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Notes/Facts/Brand vs Generic > Hypertensives > Flashcards

Hypertensives Flashcards

1
Q

Angiotensin II causes _________ and __________ leading to retention of _________

A

vasoconstriction
&
increased release of aldosterone

Na+ and H2O

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2
Q

RAAS inhibitors decrease blood pressure by _________

A

inhibiting the effects of Angiotensin II

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3
Q

What classes of drugs have shown to slow the progression of kidney disease in patients with albuminuria?

A

ACE inhibitors and ARBs

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4
Q

Angiotensin II constricts the ____________ of the nephron, causing increased workload in the glomeruli; which over time, results in _________

A

efferent arterioles

kidney damage

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5
Q

In heart failure, ACE inhibitors and ARBs protect the myocardium from what?

A

remodeling effects of Angiotensin II

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6
Q

RAAS inhibitors should NOT be used in combination due to increased risk of _________

A

adverse effects

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7
Q

RAAS inhibitors include _____

A

ACE inhibitors, ARBs, aliskiren, ARNI

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8
Q

What is a potentially fatal adverse effect that can occur with the use of any RAAS inhibitor? Who is at higher risk?

A

Angioedema: the swelling of the deeper layers of the skin caused by a build up of fluid.

More common with ACE inhibitors than ARBs or aliskiren

black patients

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9
Q

If a patient develops angioedema with any RAAS inhibitor then __________

A

all other RAAS inhibitors SHOULD BE AVOIDED

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10
Q

What class of drugs blocks the conversion of Angiotensin I to Angiotensin II? and what is the result?

A

ACE Inhibitors

decrease in vasoconstriction and decrease in aldosterone secretion

they also block the degradation of bradykinin, which is thought to contribute to vasodilatory effects and side effects of dry /hacking cough & angioedema.

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11
Q

What class of drugs blocks the degradation of bradykinin?

A

ACE inhibitors,

this is thought to contribute to the vasodilatory effects & side effects of a dry/hacking cough and angioedema

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12
Q

Lotensin *

A

benazepril

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13
Q

Vasotec *

A

enalapril

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14
Q

Vasotec IV *

A

enalaprilat

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15
Q

Prinivil *

A

lisinopril

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16
Q

Zestril *

A

lisinopril

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17
Q

Qbrelis

A

lisinopril oral solution

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18
Q

Accupril *

A

quinapril

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19
Q

Altace *

A

ramipril

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20
Q

Uncontrolled Hypertension places the patient at greater risk for ________

A

heart disease, stroke and kidney disease

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21
Q

Most patients have ________ hypertension. The cause is unknown.

A

primary or essential hypertension

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22
Q

secondary hypertension can be caused by _____________

A

renal disease (chronic kidney disease), adrenal disease, obstructive sleep apnea, or drugs

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23
Q

___________ is responsible for the conversion of angiotensinogen to angiotensin I

A

Renin

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24
Q

________ directly inhibits renin preventing the conversion of angiotensinogen to angiotensin I

A

Renin Inhibitor

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25
Q

Angiotensinogen is released by the _______

A

liver

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26
Q

Renin is released by the ______

A

kidneys

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27
Q

BP assessments should be based on an average of at least ____________readings on _________, preferably standardized to the timing of medication administration

A

2 readings

2 separate occasions

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28
Q

The ACC/AHA has defined 4 categories of blood pressure in adults:

A

normal blood pressure: SBP < 120mmHg AND DBP < 80mmHg
elevated BP: SBP 120-129mmHg AND DBP < 80mmHg

Stage 1 HTN: SBP 130-139mmHg oorrr DBP 80-89

Stage 2 HTN: SBP >= 140mmHg oorrr DBP >= 90mmHg

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29
Q

normal blood pressure =

A

SBP < 120mmHg AND DBP < 80mmHg

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30
Q

elevated blood pressure =

A

SBP 120-129mmHg AND DBP < 80mmHg

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31
Q

Stage 1 HTN =

A

SBP 130-139mmHg ooorrrrr DBP 80-89mmHg

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32
Q

Stage 2 HTN =

A

SBP >= 140mmHg ooorrrr DBP >= 90mmHg

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33
Q

Lifestyle interventions are essential to prevent hypertension. Proven interventions include:

A

Weight loss (1kg of weight loss decreases BP by ~1 mmHg)

heart healthy diet [DASH eating plan (Dietary Approaches to Stop Hypertension] that is high in fruits, vegetables, fiber and low fat dairy products

Reduce sodium intake to < 1500mg daily

Routine physical activity

Limiting alcohol consumption to one drink daily for women and two drinks daily for men

Tobacco cessation

controlling blood glucose and cholesterol to reduce cardiovascular disease risk

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34
Q

What is the correct way to use Blood pressure monitor?

