Hypertension Management & CHF Treatment

Hypertension Management (A-B-C-D)

• A: Assess and assess risk factors (age, family history, smoking, diabetes, etc).
• B: Blood Pressure (BP) measurement: Ensure proper technique and confirm measurements with repeat readings.
• C: Control and implement lifestyle modifications (diet, exercise, weight loss)
• D: Drug Therapy: Consider adding medications based on individual factors and risk.

Hypertensive Urgency vs. Hypertensive Emergency

• Hypertensive Urgency: Characterized by high BP without end-organ damage.
• Hypertensive Emergency: High BP with end-organ damage (heart, brain, kidneys).

BP Regulation Mechanisms

• Renin-Angiotensin-Aldosterone System (RAAS): regulates blood volume and vascular tone.
• Sympathetic Nervous System: Releases catecholamines (epinephrine and norepinephrine) to increase heart rate and contractility.

CHF Treatment

• Diuretics: Reduce fluid retention.
• ACE Inhibitors: Block the RAAS.
• Beta Blockers: Reduce heart rate and contractility.
• Digoxin: Improves heart function.

Beta Blockers

• Cardioselective Beta Blockers: Primarily block beta1 receptors found in the heart, reducing heart rate and contraction.
  • Example: Metoprolol
• Non-Cardioselective Beta Blockers: Block both Beta1 and Beta2 receptors, impacting the heart and bronchioles.
  • Example: Propranolol

Action Potential Phases

• Phase 0: Sodium influx - Rapid depolarization.
• Phase 1: Sodium channels close, potassium channels open; early repolarization.
• Phase 2: Calcium influx balances potassium efflux; plateau phase.
• Phase 3: Potassium efflux; repolarization.
• Phase 4: Resting membrane potential.

Adenosine

• Treats supraventricular tachycardia (SVT) by slowing conduction through the AV node.

Catecholamines

• Epinephrine: Released by the adrenal medulla.
• Norepinephrine: Released by the sympathetic nerve endings.

Chronotrope, Dromotrope, Inotrope

• Chronotrope: Affects heart rate.
• Dromotrope: Affects conduction velocity.
• Inotrope: Affects the force of contraction.

Histamine

• Receptors: H1, H2, and H3 receptors located throughout the body.
• Stimulation effects: H1 activation causes bronchoconstriction, vasodilation, and itching. H2 activation increases gastric acid secretion.

NSAIDs

• Two Major Categories: Steroidal and Non-steroidal Anti-inflammatory Drugs (NSAIDs).

Allergen, Antigen, Antibody

• Allergen: A type of antigen that triggers an allergic reaction.
• Antigen: A substance that triggers an immune response.
• Antibody: A protein produced by the immune system to neutralize or attack specific antigens.

Angina Disorders

• Stable Angina: Chest pain predictable and relieved by rest or medication.
• Unstable Angina: Chest pain unpredictable, worse with time, and not relieved by rest or medication.
• Variant Angina: Triggered by coronary artery spasm.

Beta Blockers

• Effects: Reduce heart rate and contractility.
• Uses: Hypertension, angina, arrhythmias.

NSTEMI/STEMI Medical Therapy (MONA-BAH)

• Morphine: Pain relief and reduces myocardial oxygen demand.
• Oxygen: Increases oxygen delivery to the heart.
• Nitrates: Vasodilate coronary arteries.
• Aspirin: Antiplatelet agent.
• Beta Blockers: Reduce heart rate and contractility.
• ACE Inhibitors: Block RAAS.
• Heparin: Anticoagulant.

Anticoagulants

• Heparin: Parenteral anticoagulant.
• Warfarin (Coumadin): Oral anticoagulant.

Pain Treatment

• Opioid Pharmacotherapy: Example: Morphine.
  • Non-opioid Pharmacotherapy: Example: Ibuprofen.

Hypertension Management (A-B-C-D) Approach

• A - Assess cardiovascular risk factors and target organ damage.
• B - Blood Pressure measurement: assess for white coat hypertension, masked hypertension, and ambulatory blood pressure monitoring.
• C - Classify hypertension: Stage 1, Stage 2, or Hypertensive Urgency/Emergency.
• D - Decide treatment options: lifestyle modifications, medication, or combination.

Hypertensive Urgency vs. Hypertensive Emergency

• Hypertensive Urgency: Elevated blood pressure without evidence of end-organ damage.
• Hypertensive Emergency: Elevated blood pressure with evidence of acute end-organ damage (e.g., heart attack, stroke, kidney failure).

Blood Pressure Regulation

• Renin-Angiotensin-Aldosterone System (RAAS): Regulates blood volume and vasoconstriction.
• Sympathetic Nervous System: Releases catecholamines (epinephrine, norepinephrine) promoting vasoconstriction & increased heart rate.

