Chaptern 28: Hypertension Flashcards
(142 cards)
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)
2
Q
What is the cause of secondary HTN?
A
Renal disease
3
Q
What is normal BP considered?
A
SBP < 120 mmHg and DBP < 80 mmHg
4
Q
What is stage 1 HTN considered?
A
SBP 130-139 mmHg or DBP 80-89
5
Q
What is stage 2 HTN considered?
A
SBP >/= 140 mmHg or DBP >/= 90 mmHg
6
Q
Lifestyle management of HTN includes reducing Na intake to < _____ mg daily?
A
1500
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
8
Q
What are natural products that can be used for HTN?
A
Fish oil, Coenzyme Q10, L-arginine, garlic
9
Q
What are the 4 preferred drug classes for initial treatment or titration of treatment?
A
ACEi, ARB, CCBs, or thiazide diuretics
10
Q
When to start treatment in Stage 2 HTN?
A
When SBP is >/= 140 mmHg or DBP >/= 90 mmHg
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) or 10-yr ASCVD risk >/= 10%
12
Q
What is the BP goal for all patients?
A
< 130/80 mmHg
13
Q
Initial drug selection for Non-black patients?
A
thiazide, CCB, ACEi, or ARB
14
Q
Initial drug selection for black patients?
A
thiazide or CCB
15
Q
Initial drug selection for patients with CKD (all races)?
A
ACEi or ARB
16
Q
Initial drug selection for patients with diabetes with albuminuria (all races)?
A
ACEi or ARB
17
Q
How many drugs should a patient be started on in stage 2 HTN when Average SBP and DBP >20/10 mmHg above goal?
A
2
18
Q
Which antihypertensives have a boxed warning for fetal toxicity?
A
ACEi, ARBs and aliskiren
19
Q
Pregnant patients with chronic HTN should receive drug treatment if SBP is >/= ___ or DBP is >/= ___?
A
SBP >/= 160
DBP >/= 105
20
Q
First line treatments for HTN in pregnant patients?
A
labetalol and nifedipine ER (methyldopa can be recommended but is less effective)
21
Q
Lisinopril/HCTZ brand name?
A
Zestoretic
22
Q
Losartan/HCTZ brand name?
A
Hyzaar
23
Q
Olmesartan/HCTZ brand name?
A
Benicar HCT
24
Q
Valsartan/HCTZ brand name?
A
Diovan HCT
25
Benazepril/amlodipine brand name?
Lotrel
26
Valsartan/amlodipine brand name?
Exforge
27
Atenolol/chlorthalidone brand name?
Tenoretic
28
Bisoprolol/HCTZ brand name?
Ziac
29
Triamterene/HCTZ brand name?
Maxzide, Dyazide
30
Thiazide diuretics MOA?
inhibit Na reabsorption in the DCTs, causing increased excretion of Na, Cl, water and K
31
Chlorthalidone doses
12.5-25 mg daily
32
HCTZ doses
12.5-50 mg daily
33
Thiazide diuretic CI
Hypersensitivity to sulfonamide-derived drugs
34
Thiazide diuretic SE
↓ electrolytes: K, Mg, Na
↑ electrolytes/labs: Ca, UA, LDL, TG, BG
Photosensitivity
35
Thiazides are not effective when CrCl < ___
30 mL/min
36
Which thiazide diuretic is the only one available IV
chlorthalidone
37
Which drug class should be avoided with thiazide diuretics
NSAIDs (can cause Na & water retention)
38
Thiazide diuretics can decrease ___ renal clearance and increase risk of toxicity
Lithium
39
DHP CCBs are used in what conditions
HTN, chronic stable angina and Prinzmetal’s angina
40
DHP CCB MOA
Inhibit Ca ions from entering vascular smooth muscle and myocardial cells; this causes peripheral arterial vasodilation
41
Amlodipine brand name
Norvasc
42
Nicardipine IV brand name
Cardene IV
43
Nifedipine ER brand name
Adalat CC, Procardia XL
44