A

first go to restroom and empty bladder

Sit in a chair (both feet on the floor) and relax for at least 5 minutes

Use the correct cuff size

Support the arm at heart level (resting on a desk)

Wait 1-2 minutes in between measurements

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35
Q

What Not to do when using a blood pressure monitor?

A

DON’T

talk
sit or lie down on the examination table
drink caffeine, exercise or smoke for 30 minutes prior
Use a finger or wrist monitor (less accurate)

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36
Q

Key Drugs that can increase Blood Pressure

A

Amphetamines
Cocaine
Decongestants (pseudoephedrine, phenylephrine)
Erythropoiesis-stimulating agents
Immunosuppressants (cyclosporine)
NSAIDs
Systemic steroids

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37
Q

What are some natural products that can reduce blood pressure?

A

Although not recommended by guidelines: Fish oil, coenzyme Q10, L-arginine, and garlic have some evidence for reducing blood pressure and overall cardiovascular risk.

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38
Q

What are the four preferred drug classes for Tx hypertension?

A

Ace inhibitors
ARBs
thiazides
(DHP) dihydropyridine calcium channel blockers

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39
Q

When do we start Treatment for Hypertension in patients?

A

If patients have:

Stage 2 Hypertension
or
Stage 1 Hypertension AND 1 of the following:

1) clinical CVD (stroke, heart failure, or coronary heart 
    disease)
2) 10 year ASCVD risk >= 10%
3) Does not meet Blood pressure goals after 6 months of 
    lifestyle modifications
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40
Q

What is Blood Pressure Goal?

A

All patients < 130/80 mmHg

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41
Q

Initial drug selection for hypertension in patients that are:
Non-black

A

thiazides, DHP CCBs, ACE inhibitors, or ARBs

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42
Q

Initial drug selection for hypertension in patients that are:
Black

A

thiazide or DHP CCBs

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43
Q

Initial drug selection for hypertension in patients that have CKD*** (all races):

A

ACE inhibitor or ARB (to slow the progression to ESRD)

***CKD: stage 3 (eGFR < 60mL/min/m^2) and/or albuminuria (urine albumin >= 300mg/day or albumin: creatinine ratio >= 300mg/g)

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44
Q

Initial drug selection for hypertension in patients that have Diabetes with albuminuria (all races):

A

ACE inhibitor or ARB

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45
Q

Initial drug selection for hypertension in patients that have Diabetes with CAD*** (all races):

A

Ace inhibitor or ARB

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46
Q

When do we start 2 first-line drugs (from preferred drug classes) in Stage 2 hypertension?

A

If SBP and DBP are > 20/10 mmHg above goal

ex. 150/90mmHg

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47
Q

The ADA recommends a goal BP of ___________ for patients with diabetes and high ASCVD risk, and __________ for patients at lower risk

A

< 130/80 mmHg

< 140/90 mmHg

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48
Q

The 2021 KDIGO guidelines recommend a goal SBP __________ for patients with hypertension and CKD

A

< 120 mmHg

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49
Q

which hypertension drugs have Boxed warnings for Fetal toxicity in pregnancy and should be stopped immediately?

A

ACE inhibitors
ARBs
aliskiren

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50
Q

Antihypertensive drugs can be used in pregnancy to Tx?

A

preeclampsia
gestational hypertension ( hypertension that develops during pregnancy)
chronic hypertension ( hypertension before pregnancy)

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51
Q

Preeclampsia occurs after ___________of the pregnancy and is evident by elevated blood pressure and proteinuria in the majority of cases

A

week 20

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52
Q

Preeclampsia

A

a serious blood pressure condition that develops during pregnancy, having high blood pressure and high levels of protein in their urine

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53
Q

Pregnant patients with chronic hypertension (hypertension before pregnancy) should receive treatment if ________

A

SBP >= 160mmHg or DBP >= 105mmHg

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54
Q

In patients at high risk of preeclampsia, a __________ is recommended after the first trimester

A

daily low aspirin

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55
Q

The American College of Obstetricians and Gynecologists recommend ________ and _________ as first line treatments. _________ is also recommended but may be less effective at lowering BP.

