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A - NAPLEX > Chapter 28: Hypertension > Flashcards

Chapter 28: Hypertension Flashcards

1
Q

What is the cause of primary, or essential, HTN

A

Cause is unknown, but risk factors are usually present (like obesity, smoking, excessive salt intake, etc)

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2
Q

What is the cause of secondary HTN

A

Renal disease

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3
Q

What is normal BP considered

A

SBP < 120 mmHg and DBP < 80 mmHg

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4
Q

What is stage 1 HTN considered

A

SBP 130-139 mmHg or DBP 80-89

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5
Q

What is stage 2 HTN considered

A

SBP >/= 140 mmHg or DBP >/= 90 mmHg

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6
Q

Lifestyle management of HTN includes reducing Na intake to < _____ mg daily

A

1500

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7
Q

Key drugs that can increase BP

A 
o	Amphetamines and ADHD drugs
o	Cocaine
o	Decongestants (e.g. pseudoephedrine, phenylephrine)
o	Erythropoietin-stimulating agents
o	Immunosuppressants (e.g. cyclosporine)
o	NSAIDs
o	Systemic steroids
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8
Q

What are natural products that can be used for HTN

A

Fish oil, Coenzyme Q10, L-arginine, garlic

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9
Q

What are the 4 preferred drug classes for initial treatment or titration of treatment

A

ACEi, ARB, CCBs, or thiazide diuretics

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10
Q

When to start treatment in Stage 2 HTN

A

When SBP is >/= 140 mmHg or DBP >/= 90 mmHg

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11
Q

When to start treatment in Stage 1 HTN

A

SBP 130-139 mmHg or DBP 80-89 and

  • Clinical CVD (stroke, HF, or CAD)
  • 10-yr ASCVD risk >/= 10%
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12
Q

BP goal for all pts

A

< 130/80 mmHg

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13
Q

Initial drug selection for Non-black pts

A

thiazide
CCB
ACEi
ARB

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14
Q

Initial drug selection for black pts

A

thiazide

CCB

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15
Q

Initial drug selection for pts with CKD (all races)

A

ACEi or ARB

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16
Q

Initial drug selection for pts with diabetes with albuminuria (all races)

A

ACEi or ARB

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17
Q

How many drugs should a pt be started on in stage 2 HTN when Average SBP and DBP >20/10 mmHg above goal (e.g., 150/90 mmHg)

A

2

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18
Q

Which antihypertensives have a boxed warning for fetal toxicity

A

ACEi, ARBs and aliskiren

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19
Q

Pregnant patients with chronic HTN should receive drug treatment if SBP is >/= ___ or DBP is >/= ___

A

SBP >/= 160

DBP >/= 105

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20
Q

First line treatments for HTN in pregnant pts

A

labetalol and nifedipine ER (methyldopa can be recommended but is less effective)

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21
Q

Lisinopril/HCTZ brand name

A

Zestoretic

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22
Q

Losartan/HCTZ brand name

A

Hyzaar

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23
Q

Olmesartan/HCTZ brand name

A

Benicar HCT

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24
Q

Valsartan/HCTZ brand name

A

Diovan HCT

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25
Q

Benazepril/amlodipine brand name

A

Lotrel

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26
Q

Valsartan/amlodipine brand name

A

Exforge

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27
Q

Atenolol/chlorthalidone brand name

A

Tenoretic

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28
Q

Bisoprolol/HXTZ brand name

A

Ziac

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29
Q

Triamterene/HCTZ brand name

A

Maxzide, Dyazide

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30
Q

Thiazide diuretics MOA

A

inhibit Na reabsorption in the DCTs, causing increased excretion of Na, Cl, water and K

