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Advanced Pharm > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is the diagnosing criteria for hypertension?

A

2 elevated readings, at 2 separate visits, at least one month apart

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2
Q

What are factors that can effect blood pressure?

A

Stress, smoking, caffeine, exercise

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3
Q

What work up should be done prior to initiating drug therapy for hypertension?

A

UA, lipid panel, EKG, potassium/calcium/creatine levels (effect blood pressure meds), blood glucose (diabetics should be on an ACE-I), C-reactive protein, homocysteine (protein from meat, elevated levels increase risk of heart disease)

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4
Q

When should follow up from initiation of drug therapy happen?

A

2-4 weeks depending on BP reading
2 weeks for 160/100
4 weeks for 140/90

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5
Q

What hypertension medications are safe for children?

A

ACE-I, ARBs, CCBs

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6
Q

What is the mechanism of action for the ACE inhibitors?

A

They inhibit the ACE enzyme from converting angiotensin 1 to angiotensin 2 which promotes vasodilation and decreases peripheral resistence

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7
Q

What are common side effects of ACE inhibitors?

A

Dry cough, hyperkalemia, fatigue, dizziness, headache, loss of taste

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8
Q

What is a benefit of ACE-I?

A

Renal protection by decreasing aldosterone levels

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9
Q

What is the ending of the ACE-I’s?

A

-pril

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10
Q

Who are ACE-I contraindicated for?

A

Pregnant patients and patients of child bearing age as they have been linked to teratogenic effects

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11
Q

How often can ACE-I be titrated?

A

Every 2 weeks, but every 4-6 weeks if preferred

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12
Q

If a patient cannot tolerate an ACE-I, what medication can they be transitioned to?

A

Angiotensin II Receptor Binders (ARBs)

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13
Q

What is the ending for the ARB’s?

A

-sartan

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14
Q

What is the mechanism of action of ARBs?

A

They prevent angiotensin 2 from binding to the receptor site thus promoting vasodilation

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15
Q

What are the adverse effects of ARBs?

A

Dizziness, headaches, drowsiness, N/V/D, elevated potassium

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16
Q

What labs should be monitored with ARBs?

A

BUN/Cr, BMP (mainly K+)

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17
Q

How often can ARBs be titrated?

A

Every 2 weeks but 4-6 is preferred

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18
Q

What is the first line therapy for HTN?

A

Thiazide diuretics

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19
Q

What is the mechanism of action of the thiazide diuretic?

A

They prevent reabsorption of Na/Cl in the distal tubule this promoting the excretion of Na, Cl, K+, and water, thus decreasing volume in the body and reducing blood pressure

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20
Q

What are the adverse effects of thiazide diuretics?

A

Hyponatremia, Hypokalemia, dehydration, hyperglycemia (most common with diabetics), hyperuricemia, hypochloremia

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21
Q

Why should thiazides be cautioned with diabetic patients?

A

The excretion of Na/Cl/K+ promotes the elevation of glucose and uric acid, thus potentially increasing glucose levels to hyperglycemic states in diabetic patients

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22
Q

What should we be aware of with patients with gout on thiazide diuretics?

A

Thiazides can increase uric acid levels and potentiate gout flares

23
Q

What is a medication to use in conjunction with the thiazide diuretics to prevent hypokalemia?

A

Potassium-sparing diuretics such as spironolactone

24
Q

What are the two types of potassium-sparing diuretics?

A

Aldosterone antagonists and non-aldosterone antagonists

25
Q

What is the mechanism of action of the aldosterone antagonists?

A

They block the aldosterone receptor sites promoting the retention of potassium and the excretion of Na and fluid

26
Q

What is the mechanism of action of the non-aldosterone antagonists?

A

They inhibit the sodium/potassium exchange in the distal nephron without interfering with the action/binding of aldosterone

27
Q

What are the adverse affects of the potassium-sparing diuretics?

A

Hyperkalemia, N/V, leg cramps

28
Q

What is a side effect of spironolactone specific to men?

A

Gynecomastia

29
Q

What is a side effect of spironolactone specific to women?

A

Menstrual irregularities

30
Q

What is the mechanism of action of loop diuretics?

A

They block reabsorption of Na/Cl at the Loop of Henle

31
Q

What are adverse effects of the loop diuretics?

A

Hypokalemia, hyponatremia, hypochloremia, hypotension, dehydration, ototoxicity

32
Q

Which diuretic is most effective with promoting fluid excretion?

A

Loop diuretics

33
Q

Which HTN medication is most effective to black patients due to their genetic makeup?

A

Calcium channel blockers (CCBs)

34
Q

What are the two types of CCBs?

A

Dihydropyridine and the nondihyropridine

35
Q

What is the ending of the diphydropyridine CCBs?

A

-pine

36
Q

What is the mechanism of action of CCBs?

A

They inhibit the calcium by blocking the receptors thus preventing calcium from getting into the intracellular space thus promoting vasodilation

37
Q

Which of the CCBs classes has a large effect on cardiac smooth muscle vasodilation?

A

Nondihydropridine

38
Q

What are the adverse effects of CCBs?

A

Dizziness, flushing, orthostatic hypotension, headache, edema, reflex tachycardia

39
Q

What medication can help prevent reflex tachycardia when using CCBs?

A

Beta blockers

40
Q

When are CCBs contraindicated?

A

Heart failure patients with an EF less than 35% due to the adverse effect of edema

41
Q

What is the mechanism of action of the beta blockers?

A

Beta blockers (especially selective beta-1 blockers) block the beta receptors promoting a decrease in HR and contractility thus decreasing cardiac output

42
Q

What is an adverse affect of the non-selective beta blockers?

A

They block beta 2 receptors and promote bronchoconstriction

43
Q

Which patient population should not receive non-selective beta blockers?

A

Patients with asthma as the bronchoconstriction can induce bronchospasm and asthma attacks

44
Q

What are adverse effects of beta blockers?

A

bradycardia, orthostatic hypotension, rebound cardiac excitation, AV blocks (due to the reduction of velocity impulses through the AV node from beta blockade)

45
Q

What is a non-selective beta blocker?

A

Propanolol and Carvedilol

46
Q

What do the selective beta blockers end in?

A

-olol

47
Q

What is the mechanism of action of hydralazine?

A

Selective dilation of the arterioles thus decreasing arterial pressure and peripheral resistance thus promoting an increase in cardiac output and heart rate

48
Q

What are the adverse effects of hydralazine?

A

Reflex tachycardia, increased blood volume (edema), lupus-like reaction

49
Q

When is minoxidil used in practice?

A

When there is a need for intense vasodilation

50
Q

Who is minoxidil indicated for?

A

Patients with severe hypertension unresponsive to other treatments

51
Q

What is the mechanism of action of minoxidil?

A

Selective vasodilation of the arterioles thus decreasing arterial pressure and increasing cardiac output

52
Q

What are the adverse effects of minoxidil?

A

Reflex tachycardia, fluid and sodium retention, hypertrichosis, pericardial effusion (due to increased fluid retention)

53
Q

When should patients be referred to a HTN specialist?

A

When they need 3 or more BP medications to manage their blood pressure

54
Q

What is the most effective way to manage blood pressure according to the JNC 8?

A

The use of multi-drug therapy to help promote reduction of blood pressure through various mechanisms of action which can promote using smaller doses of medications

Advanced Pharm (15 decks)

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