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CV/HTN Flashcards

(101 cards)

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1
Q

Nondihydropyridine CCBs are not recommended for which pt population?

A

adults with HFrEF

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2
Q

Which antihypertensive med can be useful for preventing recurrence of Afib?

A

ARBs

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3
Q

Preferred antihypertensive for pts with HTN and thoracic aortic disease?

A

BB

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4
Q

Preferred antihypertensives for black adults without HF or CKD?

A

thiazide or CCB

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5
Q

What are the 3 antihypertensives that are safe for use in pregnancy?

A

Methyldopa (Alpha 2 agonist)

Nifidipine (CCB)

Labetalol (BB)

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6
Q

Antihypertensivesbsolutely NOT okay during pregnancy?

A

ACE-I

ARB

Direct Renin Inhibitors

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7
Q

During a hypertensive emergency, BP should not be lowered more than….during the first hour

A

25%

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8
Q

Name a loop diuretic

A

Furosemide, bumetanide, Torsemide

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9
Q

What are loop diuretics used for?

A

HTN, HF, pulmonary edema

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10
Q

MOA for loop diuretics?

A

blocks Na+, K+, CL symporter at the thick ascending loop of henle, promotes sodium and water loss

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11
Q

Loop diuretics drug interactions?

A

increases levels of Digoxin and certain antiarrhythmics

increases levels of Lithium

NSAIDS decrease efficacy

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12
Q

What 2 diuretics should you not give to pts with sulfa allergies?

A

Loop diuretics (furosemide)

Thiazides (HCTZ)

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13
Q

Side effects of loop diuretics?

A

Hypokalemia, hypomagnesemia, hypocalcemia, hypovolemia, hyperurecemia, ototoxicity…

So monitor electrolytes!!

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14
Q

Loop diuretics can also be used to treat?

A

hypercalcemia

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15
Q

Which is a better antihypertensive, thiazides or loop diuretics?

A

thiazides

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16
Q

Name 2 thiazides

A

HCTZ

Chlorthalidone

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17
Q

Mechanisms of thiazides?

A

blocks the reabsorption of Na and Cl in the distal convoluted tubule

also provides a sustained decrease in PVR and direct smooth muscle relaxation

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18
Q

Thiazides increase the levels of which drugs?

A

ACE-I, ARB, Lithium, Carbamazepine

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19
Q

Thiazides decrease the levels of

A

anti- diabetic meds

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20
Q

Levels of thiazide are reduced by?

A

NSAIDS

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21
Q

What should you monitor in pts taking a thiazide?

A

electrolytes, BUN, Cr, Uric acid level

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22
Q

Side effects of thiazide?