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31
Q

Chlorthalidone doses

A

12.5-25 mg daily

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32
Q

HCTZ doses

A

12.5-50 mg daily

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33
Q

Thiazide diuretic CI

A

Hypersensitivity to sulfonamide-derived drugs

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34
Q

Thiazide diuretic SE

A
  • ↓ electrolytes: K, Mg, Na
  • ↑ electrolytes/labs: Ca, UA, LDL, TG, BG
  • Photosensitivity
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35
Q

Thiazides are not effective when CrCl < ___

A

30 mL/min

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36
Q

Which thiazide diuretic is the only one available IV

A

chlorthalidone

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37
Q

Which drug class should be avoided with thiazide diuretics

A

NSAIDs (can cause Na & water retention)

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38
Q

Thiazide diuretics can decrease ___ renal clearance and increase risk of toxicity

A

Lithium

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39
Q

DHP CCBs are used in what conditions

A

HTN

chronic stable angina

Prinzmetal’s angina

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40
Q

DHP CCB MOA

A

Inhibit Ca ions from entering vascular smooth muscle and myocardial cells; this causes peripheral arterial vasodilation

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41
Q

Amlodipine brand name

A

Norvasc

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42
Q

Nicardipine IV brand name

A

Cardene IV

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43
Q

Nifedipine ER brand name

A

Adalat CC

Procardia XL

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44
Q

Which CCB should not be used for chronic hypertension or acute BP reduction in non-pregnant adults (profound hypotension, MI, and/or death has occurred)

A

Nifedipine IR

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45
Q

CCB SE

A

Can cause peripheral edema/HA/flushing/palpitations/reflex tachycardia/fatigue (worse with Nifedipine IR, can occur with others), gingival hyperplasia

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46
Q

____ & ____ are considered the safest if a CCB must be used to lower BP in HFrEF

A

Amlodipine and felodipine

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47
Q

____ are used to prevent peripheral vasoconstriction in Raynaud’s

A

DHP CCBs (e.g. nifedipine ER)

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48
Q

Clevidipine (Cleviprex) CI

A

Allergy to soybeans, soy products or eggs

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49
Q

Clevidipine (Cleviprex) warnings

A

Hypotension, reflex tachycardia, infections

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50
Q

Clevidipine (Cleviprex) SE

A

Hypertriglyceridemia

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51
Q

A lipid emulsion of Clevidipine (provides __ kcal/mL): it is ____ in color

A

2

milky-white

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52
Q

Clevidipine max time of use after vial puncture is ___ hours

A

12

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53
Q

___ are primarily used to control HR in certain arrhythmias (e.g. atrial fibrillation), and sometimes used for HTN and angina

A

Non-DHP CCBs

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54
Q

Which class of CCBs are more selective for the myocardium

A

non-DHP CCBs

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55
Q

The decrease in BP produced by non-DHP CCBs is d/t ____ (↓ force of ventricular contraction) and ____ (↓ HR) effects

A

negative inotropic

negative chronotropic

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56
Q

Diltiazem brand name

A

Cardiem, Tiazac

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57
Q

Verapamil brand name

A

Calan SR

58
Q

non-DHP CCB warnings

A

HF (may worsen symptoms)

bradycardia

59
Q

non-DHP CCB SE

A

Edema

constipation (more with verapamil)

gingival hyperplasia

60
Q

Use caution with CCBs & ____

A

other drugs that ↓ HR, including BB, digoxin, clonidine, & amiodarone

61
Q

All CCBs are major substrates of CYP450 ___. Check for drug interactions and do not use with ____

A

3A4

grapefruit juice

62
Q

Diltiazem and verapamil are substrates and inhibitors of ___ and moderate inhibitors of ___

A

Pgp

CYP3A4

63
Q

Patients on diltiazem or verapamil and a statin should use lower doses of which 2 statins

A

simvastatin and lovastatin

64
Q

Which 2 classes of HTN meds have been shown to slow the progression of kidney disease in patients with albuminuria