Which CCB should not be used for chronic hypertension or acute BP reduction in non-pregnant adults
Nifedipine IR
## Footnote
profound hypotension, MI, and/or death has occurred
45
CCB SE
Can cause peripheral edema/HA/flushing/palpitations/reflex tachycardia/fatigue (worse with Nifedipine IR, can occur with others), gingival hyperplasia
46
____ & ____ are considered the safest if a CCB must be used to lower BP in HFrEF
Amlodipine and felodipine
47
____ are used to prevent peripheral vasoconstriction in Raynaud’s
DHP CCBs (e.g. nifedipine ER)
48
Clevidipine (Cleviprex) CI
Allergy to soybeans, soy products or eggs
49
Clevidipine (Cleviprex) warnings
Hypotension, reflex tachycardia, infections
50
Clevidipine (Cleviprex) SE
Hypertriglyceridemia
51
A lipid emulsion of Clevidipine (provides __ kcal/mL): it is ____ in color
2
## Footnote
milky-white
52
Clevidipine max time of use after vial puncture is ___ hours
12
53
___ are primarily used to control HR in certain arrhythmias
Non-DHP CCBs
54
Which class of CCBs are more selective for the myocardium
non-DHP CCBs
55
The decrease in BP produced by non-DHP CCBs is d/t ____ and ____ effects
negative inotropic
negative chronotropic
56
Diltiazem brand name
Cardiem, Tiazac
57
Verapamil brand name
Calan SR
58
non-DHP CCB warnings
HF (may worsen symptoms), bradycardia
59
non-DHP CCB SE
Edema, constipation (more with verapamil), gingival hyperplasia
60
Use caution with CCBs & ____
other drugs that ↓ HR, including BB, digoxin, clonidine, & amiodarone
61
All CCBs are major substrates of CYP450 ___
3A4
62
Do not use CCBs with ____ juice
grapefruit juice
63
Diltiazem and verapamil are substrates and inhibitors of ___
Pgp
64
Diltiazem and verapamil are moderate inhibitors of ___
CYP3A4
65
Patients on diltiazem or verapamil and a statin should use lower doses of which 2 statins?
simvastatin and lovastatin
66
Which 2 classes of HTN meds have been shown to slow the progression of kidney disease in patients with albuminuria?
ACEi and ARB
67
How are ACEi and ARBs beneficial in HF?
protect the myocardium from the remodeling effects of Ang II
68
ACEi MOA
block the conversion of angiotensin I to Ang II, resulting in ↓ vasoconstriction and ↓ aldosterone secretion
69
ACEi block the degradation of
bradykinin, which is thought to contribute to vasodilatory effects (& SE of dry and hacking cough)
70
Benazepril brand name
Lotensin
71
Enalapril brand name
Vasotec
72
Enalaprilat brand name
Vasotec IV
73
Lisinopril brand name
Prinivil, Zestril
74
Quinapril brand name
Accupril
75
Ramipril brand name
Altace
76
ACEi BW
Can cause injury and death to developing fetus when used in 2nd and 3rd trimesters; d/c as soon as pregnancy is detected
77
ACEi should not be used within __ hrs of sacubitril/valsartan (Entresto)
36
78
ACEi warnings
Angioedema, hyperkalemia, hypotension, renal impairment, bilateral renal artery stenosis (avoid use)
79
ACEi SE
cough, hyperkalemia, ↑ SCr, hypotension
80
Irbesartan brand name
Avapro
81
Losartan brand name
Cozaar
82
Olmesartan brand name
Benicar
83
Valsartan brand name
Diovan
84
ARB MOA
Block Ang II from binding to the angiotensin II type-1 (AT1) receptor on vascular smooth muscle, preventing vasoconstriction
85
Which class of HTN meds does not require a washout period?
ARBs
86
Which class of HTN meds has less cough and angioedema?
