Anti-Hypertensives Flashcards
(105 cards)
1
Q
List the thiazide diuretics.
A
- Chlorthalidone
- HCTZ
- Indapamide
- Metolazone
2
Q
How are thiazides administered?
A
QD in the morning
3
Q
What adverse effects are associated with thiazides?
A
- Hypokalemia
- Hypomagnesemia
- Hypercalcemia
- Hyperuricemia
- Hyperglycemia
- Hyperlipidemia
- Sexual dysfunction
- Increased TGs/cholesterol
4
Q
What do thiazides interact with?
A
Lithium toxicity with concurrent use
5
Q
When are thiazides contraindicated?
A
Sulfa allergy and anuria
6
Q
What should be monitored if a patient is on a thiazide?
A
- BUN/SCr
- Electrolytes
- Uric acid
7
Q
What trial determined that thiazides should be first-line for most HTN patients?
A
ALLHAT
8
Q
When are thiazides more effective than loops?
A
When CrCl >30
9
Q
Which thiazide is 1-2x more potent than HCTZ?
A
Chlorthalidone
10
Q
List the loop diuretics.
A
- Furosemide
- Torsemide
- Bumetanide
- Ethacrynic acid
11
Q
How are loop diuretics administered?
A
QD-BID in the morning (torsemide is QD only)
12
Q
What adverse effects are associated with loop diuretics?
A
- Hypokalemia
- Hypomagnesemia
- Hypocalcemia
- Hyperuricemia
- Ototoxicity
13
Q
When are loop diuretics contraindicated?
A
Sulfa allergy
14
Q
What should be monitored in a patient taking a loop diuretic?
A
- BUN/SCr
- Electrolytes
15
Q
Although loop diuretics aren’t first-line treatment, when are they preferred?
A
For heart failure symptom management
16
Q
When are loops more effective than thiazides?
A
When CrCl <30
17
Q
Which drug class has a high-ceiling dose response curve?
A
Loop diuretics
18
Q
List the aldosterone antagonists.
A
Spironolactone and eplerenone
19
Q
How should aldosterone antagonists be administered?
A
QD-BID in the morning/afternoon
20
Q
List the adverse effects associated with aldosterone antagonists.
A
- Hyperkalemia
- Hyponatremia
- Gynecomastia (spironolactone)
21
Q
What do aldosterone antagonists interact with?
A
ACEi/ARBs/renin inhibitors/NSAIDs increase hyperkalemia risk
22
Q
When are aldosterone antagonists contraindicated?
A
Eplerenone:
- Renal impairment
- T2DM with proteinuria
Both:
- Concomitant use of potassium-sparing diuretics
23
Q
What should be monitored in a patient taking an aldosterone antagonist?
A
- BUN/SCr
- Potassium
24
Q
Which aldosterone antagonist is preferred with resistant hypertension?
A
Spironolactone
25
What trial demonstrated that spironolactone is preferred for resistant hypertension?
PATHWAY-2
26
At what K level should aldosterone antagonists NOT be initiated?
When K \>5 mEq/L
27
At what K level should you consider holding/reducing an aldosterone antagonist? At what SCr increase?
* When K \>5.5 mEq/L
* When SCr increases \>25%
28
List the potassium-sparing diuretics.
Amiloride and triamterene
29
How should potassium-sparing diuretics be administered?
QD-BID in the morning
30
List the adverse effects associated with potassium-sparing diuretics.
* Hyperkalemia
* Increased uric acid
* Hyperglycemia
31
What parameters should be monitored in a patient taking a potassium-sparing diuretic?
* BUN/SCr
* Electrolytes
32
Since potassium-sparing diuretics are not used as a monotherapy for hypertension, what drug clas should they be combined with?
Thiazides (to minimize hypokalemia)
33
Caution should be used when administering potassium-sparing diuretics in what two disease states?
* Diabetes
* CKD (GFR \<45)
34
List the ACE inhibitors.
* Benazepril
* Captopril
* Enalapril
* Fosinopril
* Lisinopril
* Moexipril
* Perindopril
* Quinapril
* Ramipril
* Trandolapril
35
How should ACE inhibitors be administered?
QD-TID (good option for PM dosing)
36
List the adverse effects associated with ACE inhibitors.
