcards in HTN: Special Populations Deck (12)
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1

Definition of HTN in Pregnancy

Women with normal BP pre-pregnancy who have:

BP 140/90 or higher AFTER 20 wks gestation

2

HTN in Pregnancy monitoring

-Weekly BP checks and labs
-Impatient tx: stroke risk (160 or higher systolic/105 or greater diastolic, presence of renal or CVD
-Monitor for preeclampsia (>140/90 with proteinuria, vision changes, severe HA, abd pain, worsening edema)

3

What to use in preggos

-Labetalol (cat C) PO or IV
-ER nifedipine (cat C) PO
-Methyldopa (cat B) only use for women who can't use labetalol or nifedipine d/t significant sedation
-DONT use ACE/ARB, renin inhibitors--> teratogens

4

HTN and Elderly

-Lowering BP is beneficial by dec CV events, HF, death
-More prone to ADRs (dizziness, lytes, inc SCr)
-Use normal meds (ACE/ARB, DHP CCB, thiazides)
-Tailor BP goal to individual patient!

5

D/c anti-HTN in elderly

-Reporting dizziness, lightheadedness, make sure they stand up slowly
-Look for obvious BP meds to taper off unless there's a specific need to be on (b-blocker for HFrEF)

6

Peds HTN definition

-BP is 95th% or greater
-130/80 or greater for 13 years or older

7

Peds HTN tx

-Lifestyle mod first!!!!
-Still no change in 6 mo or kids w DM/kidney dz---> ACE/ARB
-Lean toward DHP-CCB for teenage girls bc ACE/ARB are teratogens

8

Peds HTN goals

-90th% for age
-<130/80 for 13 yrs or older

9

Resistant HTN

-Uncontrolled HTN despite being on 3 or more drugs including a diuretic
-Only 10% "true" resistant HTN, many d/t poor adherence or inadequate regimen

10

Resistant HTN Considerations

-Check for "pseudo resistance" (poor adherence, white cote HTN, poor monitoring)
-Check other meds that inc BP, high salt diet
-Use "core" BP lowering meds--> diuretic, ACE/ARB, CCB
-Screen for 2ndary causes of HTN (OSA, hyperaldo, RAS, hyperthyroid, etc)

11

HTN Urgency

->180/100 without organ damage
-Focus on pt, not BP value
-Dropping BP too fast can trigger CVA, AMI, etc
-Check med adherence, restart BP meds, increase dose, add med
-F/u in 2 wks (no cormorbidites) or 2 days (HF, angina, CKD)

12

HTN Emergency

->180/120 that causes organ damage
-Can lead to stroke, LOC/memory loss, ocular/renal damage, aortic dissection, angina/MI, pulm edema
-Admit to ICU and IV BP meds**