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Pharm II > Hypertension > Flashcards

Hypertension Flashcards

1
Q

what is normal BP?

A

<80

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2
Q

A Bp of 145/ 95 would be what classification?

A

Stage 1 HTN

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3
Q

A BP of 180/102 would be what?

A

Stage 2 HTN

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4
Q

A BP of 125/84 would be what?

A

Prehypertension

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5
Q

how many BPs must you have to diagnose HTN?

A

2 or more blood pressures on 2 or more visits

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6
Q

CVD risk doubles for each increment of ______ mmHg (beginning at 115/75 mmHg)

A

20/10 mmHg

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7
Q

How do you calculate Mean Arterial Pressure?

A

Cardiac Output x Peripheral Vascular resistance

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8
Q

what do antihypertensive drugs target?

A

Mean arterial pressure (CO or PVR)

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9
Q

what do antihypertensive drugs control for long term control?

A

Renin-angiotensin-aldosterone system

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10
Q

what is the kidneys response to not enough blood flow?

A

Release renin

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11
Q

What does renin release cause

A

Angiotensin 1 which is converted to angiotensin II by angiotensin converting enzyme

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12
Q

what is responsible on its own for peripheral vasoconstriction

A

Angiotensin II

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13
Q

what is responsible for noradrenaline release?

A

angiotensin II

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14
Q

what causes sodium and water retention?

A

Aldosterone release (by angiotensin II)

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15
Q

where are organic solutes and sodium bicarb reaborbed?

A

proximal tubule (early)

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16
Q

What occurs in the thin limb of the loop of henle?

A 
No NaCl absorption
Water absorption (osmotic)
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17
Q

what happens in the thick ascending limb of loop of henle

A

active reabsorbs NaCl
impereable to water- dilutes tubular fluid
potassium increases in cell secondary to interstitial Na/K ATPase

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18
Q

what does the distal convoluted tubule do?

A

Reabsorbs NacL
impermeable to water
no potassium recycling

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19
Q

what drugs that cause HTN?

A

corticosteroids
thyroid hormone excess
OCPs
NSAIDs/ COX-2

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20
Q

If a person if pre-hypertensive when do you start drug therapy?

A

Of they have a co-morbidity

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21
Q

when are 2 drugs usually required for HTN?

A

stage 2 HTN

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22
Q

If patients don’t have DM or kidney dz what is the goal of drug therapy?

A

<140/90

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23
Q

If a person has DM or kidney dz what is their BP goal?

A

<130/80

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24
Q

For stage 1 HTN what is the 1st choice.

A

Thiazide

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25
Q

for stage 1 HTN what is the 2nd choice

A 
ACEI
ARB
BB
CCB or
combo
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26
Q

Stage 2 HTN what is the drug of choice?

A

2 drug combo of :

thiazide + ACEI or ARB or BB or CCB

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27
Q

For heart failure what is the 1st choice for HTN tx?

A

ACEI + BB

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28
Q

1st choice for CAD w/ HTN?

A

BB + ACEI

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29
Q

DM 1st choice for HTN?

A

ACEI or ARB

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30
Q

CKD 1st choice for HTN?

A

ACEI or ARB

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31
Q

Recurrent stroke 1st choice for HTN?

A

ACEI + thiazide

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32
Q

Isolated systolic HTN DOC?

A

Thiazide

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33
Q

What may be used in patients unable to take ACEI?

A

ARBs

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34
Q

How often should SrCr be assessed for HTN?

A

1-2 times per year

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35
Q

Once BP is at goral and stable how often should you follow up?

A

Every 3-6 months

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36
Q

what is failure to reach goal BP in patients who are adhering to full doses of a 3 drug regimen that includes a diuretic?

A

Resistant HTN

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37
Q

If a patient has resistant HTN what should you do?

A

do a complete work up to look for underlying causes

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38
Q

what does excessive body sodium causes?

A

Vessel rigidity, fluid retention, increased release of norepinephrine and epi from sympathetic terminals and adrenal medulla

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39
Q

Does antihypertensive action correlate with diuretic activity?