* Angioedema
* Cough
* Hyperkalemia
* Acute renal failure with severe bilateral renal artery stenosis
37
When are ACE inhibitors contraindicated?
* History of angioedema on an ACEi
* Use of aliskiren in diabetics
* Pregnancy/breastfeeding
38
What should be monitored in patients on an ACE inhibitor?
* BUN/SCr
* Potassium
39
ACE inhibitors are shown to have additional benefits in which patient populations?
* Diabetes with proteinuria
* Heart failure
* Post-MI
* CKD
40
Explain the anti-hypertensive effects of ACE inhibitors.
* Vasodilation
* Reduced PVR
* Increased diuresis
41
At what K level should you consider holding/reducing ACE inhibitor doses? At what SCr increase?
* When K \>5.5 mEq/L
* When SCr increases \>30%
42
List the ARBs.
* Azilsartan
* Candesartan
* Eprosartan
* Irbesartan
* Losartan
* Olmesartan
* Telmisartan
* Valsartan
43
How should ARBs be administered?
QD-BID (good option for PM dosing)
44
What adverse effects are associated with ARBs?
* Angioedema
* Hyperkalemia
* Acute renal failure with severe bilateral renal artery stenosis
45
When are ARBs contraindicated?
* History of angioedema on an ARB
* Use of aliskiren in diabetics
* Pregnancy/breastfeeding
46
What should you monitor in patients taking ARBs?
* BUN/SCr
* Potassium
47
Why do ARBs tend to cause less cough?
They don't block bradykinin breakdown
48
Explain the anti-hypertensive effects of ARBs.
* Vasodilation
* Reduced PVR
* Increased diuresis
49
When should you consider holding/reducing the dose of an ARB?
* When K \>5.5 mEq/L
* When SCr increases \>30%
50
List an example of a direct renin inhibitor.
Aliskiren
51
What adverse effects are associated with aliskiren?
* Diarrhea
* Musculoskeletal effects (CK increase)
* Dizziness
* Headache
* Hyperkalemia
* Renal insufficiency/ARF
* Orthostatic hypotension
52
When is aliskiren contraindicated?
* Concomitant use of ACEi/ARBs in diabetics
* Pregnancy/breastfeeding
53
What should be monitored in patients taking aliskiren?
* BUN/SCr
* Potassium
54
Why does aliskiren not cause much of a cough?
It doesn't block bradykinin breakdown
55
How should aliskiren be administered?
QD
56
List some examples of dihydropyridine CCBs.
* Amlodipine
* Felodipine
* Israldipine
* Israldipine SR
* Nicardipine SR
* Nifedipine LA
* Nisoldipine
57
How should dihydropyridine CCBs be administered?
QD-BID (isradipine and nicardipine SR are BID)
58
What adverse effects are associated with dihydropyridine CCBs?
* Reflex tachycardia
* Flushing
* Dizziness
* Headache
* Peripheral edema (dose-related)
* Gingival hyperplasia
59
What warnings are associated with dihydropyridine CCBs?
Increased risk of angina/MI in patients with obstructive coronary disease due to reflex tachycardia
60
What interactions exist with dihydropyridine CCBs?
* Grapefruit juice
* CYP3A4 inducers/inhibitors
61
Dihydropyridine CCBs have additional benefit in which patient populations?
* Reynaud's
* Elderly patients with isolated systolic HTN
62
Complete the sentence: dihydropyridine CCBs are more potent ___________ than non-dihydropyridine CCBs.
vasodilators
63
Why should short-acting dihydropyridines (IR nifedipine/nicardipine)?
Reflex tachycardia
64
Which two dihydropyridine calcium channel blockers have no negative inotropic effects?
Amlodipine and felodipine
65
List the non-dihydropyridine CCBs.
* Diltiazem ER
* Verapamil ER
66
What adverse effects are associated with non-dihydropyridine CCBs?
* Bradycardia
* Headache
* Dizziness
* AV node block
* Systolic HF
* Gingival hyperplasia
* Constipation (verapamil \> diltiazem)
67
What interactions exist with non-dihydropyridine CCBs?
* Concomitant use of beta blockers (increases heart block risk)
* Grapefruit juice
* CYP3A4 inducers/inhibitors
68
When are non-dihydropyridine CCBs contraindicated?