A

labetalol (Trandate, Normodyne)
nifedipine extended release (Procardia XL, )

methyldopa (Aldomet)

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56
Q

Pregnant patients with chronic hypertension should have a blood pressure maintained between __________

A

120-160 mmHg SBP AND 80-110 mmHg DBP

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57
Q

Zestoretic *

A

Lisinopril/hydrochlorothiazide

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58
Q

Lotrel *

A

benazepril/amlodipine

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59
Q

Maxzide *

A

Triamterene/HCTZ

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60
Q

Hyzaar *

A

losartan/HCTZ

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61
Q

Exforge *

A

valsartan/amlodipine

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62
Q

Dyazide *

A

triamterene/HCTZ

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63
Q

Benicar HCT *

A

olmesartan/HCTZ

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64
Q

Diovan HCT *

A

valsartan/HCTZ

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65
Q

Tenoretic *

A

atenolol/chlorthalidone

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66
Q

Ziac *

A

bisoprolol/HCTZ

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67
Q

Edarbyclor

A

azilsartan/chlorthalidone

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68
Q

Lotensin HCT

A

benazepril/HCTZ

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69
Q

Vaseretic

A

enalapril/HCTZ

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70
Q

Avalide

A

irbesartan/HCTZ

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71
Q

Micardis HCT

A

telmisartan/HCTZ

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72
Q

Tribenzor

A

olmesartan/amlodipine/hydrochlorothiazide

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73
Q

Azor

A

olmesartan/amlodipine

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74
Q

Twynsta

A

telmisartan/amlodipine

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75
Q

Tekturna HCT

A

aliskiren/HCTZ

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76
Q

Lopressor HCT

A

metoprolol tartrate/HCTZ

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77
Q

Dutoprol

A

metoprolol succinate/HCTZ

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78
Q

Exforge HCT

A

valsartan/amlodipine/HCTZ

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79
Q

Aldactazide

A

spironolactone/HCTZ

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80
Q

Thiazide-type diuretics inhibit __________ reabsorption in the __________. This causes increased excretion of ____________

A

Na+

distal convoluted tubules of the nephrons

Na+ , Cl- , H2O , K ( sodium, chloride, water, potassium)

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81
Q

Microzide *

A

hydrochlorothiazide

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82
Q

Diuril

A

chlorothiazide

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83
Q

Mykrox

A

metolazone (thiazide type diuretic)

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84
Q

Lozol

A

indapamide (thiazide type diuretic)

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85
Q

Thiazide-Type Drug interactions

A

Drugs that can cause sodium and water retention can decrease the effectiveness of antihypertensives. (Do not use in combination)

ex. NSAIDs

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86
Q

Thiazide diuretics and lithium DDI

A

thiazide diuretics can decrease lithium renal clearance and increase the risk of lithium toxicity. Do not use in combination if possible.

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87
Q

Thiazide diuretics and dofetilide DDI

A

thiazide diuretics can increase dofetilide serum concentrations leading to an increase risk of QT prolongation; do not use in combination

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88
Q

Thalitone *

A

chlorthalidone (thiazide type diuretic)

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89
Q

what are the contraindications for thiazide type diuretics?

A

Hypersensitivity to Sulfonamide-derived drugs (not likely to cross react), anuria (failure of the kidneys to produce urine)

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90
Q

There is increased excretion of electrolytes _______ with the use of thiazide type diuretics

A

Na, Mg, K,

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91
Q

Thiazide diuretics are not effective when ___________, except for ______

A

CrCl < 30ml/min, metolazone

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92
Q

Which thiazide type diuretic is the only one available in a IV formulation?

A

chlorothiazide

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93
Q

thiazide type diuretics, should be taken early in the morning to avoid ________

A

nocturia (get up at night to use bathroom)

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94
Q

DHP CCBs (dihydropyridine calcium channel blockers) are used for: __________

A

hypertension, chronic stable angina, and Prinzmetal’s angina

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95
Q

Prinzmetal’s angina:

A

a known clinical condition characterized by chest discomfort or pain at rest with transient electrocardiograph changes in the ST segment, and with a prompt response to nitrates

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96
Q

MOA of DHP CCBs -

A

they inhibit Ca++ ions from entering vascular smooth muscle and myocardial cells, this causes peripheral arterial vasodilation “which decreases SVR and BP” (systemic vascular resistance and blood pressure) and coronary artery vasodilation

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97
Q

Norvasc *

A

amlodipine

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98
Q

Katerzia

A

amlodipine oral suspension

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99
Q

Cardene IV *

A

nicardipine IV

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100
Q

Adalat CC *

A

nifedipine ER

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101
Q

Procardia XL *

A

nifedipine ER

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102
Q

Procardia

A

nifedipine IR

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103
Q

Sular

A

nisoldipine ER

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104
Q

Plendil

A

felodipine ER

105
Q

Cleviprex

A

clevidipine

106
Q

What is the Contraindication with the drug Nicardipine

A

Should NOT be used in advanced aortic stenosis

107
Q

___________ is considered the safest if a CCB must be used to lower BP in heart failure with reduced ejection fraction

A

amlodipine

108
Q

__________ is a drug of choice in pregnancy

A

Nifedipine ER

109
Q

DHP CCBs (eg. nifedipine ER) are used to prevent peripheral vasoconstriction in __________

A

Raynaud’s (cold/blue fingers)

110
Q

Do NOT Use Nifedipine IR for _____________

A

chronic hypertension (hypertension before pregnancy) or acute blood pressure reduction in non-pregnant adults (profound hypotension, MI and/or death has occurred)

111
Q

Side effects with DHP CCBs

A

generally well tolerated, peripheral edema/headache/flushing/palpitations/reflex tachycardia/fatigue (worse with nifedipine IR) nausea, gingival hyperplasia (more with non-DHP CCBs)

112
Q

Which DHP CCBs have an OROS/gel matrix formulation and can leave a ghost tablet (empty shell) in stool

A

Adalat CC and Procardia XL: Nifedipine ER formulations

113
Q

If patient has an allergy to soybeans, soy products or eggs, which CCB is contraindicated for the patient??

