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Flashcards in 00 Hypertension Deck (103):
1

What blood pressure is considered "Pre-Hypertension"?

S: 120-139 or D: 80-89

2

What blood pressure is considered "Stage 1 Hypertension"?

S: 140-159 or 90-99

3

For the general population > 60 years, when should BP treatment be initiated?

SBP: 150+ or DBP: 90+

4

For the general population < 60 years, when should BP treatment be initiated?

SBP: 140+ or DBP: 90+

5

For 18+ years with CKD, when should BP treatment be initiated?

SBP: 140+ or DBP: 90+

6

For 18+ years with diabetes, when should BP treatment be initiated?

SBP: 140+ or DBP: 90+

7

What is recommended for initial treatment in the general population +/- DM (non-black)?

Thiazide diuretic, CCB, ACE-I, ARB

8

What is recommended for initial treatment in 18+ years, CKD, any race, +/- DM?

ACE-I or ARB (both of these could be initial or add-on to improve kidney outcomes)

9

What is recommended for initial treatment in the general black population?

Thiazide diuretic, CCB

10

If a loop and thiazide are given together, how must you space them?

Thiazide first, followed by loop one hour later

11

How do thiazides work?

Inhibits sodium reabsorption in the DISTAL CONVOLUTED TUBULES --> increase water excretion

12

What is the generic name for Diuril?

Chlorothiazide (Thiazide)

13

What is the generic name for Lozol?

Indapamide (Thiaizde)

14

What is the generic name for Zaroxolyn?

Metolazone (Thiaizde)

15

What is the generic name for Thalitone?

Chlorthalidone (Thiazide)

16

What is the only thiazide that can be given IV?

Diuril (Chlorothiazide)

17

What are the only thiazides that are effective when CrCl < 30?

Lozol (Indapamide) and Zaroxolyn (Metolazone)

18

What are the electrolyte imbalances caused by thiazides?

Hypo: K, Na, Mg, Cl. Hyper: Ca

19

What are the metabolic ADRs caused by thiazides?

Hyperglycemia, hyperuricemia, hypercholesterolemia. Photosensitivity

20

What are the contraindicates to thiazide use?

Sulfa allergy, Anuria, Renal decomposition, Pregnancy

21

What is the MOA of loop diuretics?

Inhibits Na and Cl reabsorption in the ASCENDING LOOP OF HENLE and the distal renal tubule --> increased water excretion

22

What is the generic name of Lasix?

Furosemide (loop)

23

What is the generic name of Demadex?

Torsemide (loop)

24

What is the generic name of Bumex?

Bumetanide (loop)

25

What is the generic name of Edecrin?

Ethacrynic Acid (loop) - only loop and thiazide that has no precaution with sulfa allergy

26

What are the Oral Loop Equivalents?

40 furosemide ~ 1 bumetanide ~ 10-20 torsemide

27

Whats unique about the IV formulations of loop diuretics?

They are light sensitive

28

What are the electrolyte imbalances caused by Loops?

Hypo: Na, K, Mg, Cl, AND Ca

29

When are Loops contraindicated?

Anuria

30

What is the BBW with Loops?

Excessive amounts --> profound diuresis --? fluid/electrolyte depletion

31

What is the MOA of Potassium Sparing/Aldosterone Antagonist Diuretics?

Competitive aldosterone antagonist in the distal renal tubule, leads to increase in Na, Cl, and water excretion while conserving K and H ions

32

What is the generic name of Midamor?

Amiloride (K-Sparing)

33

What is the generic name of Dyrenium?

Triamterene (K-Sparing)

34

What is the generic name of Inspra?

Eplerenone (Aldosterone Antagonist)

35

What is the generic name of Aldactone?

Spironolactone (Aldosterone Antagonist)

36

What is the only route that K-sparing and aldosterone antagonists can be give?

PO

37

How do Eplerenone and Spironolactone compare?

Eplerenone is ~100 times more potent than spironolactone

38

What electrolyte imbalance can be caused by k-sparing/aldosterone antagonists?

Hypo: Na, Mg

39

What is a unique ADR of Triamterene?

Nephrolithiasis

40

What is a unique ADR of Spironolactone?

Gynecomastia

41

What is the BBW with Spironolactone?

Tumorigenic

42

What is the BBW for both K-sparing diuretics?

Potentially fatal hyperkalemia

43

What is the generic name of Lotensin?

Benazepril (ACE-I)

44

What is the generic name of Capoten?

Captopril (ACE-I)

45

What is the generic name of Vasotec?

Enalapril (PO), Enalaprilat (IV) (ACE-I)

46

What is the generic name of Prinivil, Zestril?

Lisinopril (ACE-I)

47

What is the generic name of Altace?

Ramipril (ACE-I)

48

What is the only ACE-I that comes in IV form?

Enalaprilat

49

What are some common ADRs with ACE-I?

CAPTOPRIL: Cough, Angioedema, Pancreatitis/Proteinuria, Taste loss, Orthostatic hypotension, Pregnancy category D, Renal failure/rash, Increased potassium, Lithium increases

50

What is the generic name of Atacand?

Candesartan (ARB)

51

What is the generic name of Cozaar?

Losartan (ARB)

52

What is the generic name of Benicar?

Olmesartan (ARB)

53

What is the generic name of Diovan?

Valsartan (ARB)

54

What is the generic name of Tekturna?