A

ACEi and ARB

65
Q

How are ACEi and ARBs beneficial in HF

A

protect the myocardium from the remodeling effects of Ang II

66
Q

ACEi MOA

A

block the conversion of angiotensin I to Ang II, resulting in ↓ vasoconstriction and ↓ aldosterone secretion

67
Q

ACEi block the degradation of

A

bradykinin

which is thought to contribute to vasodilatory effects (& SE of dry and hacking cough)

68
Q

Benazepril brand name

A

Lotensin

69
Q

Enalapril brand name

A

Vasotec

70
Q

Enalaprilat brand name

A

Vasotec IV

71
Q

Lisinopril brand name

A

Prinivil
Zestril

72
Q

Quinapril brand name

A

Accupril

73
Q

Ramipril brand name

A

Altace

74
Q

ACEi BW

A

Can cause injury and death to developing fetus when used in 2nd and 3rd trimesters; d/c as soon as pregnancy is detected

75
Q

ACEi should not be used within __ hrs of sacubitril/valsartan (Entresto)

A

36

76
Q

ACEi warnings

A

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

77
Q

ACEi SE

A

cough, hyperkalemia, ↑ SCr, hypotension

78
Q

Irbesartan brand name

A

Avapro

79
Q

Losartan brand name

A

Cozaar

80
Q

Olmesartan brand name

A

Benicar

81
Q

Valsartan brand name

A

Diovan

82
Q

ARB MOA

A

Block Ang II from binding to the angiotensin II type-1 (AT1) receptor

on vascular smooth muscle preventing vasoconstriction

83
Q

Which class of HTN meds does not require a washout period

A

ARBs

84
Q

Which class of HTN meds has less cough and angioedema

A

ARBs

85
Q

Olmesartan warning

A

sprue-like enteropathy

86
Q

Aliskiren CI

A

Do not use with ACEi or ARBs in patients with diabetes

87
Q

All RAAS inhibitors ↑ risk for ____

A

hyperkalemia

88
Q

ACEi and ARBs can ↓ ____ renal clearance and ↑ the risk of toxicity

A

lithium

89
Q

____ is a non-selective aldosterone receptor antagonists that also blocks ___

A

Spironolactone

androgen

90
Q

____ is a selective aldosterone antagonist that does NOT exhibit endocrine side effects

A

Eplerenone

91
Q

Spironolactone brand name

A

Aldactone

92
Q

Amiloride and triamterene BW

A

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

93
Q

K-sparing diuretics CI

A

Do not use if hyperkalemia

severe renal impairment

Addison’s disease (spironolactone)

94
Q

K-sparing diuretics SE (all meds)

A

Hyperkalemia, ↑ SCr, dizziness

95
Q

Spironolactone SE

A

gynecomastia, breast tenderness, impotence

96
Q

Which BB should be used if treating chronic HF

A

Bisoprolol, carvedilol, or metoprolol succinate

97
Q

BB with intrinsic sympathomimetic activity (ISA) like ____ do not ↓ HR to the same degree as BB without ISA and are not recommended in post-MI pts

A

acebutolol

98
Q

Atenolol brand name

A

Tenormin

99
Q

Esmolol brand name

A

Brevibloc

100
Q

Esmolol formulation

A

injection

101
Q

Metoprolol tartrate brand name

A

Lopressor

102
Q

Metoprolol succinate ER brand name

A

Toprol XL

103
Q

Beta-blockers BW

A

Do not d/c abruptly; gradually taper dose over 1-2 weeks to avoid acute tachycardia, HTN, and/or ischemia

104
Q

BB warnings

A
  • Use caution in pts with diabetes: can worsen hyperglycemia or hypoglycemia and mask hypoglycemic symptoms
  • Caution with bronchospastic diseases (e.g. asthma, COPD), Beta-1 selective preferred
  • Caution in Raynaud’s/other peripheral vascular diseases, and HF
105
Q

Beta-blockers side effects

A

Bradycardia, fatigue, hypotension, dizziness, depression, impotence, cold extremities (can exacerbate Raynaud’s)