A

Cleviprex (clevidipine) - DHP CCB

114
Q

Which DHP CCB comes as a lipid emulsion (providing 2 kcal/mL) and is a milky white in color?

A

Cleviprex (clevidipine)

115
Q

What is the maximum time of use after vial puncture of Cleviprex?

A

12 hours

116
Q

Propofol (_________) is another lipid emulsion that provides _________ kcal/mL and requires tubing and vial changes every 12 hours

A

Diprivan

1.1kcal/mL

117
Q

The non-DHP CCBs include ________ and ________

A

verapamil and diltiazem

118
Q

Primarily the non-DHP CCBs are used to ____________. Sometimes are used for ______

A

control HR in certain arrhythmias (atrial fibrillation)

hypertension and angina

119
Q

MOA for non-DHP CCBs:

A

they inhibit Ca++ ions from entering vascular smooth muscle and myocardial cells, by blocking Ca++ channels, BUT are more selective for the myocardium than the DHP CCBs.

120
Q

The decrease in blood pressure produced by non-DHP CCBs is due too ____________

A

negative inotropic (decrease force of ventricular contraction)

&

negative chronotropic (decrease heart rate) effects

121
Q

Cardizem *

A

diltiazem

121
Q

Tiazac *

A

diltiazem

122
Q

Calan SR *

A

verapamil

123
Q

Verelan

A

verapamil

124
Q

what are the contraindications with diltiazem

A

1) patient has Sick Sinus Syndrome or a 2nd or 3rd degree AV block —- Unless they have a functioning ventricular pacemaker

2) patient has severe hypotension ( less than 90 mmHg systolic) or cardiogenic shock

3) hypersensitivity to the drug

4) patient with acute myocardial infarction and pulmonary congestion

125
Q

what are the contraindications with verapamil

A

1) atrial flutter or atrial fibrillation and an accessory by pass tract

2) severe left ventricular dysfunction

3) severe hypotension ( less than 90 mmHg systolic) or cardiogenic shock

4) patient has Sick Sinus Syndrome or a 2nd or 3rd degree AV block —- Unless they have a functioning ventricular pacemaker

126
Q

Non-DHP CCBs are used to _________

A

reduce rapid heart rate in atrial fibrillation

127
Q

IV:PO conversions of non DHP CCBs ____

A

are NOT 1:1

128
Q

side effects with non-DHP CCBs include _________

A

edema, constipation (more with verapamil) gingival hyperplasia

headache, dizziness

129
Q

Warnings with using non-DHP CCBs include _________

A

Heart failure (may worsen symptoms), bradycardia, hypotension. increased LFTs

cardiac conduction abnormalities (diltiazem)

hypertrophic cardiomyopathy (verapamil)

130
Q

All CCBs are major substrates of __________ except for _________. Do NOT use with ________

A

CYP450 3A4

clevidipine

grapefruit juice

131
Q

diltiazem and verapamil are inhibitors of _________

A

P-gp and moderate inhibitors or CYP3A4

132
Q

Patients who take statins should use lower doses of ________ and __________ or can use a statin that is NOT metabolized by CYP3A4 including __________

A

simvastatin or lovastatin

pitavastatin
pravastatin
rosuvastatin

133
Q

With CCBs use caution with other drugs that decrease HR including: ____________

A

beta blockers, digoxin, clonidine, amiodarone

dexmedetomidine

134
Q

What are the Boxed Warnings with ACE inhibitors?

A

Cause injury and death to the developing fetus when used in the 2nd and 3rd trimesters; Discontinue as soon as pregnancy is detected

135
Q

What are the Contraindications with ACE inhibitors?

A

DO NOT Use with Hx of angioedema

DO NOT Use within 36 hours of Entresto

Do Not Use with aliskiren in diabetes

136
Q

What are the Warnings with ACE inhibitors?

A

Angioedema, hyperkalemia, hypotension, renal impairment, bilateral renal artery stenosis (avoid use)

137
Q

What are the Side effects with ACE inhibitors?

A

generally well tolerated, cough, hyperkalemia, increased SCr, hypotension/dizziness [increased risk if volume-depleted (with concurrent diuretic)], headache

138
Q

What do we monitor for in ACE inhibitors?