* Heart block
* Left ventricular dysfunction
69
What should be monitored in patients taking non-dihydropyridine CCBs?
Heart rate
70
Non-dihydropyridine CCBs are shown to have additional benefit in which patient populations?
* Supraventricular tachyarrhythmias (atrial fibrillation)
* Patients with angina who don't tolerate beta blockers
71
Explain the negative inotropic effect of non-dihydropyridine CCBs.
Slow AV node conduction and decrease heart rate
72
Which formulation of non-dihydropyridine CCBs are preferred for hypertension?
Extended-release
73
List the cardioselective beta blockers.
* Atenolol
* Betaxolol
* Bisoprolol
* Metoprolol tartrate/succinate
* Nebivolol
74
How are cardioselective beta blockers administered?
QD-BID (metoprolol tartrate)
75
What adverse effects are associated with beta blockers?
* Bronchospasm
* Bradycardia
* Fatigue
* Exercise intolerance
* Depression
76
When are beta blockers contraindicated?
* 2nd/3rd degree heart block
* Decompensated heart failure
* Post-MI (ISA only)
* Severe bradycardia
* Sick sinus syndrome
77
Since beta blockers are not first-line for HTN unless a compelling indication is present, what compelling indications are there?
Heart failure and CAD
78
Beta blockers are shown to have additional benefit in which patient populations?
* Tachyarrhythmias
* Tremors
* Migraines
* Thyrotoxicosis
79
How do beta blockers decrease CO?
Decrease heart rate and force of contraction
80
Can you discontinue beta blockers immediately?
No
81
Which beta blocker has nitric oxide-indued vasodilation?
Nebivolol
82
List the nonselective beta blockers.
* Nadolol
* Propranolol IR/LA
83
How should nonselective beta blockers be administered?
QD-BID (propranolol IR)
84
When should nonselective beta blockers be avoided?
Bronchospastic airway disease
85
List the ISA beta blockers.
* Acebutolol
* Penbutolol
* Pindolol
86
How should ISA beta blockers be administered?
QD (penbutolol) - BID
87
When should ISA beta blockers be avoided?
Heart failure and IHD
88
List the mixed alpha/beta blockers.
Carvedilol and labetalol
89
How should mixed alpha/beta blockers be administered?
BID
90
What beta blocker is preferred in patients with peripheral artery disease?
Carvedilol
91
What class of beta blocker is preferred with reactive airway disease?
Cardioselective beta blockers
92
What should you monitor in patients taking beta blockers?
Heart rate
93
List the direct arterial vasodilators.
Hydralazine and minoxidil
94
How is minoxidil administered?
QD-TID
95
How is hydralazine administered?
BID-QID
96
What adverse effects are associated with direct arterial vasodilators?
* Palpitations
* Tachycardia
* Chest pain
* GI side effects
* Headache
* Hematologic dyscrasias
* Hepatotoxicity
* Lupus-like syndrome/rash (hydralazine)
* Fluid retention
* Hair growth (minoxidil)
97
What warnings are associated with direct arterial vasodilators?
* May cause pericarditis/pericardial effusion that may progress to tamponade
* May increase O2 demand and exacerbate angina pectoris
* Max therapeutic doses of a diuretic and 2 other anti-hypertensives should be used before these are ever added; should be given with a diuretic to minimize gluid gain and a beta blocker
98
Direct arterial vasodilators are only indicated for patients with special indications or very difficult-to-control BP. List some of these conditions.
Severe CKD, hemodialysis
99
Which is more potent: minoxidil or hydralazine?
Minoxidil
100
Direct arterial vasodilators should be used in caution with what conditions?
* CVA
* Renal impairment
* CAD
* Liver disease
* SLE
101
List the alpha-1 blockers.
* Doxazosin
* Prazosin
* Terazosin
102
What adverse effects are associated with alpha-1 blockers?
Orthostatic hypotension (especially in the elderly)
103
Alpha-1 blockers are second-line for HTN in which patients?
HTN patients with concomitant BPH
104
List the central alpha-2 agonists.
* Clonidine
* Methyldopa
* Guanfacine
105
How should clonidine be administered?
BID-TID