A

No

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40
Q

HCTZ has a ____ diuretic effect but a potent antihypertensive.

A

low

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41
Q

A loop diuretic is a ________ diuretic but has low antihypertensive effect.

A

potent

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42
Q

MOA of HCTZ

A

Inhibit luminal NaCl transport in distal tubule

Changes in urine ionic content –> increase loss of Na+, K+, water

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43
Q

In heart failure a thiazide diuretic + what has synergistic diuretic effect.

A

loop diuretic

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44
Q

thiazide diuretics are also used to prevent _____________ due to hypercalciuria.

A

kidney stones

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45
Q

ADRS of HCTZ

A 
hypokalemia
hyperuricemia
hypomagnesia
impaired carb tolerance, hyperglycemia 
hyperlipidemia 
impotence
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46
Q

what are some other thiazide drugs?

A

Metolazone (usually for CHF)

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47
Q

what is a main loop diuretics?

A

Furosemide

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48
Q

where do loop diuretics work in the kidney?

A

ascending loop of Henle at chloride pump

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49
Q

Uses for loop diuretics

A 
edema
heart failure
hypercalcemia
hyperkalemia
acute renal failure
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50
Q

ADRs of furosemide?

A

Ototoxicity

allergic rxn

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51
Q

what is a potassium-sparing diuretic?

A

Spironolactone

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52
Q

MOA of spironolactone?

A

Synthetic steroid antagonist of aldosterone

inhibits Na+ reabsorption and K+ secretion in collecting tubules

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53
Q

Therapeutic uses of spironolactone

A

primary aldosteronism

blunt K+ wasting tendencies of other diuretics

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54
Q

ADRs of spironolactone

A

Gynecomastia
menstrual irregularities
hyperkalemia
hypercholermic metabolic acidosis

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55
Q

what supplements should you d/c before starting spironolactone?

A

potassium supplements

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56
Q

What is a potassium sparing diuretics that isn’t an antagonist of aldosterone. Has an ADR of kidney stones

A

Triamterene

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57
Q

What is triamterene usually combined with?

A

A thiazide diuretic

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58
Q

How do NSAIDs interact w/ diuretics?

A

decrease diuretic activity

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59
Q

What drugs decrease the absorption of furosemide (loop diuretics)?

A

Cholestyramine and sucralfate

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60
Q

What does the combo of diuretics with ACEI cause?

A

exaggerated hypotension

61
Q

what does the combo of thiazides and digoxin lead to?

A

Incrased risk of arrhythmias

62
Q

Diabetic meds plus diuretic can lead to what?

A

decreased glucose tolerance

63
Q

Potassium sparing diuretics and ACEI will cause what?

A

exaggerated hyperkalemia

64
Q

what is the prototype of ACEI?

A

Enalapril

65
Q

MOA of ACEI

A

block conversion of angiotensin I –> angiotensin II

66
Q

What does ACEI stand for?

A

Angtiotensin Converting Enzyme Inhibitor

67
Q

What do ACEI do?

A

stimulate synthesis of vasodilatory prostaglandins
decrease aldosterone & Na/H2O retention
inhibit breakdown of bradykinin –> increased No and prostacycline

68
Q

how do you get aldosterone while on an ACEI

A

Angiotensin I –> Angiotensin II via non-ACE enzymes

69
Q

Contraindications of ACEI

A

pregnancy

renovascular hypertension

70
Q

ADRs of ACEI

A

Dry cough, altered taste, rashes, fever
Hyperkalemia
angioedema (face, neck, laryngeal swelling)

71
Q

ADRs of ACEI in kidney

A

elevations of SrCr and BUN

72
Q

Problem with ACEI if respond too well

A

hypotension and first-dose syncope

greater if hypovolemia or on diuretics

73
Q

what is the prototype of ARB

A

Losartan

74
Q

What does ARB stand for?

A

Angiotensin Receptor Blockers

75
Q

what do ARBs drug names end in?