A

blood pressure, K “potassium”, renal function, signs and symptoms of angioedema

139
Q

Capoten

A

captopril - “12.5mg BID - 50mg TID”

140
Q

Avapro *

A

irbesartan

141
Q

Cozaar *

A

losartan

142
Q

Benicar *

A

olmesartan

143
Q

Diovan *

A

valsartan

144
Q

Edarbi

A

azilsartan

145
Q

Micardis

A

telmisartan

146
Q

What are some benefits with ARBs over ACE inhibitors?

A

Less cough
Less angioedema
No washout period required with Entresto

147
Q

What is an important pearl with azilsartan (Edarbi)?

A

Keep in original container to protect from light and moisture

148
Q

What Warning does olmesartan (Benicar) have?

A

sprue-like enteropathy (ongoing damage or irritation and swelling to the small intestine) - severe, chronic diarrhea with substantial weight loss; can occur months to years after drug initiation.

149
Q

Tekturna

A

aliskiren

150
Q

what class of medications prevents the conversion of angiotensinogen to angiotensin I ?

A

Direct Renin Inhibitor

ex. Tekturna

151
Q

Contraindications with Tekturna

A

Do NOT use with ACE inhibitors or ARBs in patients with diabetes

152
Q

Pearls/Notes to know about Tekturna

A

Avoid high fat foods (reduces absorption)
tablets must be protected from moisture
Take with or without food but be consistent in administration with regard to meals

153
Q

Dosing of Tekturna

A

150-300mg daily

154
Q

All RAAS inhibitors have increased risk of ________

A

hyperkalemia. Other medications that increase potassium should be used cautiously. Patients should avoid salt substitutes that contain potassium chloride

155
Q

ACE inhibitors and ARBs should NOT be used in combination with ____________. ACE inhibitors or ARBs are contraindicated with ________ in patients with diabetes

A

Entresto

Tekturna

156
Q

MOA of Tekturna -

A

inhibits the conversion of angiotensinogen to angiotensin 1, therefore decreased formation of Angiotensin 1 leading to a decrease in formation of Angiotensin 2.

157
Q

ACE inhibitors and ARBs can ____________ lithium renal clearance and __________ the risk for lithium toxicity

A

decrease lithium renal clearance

&

increase the risk for lithium toxicity

158
Q

Potassium-sparing diuretics _________ and ___________ have minimal blood pressure lowering effects. They are often used in combination with HCTZ to ___________ seen with thiazide diuretics.

A

triamterene
amiloride

counteract the mild potassium losses

159
Q

The aldosterone receptor antagonists _________ and ___________ are the preferred add-on drugs in “resistant hypertension” = (uncontrolled blood pressure despite maximum tolerated doses of a CCB + thiazide diuretic + ACE inhibitor or ARB) AND they are commonly used in ________

A

spironolactone and eplerenone

heart failure

160
Q

which aldosterone receptor antagonist is nonselective and which one is selective?

A

spironolactone = non-selective aldosterone receptor antagonist (also blocks androgen)

eplerenone = selective aldosterone receptor antagonist ( DOES NOT

161
Q

The potassium sparing diuretics compete with aldosterone at receptor sites in the _________ and ___________ of the nephron, increasing excretion of ________ and _______ but conserving potassium

A

distal convoluted tubule and collecting ducts

Na+ & H2O

162
Q

Aldactone *

A

spironolactone tablets

163
Q

CaroSpir

A

spironolactone oral suspension

(approved for HF and edema due to cirrhosis) is not therapeutically equivalent to Aldactone and dosing recommendations differ

164
Q

Dyrenium

A

triamterene

165
Q

Dyazide **

A

brand D/C triamterene/HCTZ

166
Q

Maxzide *

A

triamterene/HCTZ

167
Q

amiloride

A
168
Q

Inspra

A

eplerenone

169
Q

Eplerenone is a major substrate of ___________; Do NOT USE with ________

A

CYP3A4

CYP3A4 inhibitors

(ketoconazole, itraconazole, clarithromycin, ritonavir)

170
Q

What are the Boxed Warnings with amiloride & triamterene:

A

hyperkalemia (K>5.5mEq/L) - more likely in patients with diabetes, renal impairment, or elderly patients

171
Q

What are the Contraindications with Aldactone

A

Do NOT Use if hyperkalemia, severe renal impairment, Addison’s disease

172
Q

What are the Contraindications with Inspra

A

Do NOT Use if patient taking strong CYP3A4 inhibitors

173
Q

What are the side effects seen with Aldactone

A

increased K, (hyperkalemia), increased SCr, dizziness
gynecomastia(enlargement of breast tissue in men), breast tenderness, impotence, irregular menses

174
Q

What are the side effects seen with Inspra

A

increased TG,

increased K (hyperkalemia), increased SCr, dizziness

175
Q

What do we monitor with potassium sparing diuretics?