106
Q

Which 2 BB should be taken with or immediately following food, while the others can be taken without regard to food

A 
Lopressor (metoprolol tartrate)
Toprol XL (metoprolol succinate)
107
Q

IV:PO ratio for metoprolol tartrate

A

1:2.5

108
Q

What are the beta-1 selective drugs

A

Remember: AMEBBA

  • Atenolol
  • Metoprolol
  • Esmolol
  • Bisprolol
  • Betaxolol
  • Acebutolol
109
Q

Nebivolol brand name

A

Bystolic

110
Q

Which BB is a B1 selective blocker with Nitric oxide-dependent vasodilation

A

Nebivolol

111
Q

Which BB are B1 and B2 non-selective

A

Propranolol
Nadolol

112
Q

Non-selective BB are used in

A

portal HTN

113
Q

Propranolol brand name

A

Inderal LA, Inderal XL

114
Q

Nadolol brand name

A

Corgard

115
Q

Propranolol has high __ solubility & therefore causes more ____ SE, but this makes it more useful in conditions like ____

A

lipid
CNS
migraine ppx

116
Q

Which BB are non-selective BB and Alpha-1 blockers

A

Carvedilol, labetalol

117
Q

Carvedilol brand name

A

Coreg
Coreg CR

118
Q

How should all forms of carvedilol be taken

A

with food

119
Q

T/F: carvedilol dosing conversions are 1:1

A

false

120
Q

Labetalol SE

A

dizziness

121
Q

BB can decrease ___ secretion

A

insulin

122
Q

____ is commonly used for resistant HTN and in pts who cannot swallow since it’s available as a patch

A

Clonidine

123
Q

Clonidine brand name for HTN

A

Catapres, Catapres-TTS patch

124
Q

Clonidine brand name for ADHD

A

Kapvay

125
Q

Guanfacine ER brand name for ADHD

A

Intuniv

126
Q

Methyldopa (Centrally-acting alpha-2 adrenergic agonist) CI

A

concurrent use with MAOi

127
Q

Methyldopa warning

A

risk for hemolytic anemia

128
Q

Centrally-acting alpha-2 adrenergic agonists warning

A

Do not d/c abruptly

(can cause rebound HTN)

; must taper over 2-4 days

129
Q

Centrally-acting alpha-2 adrenergic agonists SE

A
  • Dry mouth, somnolence, fatigue, dizziness, constipation, ↓ HR, hypotension
130
Q

Methyldopa SE

A

hypersensitivity rxn [e.g. drug-induced lupus erythematosus (DILE)]

131
Q

Clonidine patch is applied how many times per week

A

once

132
Q

Hydralazine warning

A

DILE

133
Q

Hydralazine SE

A

Peripheral edema/HA/flushing/palpitations/reflex tachycardia

134
Q

Minoxidil SE

A

Fluid retention, tachycardia, hair growth

135
Q

Hypertensive crises is BP >/=

A

180/120 mmHg

136
Q

patient has acute target organ damage (e.g. encephalopathy, stroke, acute kidney injury, acute coronary syndrome, aortic dissection, acute pulmonary edema)

A

Hypertensive emergency

137
Q

How is hypertensive emergency treated

A

IV meds (chlorothizaide, clevidipine, diltiazem, enalaprilat, esmolol, hydralazine, labetalol, metoprolol tartrate, nicardipine, nitroglycerin, nitroprusside, propranolol, verapamil)

138
Q

In hypertensie crisis, Decrease BP by no more than __% (within first __), then if stable, decrease to ~160/100 mmHg in the next 2-6 hrs

A

25

hour

139
Q

How is hypertensive urgency treated

A

any oral med that has a short onset of action

140
Q

Hypertensive urgency- decrease BP gradually over ___-___ hrs

A

24-48

A - NAPLEX (83 decks)

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