A

-sartan

76
Q

MOA of ARBs

A

Block the angiotensin II receptors competitively inhibiting angiotensin II binding to AT1 receptors. Blocks pressor and aldosterone-releasing effects causing vasodilation and decreased PVR

77
Q

Do ARBs 100% cut off aldosterone?

A

no, there are other pathways

78
Q

Difference b/w ARBs and ACEIs?

A

Unlike ACEI do not stimulate synthesis of vasodilatory compounds

79
Q

What can ARBs be 1st line for?

A

DM (due to effects of BUN/ CrCl with ACEI)

80
Q

Contraindications with ARBs

A

Pregnancy

renal artery stenosis

81
Q

ADRs with ARBd

A

altered taste
hyperkalemia
elevations in SRCr, BUN

82
Q

What ADR does losartan do?

A

reduces uric acid

83
Q

Effects of Beta Blockers

A

reduction in HR
reduction in contractility
Reduction in BP
Suppression sympathetic nervous system activity

84
Q

therapeutic uses for beta blockers

A

ischemic heart dz
heart failure
dysrhythmias
hypertension

85
Q

What are Beta-1 selective BBs?

A

Atenolol
Metoprolol
Acebutolol
Bisoprolol

86
Q

What are Beta 1 and Beta 2 blockers?

A 
Propranolol
Sotolol
Timolol
Nadalol
Pindolol
Carvidelol
Labetaolol
87
Q

what is Intrinsinsic Sympathomimetic Activity (ISA)?

A

Partial agonist activity, less reduction in resting HR, Co, and BP

88
Q

What BBs are intrinsic sympathomimetic activity (ISA)?

A

acebutolol
pindolol
carteolol

89
Q

why can partial agonists (ISAs) be beneficial?

A

Doesn’t reduce HR as much, could be good for people who have a huge effect to BBs

90
Q

What BBs have alpha-1 blocking activity which adds vasodilatory properties.

A

Carvidelol

Labetaolol

91
Q

Contraindications of BBs

A

Severe asthma

severe bradycardia, heart block, over HF

92
Q

What conditions should you use caution with BBs with?

A

Asthma/ COPD
peripheral vascular dz
DM
dyslipidemia

93
Q

ADRs of BBs

A

fatigue, lethargy, insomnia, depression
bronchoconstriction, cold extremities
decreased libido and impotence

94
Q

what can abrupt withdrawal of BB lead to?

A

may precipitate MI

95
Q

How do BB affect lipids

A

decrease HDL, increase LDL

96
Q

what should you monitor with BBs

A

BP, HR
symptoms of HF, difficulty breathing
CNS disturbances

97
Q

MOA of CCBs

A

block inward movement of Ca by binding to L-type calcium channels. Lead to smooth muscle relaxation and arteriolar dilation.

98
Q

Therapeutic uses of CCBs

A

HTN
ischemic heart dz
dysrhythmias (non-dihydropyrididines only)

99
Q

what are 2 non-dihydropyridines CCBs?

A

Verapamil

Diltiazem

100
Q

What are dihydropyridines CCBs?

A

Nifedipine (prototype)
felodipine
amlodipine
isradapine

101
Q

what type of CCBs have more affinity for the periphery?

A

dihydropyridines

102
Q

problem of decreased PVR through greater peripheral vasodilation.

A

Body may repond with reflex tachycardia

103
Q

What are 2 second generations CCB that are widely used for HTN.

A

amlodipine

felodipine

104
Q

ADRs of dihydropyridines CCB

A

hypotension
dizziness
peripheral edema- through cap dilation

105
Q

ADRs of non-dihydropyridines

A

HPOTN
dizziness
bradycardia
exacerbation of HF

106
Q

if a patient has trouble with blood sugars or lipids what should you give them probably?

A

CCB

107
Q

what CCB can cause constipation and you should prescribe doucsate at the same time.

A

Verapamil

108
Q

what does verapamil increase the plasma levels of?

A

Digoxin

109
Q

When should immediate release CCB be avoided?

A

CV indications due to potential cardiac ischemia

110
Q

Non-dihydropyridines shoudl be given with caution in patients taking what due to possibility of AV block or heart failure?