A

Blood pressure, K, renal function, fluid status, signs and symptoms of heart failure

176
Q

Potassium Sparing diuretics can _________ lithium renal clearance and __________ the risk of lithium toxicity

A

decrease

increase

177
Q

Selection of a specific Beta blocker will depend on the _____ being treated.

A

condition

178
Q

bisoprolol, carvedilol or metoprolol succinate should be used if treating _________

A

chronic heart failure

179
Q

MOA of Beta blockers:

A

they decrease BP by competitively blocking beta-1 and/or beta-2 adrenergic receptors, resulting in decreases in HR and myocardial contractility

180
Q

Which beta-blockers have alpha-1 blocking properties

A

carvedilol & labetalol

181
Q

Beta-blockers with (ISA) ____________ include: ______

A

intrinsic sympathomimetic activity

acebutolol, penbutolol, pindolol

182
Q

Beta-blockers with ISA are NOT recommended in patients __________. They Do Not _________ heart rate to the same degree as beta-blockers with ISA

A

post-MI (myocardial infarction)

decrease

183
Q

If a beta-blocker is needed in a patient with bronchospastic disease (asthma, COPD) a ______________ agent is preferred

A

beta-1 selective

184
Q

Tenormin *

A

atenolol ——————- beta-1 selective

185
Q

Brevibloc *

A

esmolol ————beta-1 selective

injection

186
Q

Lopressor *

A

metoprolol tartrate ————-beta-1 selective

tablet, injection

187
Q

Toprol XL *

A

metoprolol succinate ———– beta-1 selective

tablet

188
Q

Kapspargo Sprinkle

A

metoprolol succinate ———-beta-1 selective
capsule sprinkle

189
Q

Betoptic S

A

betaxolol —– beta-1 selective ophthalmic solution

also available as a tablet

190
Q

Remember “AMEBBA” for Beta-1 selective beta blockers

A

atenolol
metoprolol
esmolol
bisoprolol
betaxolol
acebutolol

191
Q

What is the beta blocker that is Beta-1 selective with Nitric Oxide-Dependent Vasodilation

A

Bystolic —– nebivolol

192
Q

What are the Non-selective beta-blockers?

A

Inderal ——— propranolol
Corgard——— nadolol
pindolol
timolol
Coreg ——— carvedilol
labetalol

193
Q

Inderal LA

A

propranolol ——— non-selective beta-blocker

Dosing: 80-160mg daily MAX: 640mg daily

194
Q

Inderal XL

A

propranolol ——– non-selective beta-blocker

dosing: 80mg daily MAX 120mg daily

195
Q

Corgard

A

nadolol ———— non-selective beta-blocker

dosing: 40-320mg daily

196
Q

Trandate *

A

labetalol

197
Q

Normodyne *

A

labetalol

198
Q

Coreg *

A

carvedilol IR

199
Q

What are the Boxed Warnings with Beta-Blockers

A

Do NOT discontinue abruptly (particularly in patients with CAD/IHD); gradually taper dose over 1-2 weeks to avoid acute tachycardia, hypertension, and/or ischemia

200
Q

What are the Contraindications with Beta-1 selective blockers

A

severe bradycardia; 2nd or 3rd degree AV block or sick sinus syndrome (unless a permanent pacemaker is in place); overt cardiac failure or cardiogenic shock

esmolol- pulmonary hypertension; use of IV non-DHP CCBs

201
Q

What are the Warnings with beta-blockers

A

Use Caution in patients with diabetes: can worsen hyperglycemia or hypoglycemia and mask hypoglycemic symptoms.

Use Caution with bronchospastic diseases (asthma, COPD), beta-1 selective preferred

Use Caution with Raynaud’s/ other peripheral vascular diseases, pheochromocytoma and heart failure (slow dose titration required if used in these conditions)

Can mask signs of hyperthyroidism (tachycardia), can worsen CNS depression

202
Q

Side effects with beta-blockers

A

bradycardia, fatigue, hypotension, dizziness, depression, impotence (less than thiazides),

cold extremities (can exacerbate Raynaud’s)

203
Q

Monitoring with beta blockers

A

Heart Rate, BP

(decrease dose if HR < 55 BPM)

204
Q

Notes/Pearls with Beta blockers

A

oral drugs: titrate doses every 1-2 weeks (as tolerated), take without regard to meals (EXCEPT for Lopressor & Toprol XL, SHOULD be taken with or immediately following food)

205
Q

What is the IV:PO ratio for metoprolol tartrate

A

1:2.5

206
Q

When switching from metoprolol tartrate to metoprolol succinate, the TDD _____________