ARBs
87
Olmesartan warning
sprue-like enteropathy
88
Aliskiren CI
Do not use with ACEi or ARBs in patients with diabetes
89
All RAAS inhibitors ↑ risk for ____
hyperkalemia
90
ACEi and ARBs can ↓ ____ renal clearance and ↑ the risk of toxicity
lithium
91
____ is a non-selective aldosterone receptor antagonists that also blocks ___
Spironolactone
Androgen
92
____ is a selective aldosterone antagonist that does NOT exhibit endocrine side effects
Eplerenone
93
Spironolactone brand name
Aldactone
94
Amiloride and triamterene BW
hyperkalemia (K > 5.5 mEq/L) – more likely in patients with diabetes, renal impairment, or elderly patients
95
K-sparing diuretics CI
Do not use if hyperkalemia, severe renal impairment, Addison’s disease (spironolactone)
96
K-sparing diuretics SE (all meds)
Hyperkalemia, ↑ SCr, dizziness
97
Spironolactone SE
gynecomastia, breast tenderness, impotence
98
Which BB should be used if treating chronic HF
Bisoprolol, carvedilol, or metoprolol succinate
99
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
acebutolol
100
Atenolol brand name
Tenormin
101
Esmolol brand name
Brevibloc
102
Esmolol formulation
injection
103
Metoprolol tartrate brand name
Lopressor
104
Metoprolol succinate ER brand name
Toprol XL
105
Beta-blockers BW
Do not d/c abruptly; gradually taper dose over 1-2 weeks to avoid acute tachycardia, HTN, and/or ischemia
106
BB warnings
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.
107
Beta-blockers side effects
Bradycardia, fatigue, hypotension, dizziness, depression, impotence, cold extremities (can exacerbate Raynaud’s)
108
Which 2 BB should be taken with or immediately following food, while the others can be taken without regard to food
Lopressor (metoprolol tartrate), Toprol XL (metoprolol succinate)
109
IV:PO ratio for metoprolol tartrate
1:2.5
110
What are the beta-1 selective drugs
Remember: AMEBBA
Atenolol, Metoprolol, Esmolol, Bisprolol, Betaxolol, Acebutolol
111
Nebivolol brand name
Bystolic
112
Which BB is a B1 selective blocker with Nitric oxide-dependent vasodilation
Nebivolol
113
Which BB are B1 and B2 non-selective
Propranolol and Nadolol
114
Non-selective BB are used in
portal HTN
115
Propranolol brand name
Inderal LA, Inderal XL
116
Nadolol brand name
Corgard
117
Propranolol has high __ solubility & therefore causes more ____ SE, but this makes it more useful in conditions like ____
lipid
## Footnote
CNS, migraine ppx
118
Which BB are non-selective BB and Alpha-1 blockers
Carvedilol, labetalol
119
Carvedilol brand name
Coreg, Coreg CR
120
How should all forms of carvedilol be taken
with food
121
T/F: carvedilol dosing conversions are 1:1
false
122
Labetalol SE
dizziness
123
BB can decrease ___ secretion
insulin
124
____ is commonly used for resistant HTN and in pts who cannot swallow since it’s available as a patch
Clonidine
125
Clonidine brand name for HTN
Catapres, Catapres-TTS patch
126
Clonidine brand name for ADHD
Kapvay
127
Guanfacine ER brand name for ADHD
Intuniv
128
Methyldopa (Centrally-acting alpha-2 adrenergic agonist) CI
concurrent use with MAOi
129
Methyldopa warning
risk for hemolytic anemia
130
Centrally-acting alpha-2 adrenergic agonists warning
Do not d/c abruptly (can cause rebound HTN); must taper over 2-4 days
131
Centrally-acting alpha-2 adrenergic agonists SE
Dry mouth, somnolence, fatigue, dizziness, constipation, ↓ HR, hypotension
132
Methyldopa SE
hypersensitivity rxn [e.g. drug-induced lupus erythematosus (DILE)]
133
Clonidine patch is applied how many times per week
once
134
Hydralazine warning
DILE
135
Hydralazine SE
Peripheral edema/HA/flushing/palpitations/reflex tachycardia
136
Minoxidil SE
Fluid retention, tachycardia, hair growth
137
Hypertensive crises is BP >/=
180/120 mmHg
138
patient has acute target organ damage (e.g. encephalopathy, stroke, acute kidney injury, acute coronary syndrome, aortic dissection, acute pulmonary edema)
Hypertensive emergency
139
How is hypertensive emergency treated
IV meds (chlorothizaide, clevidipine, diltiazem, enalaprilat, esmolol, hydralazine, labetalol, metoprolol tartrate, nicardipine, nitroglycerin, nitroprusside, propranolol, verapamil)
140
In hypertensive crisis, Decrease BP by no more than __% (within first __), then if stable, decrease to ~160/100 mmHg in the next 2-6 hrs
25
hour
141
How is hypertensive urgency treated
any oral med that has a short onset of action
142
Hypertensive urgency- decrease BP gradually over ___-___ hrs
24-48