A

BBs

111
Q

What are alpha 1 blocking agents?

A

Prazosin
Doxazosin
Terazosin

112
Q

MOA of alpha 1 blockers

A

Lows MAP by causing relaxation of both arterial and venous smooth muscle
minimal changes in CO, renal blood flow and GFR

113
Q

Primary use for alpha 1 blockers

A

BPH

114
Q

why are alpha 1 blockers not often used for HTN?

A

body will respond with increasing CO (increase HR in response) and high incidence of postural HTN.

115
Q

ADRs of alpha 1 blockers?

A

first dose syncope
dizziness, HA, fatigue
postural HPOTN
palpitations

116
Q

what is a centrally acting alpha 2 agonist?

A

clonidine

117
Q

MOA of clonidine?

A

inhibition of NE release causing vasodilation.

118
Q

Indications for clonidine?

A

HTN
drug withdrawal
side effects w/ neuroletpcis

119
Q

what can abrupt d/c of clonidine cause?

A

severe hypertension

120
Q

ADRs with clonidine

A 
dry mouth
sedation
depression
HPOTN
sexual dysufnction 
urinary retention
121
Q

what is an analogue of L-Dop that acts an an alpha 2 agonists.

A

Methyldopa

122
Q

when is methyldopa an agent of choice?

A

Patients with chronic renal dz and pregnancy

123
Q

ADRs of methyldopa

A

Sedation, depression, dry mouth
hyperprolactinemia
nightmares

124
Q

ADRs of hydralazine

A

HA, palpitations
angina or ischemic arrhythmias due to reflex tachycardia
high doses can present with lupus like symptoms

125
Q

MOA of hydralazine

A

acts on smooth muscle, primarily arterioles, to decrease tone

126
Q

What is a renin inhibitor?

A

Aliskiren

127
Q

Does aliskiren inhibit bradykinin breakdown like ACEI?

A

No

128
Q

ADRs with aliskiren

A

angioedema, cough, increase SrCr

129
Q

Contradincitionas with aliskiren

A

pregnancy

130
Q

Metabolism of aliskiren

A

CYP3A4

131
Q

drug-drug interactions with aliskiren

A

competitive inhibition of aliskiren metabolism by atorvastatin and ketoconazole
decreased efficacy of furosemide with cocurrent admin

132
Q

DOC for pregnant patients with HTN

A

Methyldopa or labetalol

133
Q

If IV therapy is needed for pregnancy HTN what is prefered

A

hydralazine

134
Q

what is isolated systolic HTN?

A

SBP >140 with DBP <90

135
Q

who does isolated systolic HTN usually occur in?

A

elderly patients

136
Q

what is preferred therapy for isolated systolic HTN?

A

thiazide diuretics

137
Q

If you lower BP too fast with isolated systolic HTN what can happen?

A

hyperprofusion

138
Q

Severely elevated BP without acute end organ damage

A

HTN urgency

139
Q

Severely elevated BP associated with acute and ongoing organ damage in the kidneys, brain, heart, eyes, or vascular system

A

HTN Emergency

140
Q

End organ damage is usually associated with DBP > than what?

A

130 mm Hg

141
Q

tx for HTN urgency

A

Captopril, clonidine, labetolol

142
Q

how fast should BP be lowered with HTN urgency?

A

hours to days

143
Q

how fast should BP be lowered with HTN emergency?

A

minutes to hours to minimize end-organ damage

144
Q

Drugs for HTN emergencies

A

Nitoprusside (SNP) IV

145
Q

MOA of nitroprusside

A

prodrug that decomposes to NO causing vasodilation

146
Q

does nitroprusside work well in patients with cardiac failure?

A

No

147
Q

what type toxicity can long duration nitroprusside metabolism cause?

A

cyanide toxicity

148
Q

what can be administered to to reduce cyanide toxicity associated with long term nitroprusside?

A

thiosulfate (produced thiocyanate a less toxic form)

Pharm II (16 decks)

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