A

is the same and should be used

207
Q

Notes/Pearls with Non-Selective Beta blockers

A

are used in portal hypertension

208
Q

Notes/Pearls with the non-selective beta blocker propranolol

A

Has high lipid solubility (lipophilic) and crosses the blood-brain barrier; it is associated with more CNS side effects, but this makes it useful for other conditions (migraine prophylaxis, essential tremor)

209
Q

what is the conversion ratio going from carvedilol CR to carvedilol IR

A

Coreg CR 10mg daily = Coreg 3.125mg BID

Dose conversions ARE NOT 1:1

210
Q

Notes/Pearls with carvedilol

A

Take ALL forms of carvedilol with food to decrease the rate of absorption and the risk of orthostatic hypertension

Coreg CR 10mg daily = Coreg 3.125mg BID

Dose conversions ARE NOT 1:1

211
Q

Contraindications with carvedilol

A

Severe hepatic impairment

severe bradycardia; 2nd or 3rd degree AV block or sick sinus syndrome (unless a permanent pacemaker is in place); overt cardiac failure or cardiogenic shock

212
Q

Warnings with carvedilol

A

Intraoperative floppy iris syndrome has occurred in cataract surgery patients who were on or were previously treated with an alpha-1 blocker

213
Q

which beta blockers are nonselective and are alpha-1 blockers

A

carvedilol

labetalol

214
Q

which beta blocker is the drug of choice in pregnancy

A

labetalol

injection is commonly used in the hospital setting and can be administered by repeated IV push or slow continuous infusion

215
Q

Hemangeol

A

propranolol oral solution

group 2 antiarrhythmic

216
Q

Timoptic

A

timolol ————– non-selective beta-blocker

217
Q

Beta Blocker Drug Interactions

Beta blockers can enhance the _______________ effects of insulin and sulfonylureas AND ______ some of the symptoms of _________(shakiness, palpitations, anxiety) symptoms of sweating and hunger are not masked.

A

hypoglycemic
mask
hypoglycemia

218
Q

Beta Blocker Drug Interactions

beta blockers can _________ insulin secretion, causing _________.

A

decrease

hyperglycemia

219
Q

Beta Blocker Drug Interactions

Use CAUTION when administering other drugs that decrease HR including _______________________

A

diltiazem, verapamil, digoxin, clonidine, amiodarone and dexmedetomidine (Precedex)

220
Q

which beta blockers are major substrates for CYP2D6

A

carvedilol, propranolol, and metoprolol

221
Q

which beta blockers are inhibitors of P-gp and can increase the serum concentrations of P-gp substrates like (cyclosporine, dabigatran, digoxin, ranolazine)

A

carvedilol & propranolol

222
Q

Contraindications with Bystolic (_________)

A

nebivolol

Severe Liver impairment ( Child-Pugh > class B)

223
Q

Catapres **

A

clonidine
dosing: 0.1-0.2mg PO BID. Max dose is 2.4mg daily
centrally-acting alpha-2 adrenergic agonists
commonly used for resistant hypertension

224
Q

Catapres-TTS *

A

clonidine transdermal patch
centrally-acting alpha-2 adrenergic agonists
indicated for resistant hypertension

TTS-1 = 0.1mg/24hr
TTS-2 = 0.2mg/24hr
TTS-3 = 0.3mg/24hr

225
Q

Tenex *

A

guanfacine IR
dosing: 1-2mg QHS
centrally-acting alpha-2 adrenergic agonists
Indicated for resistant hypertension

226
Q

Intuniv *

A

guanfacine ER
centrally-acting alpha-2 adrenergic agonists
Indicated for ADHD

227
Q

which medications are centrally-acting alpha-2 adrenergic agonists

A

clonidine
guanfacine
methyldopa

228
Q

Apresoline *

A

hydralazine
vasodilator

229
Q

Kapvay *

A

clonidine
centrally-acting alpha-2 adrenergic agonists
Indicated for ADHD

230
Q

Aldomet

A

methyldopa
centrally-acting alpha-2 adrenergic agonists
indicated for hypertension
preferred drug in pregnancy

231
Q

MOA of clonidine, guanfacine, and methyldopa

A

decrease blood pressure by stimulating alpha-2 adrenergic receptors in the brain and reducing sympathetic outflow of norepinephrine, which decreases SVR and HR

232
Q

clonidine is commonly used for ________ and in patients who CAN NOT swallow since it is available as a patch formulation. Patch is changed ______ , it can help with adherence.