Aliskiren (Direct Renin Inhibitor)

55

What is the generic name of Norvasc?

Amlodipine (CCB)

56

What is the generic name of Plendil?

Felodipine (CCB)

57

What is the generic name of Cardene?

Nifedipine (CCB)

58

What is the generic name of Sular?

Nisoldipine (CCB)

59

What is the only DHP-CCB that can be given IV?

Cardene (Nicardipine)

60

What are some common ADRs with DHP-CCBs?

Peripheral edema, Reflex tachycardia (mostly with Nicardipine and Nisoldipine), Flushing, HA/dizziness, Gingival hyperplasia, Rash

61

What are DDI's like with DHP-CCBs?

All of them are substrates of 3A4

62

What is the generic name of Cardizem?

Diltiazem (Non-DHP CCB)

63

What are some other brand names of Diltiazem?

Dilacor, Diltia, Tiazac, Taztia

64

What is the generic name of Calan?

Verapamil (Non-DHP CCB)

65

What is the most common ADR with Diltiazem?

HA and flushing

66

What is the most common ADR with Verapamil?

Constipation and Gingival hyperplasia

67

What are the DDI's like with Non-DHP CCBs?

Both 3A4 substrates and inhibitors

68

What is the generic name of Tenormin?

Atenolol (b1-selective BB)

69

What is the generic name of Lopressor?

Metoprolol Tartrate (b1-selective BB)

70

What is the generic name of Brevibloc?

Esmolol (b1-selective BB)

71

What is the generic name of Toprol XL?

Metoprolol Succinate (b1-selective BB)

72

What is the generic name of Bystolic?

Nebivolol (b1-selective BB AND increases NO production--> vasodilation)

73

What are the B1-Selective BBs?

"No AMEBBA": Nebivolol, Atenolol, Metoprolol, Esmolol, Betaxolol, Bisoprolol, Acebutolol

74

Which type of BB's cause more bradycardia?

B1-selective

75

Which type of BB's are a more suitable consideration for patients with asthma?

B1-selective

76

What is the generic name of Sectral?

Acebutolol (partial b-receptor agonist w/ ISA activity)

77

What is the generic name of Visken?

Pindolol (partial b-receptor agonist w/ ISA activity)

78

What are the Partial B-receptor agonist BB's with Intrinsic Sympathomimetic Activity (ISA)?

"CAPP": Carteolol, Acebutolol, Penbutolol, Pindolol

79

Which BB's have high lipid solubility?

Propranolol, Penbutolol, Carvedilol

80

What are the ADRs with BB's that have high lipid solubility?

Cross BBB easier, more CNS side effects: sedation, mental confusion, nightmares. Increased first past metabolism, shorter duration of action

81

What are the contraindications to BB use?

2nd/3rd degree heart block. Sinus bradycardia (HR < 50-55). Severe/uncontrolled asthma. Decompensated cardiac failure. Pregnancy. Caution in diabetics d/t masking hypoglycemia symptoms

82

What is the generic name of Coreg?

Carvedilol (combined non-selective a/b blocker)

83

What is the generic name of Normodyne, Trandate?

Labetalol

84

How should patients take Carvedilol?

With food

85

What is the generic name of Minipress?

Prazosin (a-1 blocker)

86

What is the generic name of Hytrin?

Terazosin (a-1 blocker)

87

What is the generic name of Cardura?

Doxazosin (a-1 blocker)

88

What are some common ADRs with a-1 blockers?

Orthostatic hypotension (including "1st" dose phenomenon). Sodium and fluid retention

89

What are a-1 blockers contraindicated?

With concurrent use of PDE-5 inhibitors

90

What is the generic name of Catapress?

Clonidine (central/peripheral acting a-2 adrenergic agonist)

91

What is the generic name of Kapvay?

Clonidine ER (central/peripheral acting a-2 adrenergic agonist)

92

What is the generic name of Aldomet?

Methyldopa (central/peripheral acting a-2 adrenergic agonist)

93

What is the generic name of Serpasil?

Reserpine (central/peripheral acting a-2 adrenergic agonist)

94

What are some common ADRs with clonidine?

Sedation (tolerance does not develop), orthostatic hypotension, dry mouth, constipation

95

When is methyldopa contraindicated?

Active liver disease. Concurrent use of MAO-I

96

When is reserpine contraindicated?

Active GI disease (eg ulcers, etc), depression, severe renal failure, ulcerative colitis

97

What is the generic name of Apresoline?

Hydralazine (direct vasodilator)

98

What is the generic name of Loniten?

Minoxidil (direct vasodilator)

99

What is a unique ADR of Minoxidil?

Hirsutism

100

What medications are used for Hypertensive Urgency?

PO Medications: Captopril, Clonidine, Labetalol. Reduce BP gradually over 24-48 hours to safe levels (<160/100)

101

What medications are used for Hypertensive Urgency?

Use IV meds: Sodium nitroprusside, Nitroglycerine, Labetolol, Esmolol, Propranolol, Nicardipine, Clevidipine, Fenoldopam mesylate, Hydralazine, Phentolamine, Enalaprilat

102

What is the general recommendation for HTN in pregnancy?

Start with methyldopa or labetalol (methyldopa is still DOC). If additional treatment is needed: long acting CCB Nifedipine is safe. NO ACE-I, ARBs, DIRECT RENIN INHIBITOR!!!

103

What is the DOC for preeclampsia?

Hydralazine