Congestive Heart Failure (CHF) Treatment

• Lifestyle Modifications: Diet, exercise, smoking cessation, weight management.
• Medications:
  • ACE inhibitors: reduce afterload
  • Beta Blockers: reduce heart rate and contractility
  • Diuretics: reduce fluid retention
  • Digoxin: Increase heart contractility

Pharmacodynamics of Medications

• Pharmacodynamics: Refers to what the drug does to the body.
• Understanding onset of action is crucial for selecting the appropriate medication for a particular situation.

Cardioselective vs. Non-Cardioselective Beta Blockers

• Cardioselective Beta Blockers: Primarily block beta-1 receptors in the heart.
  • Example: Metoprolol
• Non-Cardioselective Beta Blockers: Block both beta-1 (heart) and beta-2 (lungs) receptors.
  • Example: Propranolol

Action Potential Phases

• Phase 0: Rapid depolarization and sodium influx.
• Phase 1: Early repolarization and potassium efflux.
• Phase 2: Plateau phase, calcium influx, and sustained contraction.
• Phase 3: Repolarization, potassium efflux, and relaxation.
• Phase 4: Resting membrane potential, sodium/potassium pump restores ionic balance.

Adenosine

• Used to terminate supraventricular tachycardia (SVT).

Catecholamines

• Epinephrine (Adrenaline): Released by the adrenal medulla.
• Norepinephrine (Noradrenaline): Released by the sympathetic neurons.

Chronotropes, Dromotropes, and Inotropes

• Chronotrope: Affects heart rate.
• Dromotrope: Affects conduction velocity through the heart.
• Inotrope: Affects myocardial contractility.

Histamine

• Histamine Receptors: H1, H2, H3, and H4.
• H1 Receptor Stimulation: Involved in allergic reactions, causing vasodilation, bronchoconstriction, and itching.

###Adverse Effects of Medications

• Be aware of possible adverse effects of commonly used medications.

Acute vs. Chronic Pain

• Acute Pain: Short-lived, less than 3 months, resolves with treatment.
• Chronic Pain: Persistent, lasts longer than 3 months, may be resistant to treatment.

NSAID Categories

• Nonsteroidal Anti-inflammatory Drugs (NSAIDs):
  • Traditional NSAIDs: Ibuprofen, naproxen, diclofenac.
  • COX-2 Inhibitors: Celecoxib, rofecoxib (discontinued).

Allergen vs. Antigen vs. Antibody

• Allergen: A substance that causes an allergic reaction.
• Antigen: Any substance that triggers an immune response.
• Antibody: A protein produced by the immune system to fight off antigens.

Aspirin in Ischemic Cardiac Events

• Aspirin (ASA): Inhibits platelet aggregation, preventing clot formation.
• First-Line Treatment: For acute coronary syndrome (ACS), including STEMI and NSTEMI.

Angina Types

• Stable Angina: Predictable chest pain triggered by exertion or stress.
• Unstable Angina: New onset, more severe, or occurs at rest.
• Variant Angina (Prinzmetal's Angina): Caused by coronary artery spasm.

Beta Blockers Action

• Beta Blockers: Reduce heart rate, contractility, and blood pressure.

NSTEMI and STEMI Treatments

• MONA-BAH: Treatment algorithm for acute coronary syndromes (ACS).
• M Morphine
• O Oxygen
• N Nitrates
• A Aspirin
• B Beta Blocker
• A ACE Inhibitor (for STEMI)
• H Heparin (for STEMI)

Anticoagulants

• Anticoagulants: Reduce the risk of blood clots.
  • Examples: Warfarin, heparin, dabigatran.

Drug Families

• Propranolol: Belongs to the beta-blocker family.

Suboxone

• Suboxone: A combination of buprenorphine and naloxone used for opioid addiction treatment.

Pain Management: Opioid vs. Non-Opioid Pharmacotherapy

• Opioid Analgesics: Morphine, fentanyl, hydromorphone.
• Non-Opioid Analgesics: Ibuprofen, acetaminophen (Tylenol).

Respiratory Diseases and Treatments

• Asthma: Albuterol, inhaled corticosteroids.
• Chronic Obstructive Pulmonary Disease (COPD): Bronchodilators, inhaled corticosteroids.

Medical Math: Want Over Have

• Want Over Have: A commonly used formula for calculating dosages.

Anything Covered in Class

• All content discussed in class is fair game for assessment.

This quiz covers essential concepts in hypertension management, including risk assessment, blood pressure measurement, and lifestyle modifications. It also explores the differences between hypertensive urgency and emergencies, as well as treatment options for congestive heart failure. Test your knowledge on these critical healthcare topics.