A

resistant hypertension

weekly

233
Q

Contraindications with Methyldopa:

A

concurrent use with MAO inhibitors

active liver disease

234
Q

Warnings with Centrally acting alpha-2 adrenergic agonists

A

DO NOT DISCONTINUE abruptly ( can cause rebound hypertension, sweating, anxiety, tremors) Must taper gradually over 2-4 days

235
Q

Warnings with Methyldopa

A

risk for hemolytic anemia (detected by a positive Coombs test), hepatic necrosis

236
Q

Side Effects with centrally acting alpha 2 adrenergic agonists

A

dry mouth, somnolence, fatigue, dizziness, constipation, decrease HR, hypotension, impotence

headache, depression, behavioral changes ( irritability, confusion, anxiety, nightmares)

clonidine patch: skin rash, pruritus, erythema

methyldopa: hypersensitivity reactions (drug-induced lupus erythematosus (DILE)), edema or weight gain (control w/ diuretics), increase prolactin levels

237
Q

Notes/pearls with Catapres-TTS

A

remove before MRI

238
Q

Apresoline *

A

hydralazine
direct vasodilator
Dosing: PO 10-50mg QID
MAX dose 300mg daily

IM, IV: 10-20mg Q 4-6H PRN

239
Q

Rogaine for Men or Women

A

minoxidil
-OTC topical for hair growth

240
Q

minoxidil

A
241
Q

MOA of hydralazine

A

causes direct vasodilation of arterioles, with little effect on veins. The result is a decrease in SVR and reduction in BP

242
Q

MOA of minoxidil

A

causes direct vasodilation of arterioles, with little effect on veins. The result is a decrease in SVR and reduction in BP

243
Q

Blood Pressure = __________ x ___________

A

(SVR) systemic vascular resistance x (CO) cardiac output

244
Q

Cardiac Output (CO) = __________ x ________

A

stroke (Blood) volume x Heart Rate (HR)

245
Q

MOA of alpha-blockers =

A

bind to alpha-1 adrenergic receptors, which results in peripheral vasodilation of arterioles and veins. NOT RECOMMENDED for hypertension but may be used in men who have (BPH) benign prostatic hyperplasia

246
Q

drugs that are alpha blockers -

A

doxazosin, prazosin, terazosin

247
Q

Hypertensive crisis is defined as ______

A

rapidly accelerating blood pressure (generally >= 180/120)

248
Q

What are the two types of hypertensive crisis:

A

1) hypertensive emergency = rapidly accelerating blood pressure WITH acute target ORGAN DAMAGE that may be life threatening (encephalopathy, stroke, acute kidney injury, acute coronary syndrome)

2) hypertensive urgency - no evidence of acute target organ damage

249
Q

Treatment of Hypertensive Emergency:

A

Treat with IV medications

Decrease Blood Pressure by no more than 25% within the first hour, then if stable, decrease to ~160/100 mmHg in the next 2-6 hours

250
Q

Treatment of Hypertensive Urgency:

A

Treat with any oral medications that has a short onset of action (15-30min)

Decrease Blood pressure gradually over 24-48 hours

251
Q

What are some of the KEY IV hypertensive medications for Hypertensive Emergency?

A

Labetalol Nicardipine Metoprolol tartrate
Diltiazem Verapamil
Hydralazine Propranolol

Chlorothiazide Clevidipine
Nitroglycerin Nitroprusside
Enalaprilat Esmolol

252
Q

All Hypertensive products:

A

Can cause Orthostasis ( a decrease in blood pressure that happens soon after standing or sitting up)

check your blood pressure regularly

Take blood pressure medications as directed, even if you feel well. Lowering blood pressure helps decrease risk of complications such as heart disease, kidney disease and stroke.

253
Q

Thiazide-Type diuretics Counseling/Key points

A

Take this medication early in the day ( no later than 4pm) to avoid getting up at night to go to the bathroom.

Can cause:
-Hyperglycemia
-Photosensitivity
-Sexual dysfunction

254
Q

Calcium Channel Blockers Counseling/Key points

A

Can cause:
-peripheral edema
-gingival hyperplasia

Adalat CC: take on an empty stomach
ghost tablet in the stool (Adalat CC and Procardia XL)

255
Q

ACE inhibitors, ARBs, Aliskiren Counseling/Key points

A

Avoid in pregnancy (teratogenic)
Allergy/anaphylaxis (angioedema)
Ace inhibitors: dry, hacking cough

256
Q

Beta-blockers Counseling/Key points

A

DO NOT discontinue abruptly without consulting your healthcare provider

This medication can mask symptoms of low blood sugar. If you have diabetes, check blood sugar if you notice sweating or hunger.

Can cause sexual dysfunction.

Coreg/Coreg CR - take with food

Lopressor/Toprol XL - take with food or immediately after meals

257
Q

Counseling/Key points for Clonidine

A

Do NOT discontinue without consulting your healthcare provider

patch: apply weekly to upper outer arm or chest The white adhesive cover can be applied over the patch to keep it in place. Remove before an MRI

can cause sexual dysfunction

Notes/Facts/Brand vs Generic (23 decks)

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