A

hypokalemia, hyponatremia,

hypercalcemia, hyperglycemia, hyperlipidemia, hyperurecemia

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23
Q

Name 2 potassium sparing diuretics

A

Amiloride, Triaterene

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24
Q

Potassium sparing diuretics MOA

A

works proximal to the distal convoluted tubule

prevents Na reabsorption while sparing K

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25
Potassium sparing diuretics decrease levels of?
cardiac glucoside, quinidine
26
Levels of potassium sparing diuretics are decreased by?
NSAIDS
27
Potassium sparing diuretics should be avoided in which pts?
renal failure those taking an ACE-I
28
What should you monitor in pts taking an potassium sparing diuretic?
K+ levels
29
Spironolactone is a...
Aldosterone antagonist
30
Which drug is commonly used for HTN and diuresis in peds?
Spironolactone
31
Spironolactone can also be used for?
HF, hirsutism, and polycystic ovarian cancer
32
Aldosterone antagonist MOA?
blocks aldosterone receptor in the distal convoluted tubule, inhibiting Na and water retention, also inhibits vasoconstriction
33
Why are aldosterone antagonists commonly used in combo with thiazides or loop diuretics?
to counteract K+ loss
34
Side effects of aldosterone antagonists?
hyperkalemia, hyponatremia, gynecomastia , menstrual irregularities, impotence, GI upset
35
Do you need to adjust the dosing of Aldosterone antagonists for renal pts?
YES
36
ACE-I MOA?
Inhibits ACE, preventing the conversion of Ang I to Ang II, reducing Ang II mediated vasoconstriction and aldosterone secretion. bradykinin accumulation also causes vasodilation
37
In what populations are ACE-I/ARBs most effective?
young white pts pts with DM
38
ACE-I/ARB drug interactions
other antihypertensives, potassium sparing diuretics, NSAIDS, K+ supplements
39
ACE-I/ARB side effects
hypotension in pts with bilateral renal artery stenosis, Sr Cr increase ~35%, hyperkalemia, HA, dizziness, fatigue, nausea, taste disturbances ACE: cough, angioedema
40
What should you monitor on a pt taking an ace or an arb?
BUN, Cr, K+, CBC
41
Name a renin inhibitor
Aliskiren
42
renin inhibitor MOA
inhibits renin, reduces activity of Ang I, Ang II and Aldosterone
43
Contraindications for renin inhibitor?
pregnancy, CKD, hyperkalemia
44
In addition to treatment of HTN, lipophilic BB such as Propranolol can be used for what?
migraine HA prevention, essential tremor, thyrotoxicosis, anger/rage management
45
Beta blocker MOA?
block beta 1 and beta 2 receptors of the SNS---> decrease CO and inhibit renin release
46
What drugs interact with BBs?
NSAIDS, CCB, Digoxin, other SNS/PNS agents
47
Side effects of BBs?
bradycardia, hypotension, AV conduction abnormalities, development of acute HF, asthma/COPD exacerbations, transient increase in blood glucose and serum cholesterol
48
Propranolol and Metoprolol have an extensive....
first pass effect
49
Labetelol and Carvedilol are..
Beta 1 blocker and Alpha 1 blocker
50
Suffix for Alpha 1 blockers?
"zosin"
51
Name 2 alpha 1 blockers
prazosin, terazosin, doxazosin
52
What are alpha 1 blockers used for?
treatment of HTN, PTSD related nightmares, BPH
53
Alpha 1 blockers MOA
targets the alpha 1 receptors on vascular smooth muscle --> inhibits the uptake of catecholamines--->vasodilation/decrease in PVR
54
Alpha 1 blockers cross.....
the blood brain barrier
55
What can be given with alpha 1 blockers to increase their efficacy?
a diuretic
56
Alpha 1 blockers decrease levels of
Dabgatran, Linaglipin, Vincristi
57
Efficacy of alpha 1 blockers are decreased by
Methylphenidate
58
Side effects of alpha 1 blockers
first dose phenomenon, orthostatic hypotension, reflex tachycardia, dizziness, vivid dreams, priapism, Na and water retention
59
when should advise pts to take alpha 1 blockers?
at bedtime use cautiously in elderly
60
Name 2 central alpha 2 agonists
Clonidine, Methlydopa
61
central alpha 2 agonist MOA
stimulates alpha 2 receptors in the brain which reduces sympathetic outflow --> can decrease HR, CO, TPR, plasma renin activity and baroreceptor reflexes
62
Central alpha 2 agonist increase the efficacy of...
antihypertensives, BB, lithium, pDE5
63
Methlydopa should not be used in pts who have
liver disease
64
Side effects of central 2 agonists
sodium and water retention (give with diuretic except in pregnancy) bradycardia, orthostatic hypotension, dizziness, rebound HTN Clonidine: high occurrence of anticholinergic effects Methlydopa: hepatitis, hemolytic anemia, fever
65
What should you monitor in pts on central alpha 2 agonists
hepatic and renal status
66
What should you avoid when using central alpha 2 agonists?
abrupt cessation
67
Name a peripheral adrenergic antagonist
Reserpine
68
What are peripheral adrenergic antagonists used for?
HTN, psychosis
69
Peripheral adrenergic antagonist MOA
depletes NE from sympathetic nerve endings and blocks transport of NE into its storage granules. Leads to decrease in PVR. Depletes catecholamines from the brain and myocardium which may lead to depression and decreased CO
70
Reserpine has a ...onset and .....
slow long duration of action
71
Side effects of peripheral adrenergic antagonists
significant Na and water retention (give with diuretic), leads to reflex parasympathetic activity- nasal stuffiness, increased gastric acid secretion, diarrhea, bradycardia
72
When should you adjust peripheral adrenergic agonists?
when CrCl <10ml/min
73
Suffix for CCB
"dipine"
74
What are the two different types of CCBs?
Non-dihydropyridine: cardiac depressants- slow HR Dihydropyridine: vasodilators
75
Name 2 non-dihydropyridine CCBs
Verapamil, Diltiazem
76
Name 2 dihydropyridine CCBs
Amlodipine, Nifedipine
77
Non-dihydropyridine use?
treatment of HTN, SVT
78
Dihydropyridine use?
HTN, Raynauds
79
CCB MOA?
inhibit influx of calcium across the cell membrane leading to coronary and peripheral vasodilation
80
Non-dihydropyridines work on the ...
heart
81
Dihydropyridines work on the...
peripheral arterioles
82
CCBs inhibit the metabolism of which drugs?
cyclosporin, Digoxin, Lovastatin, Tracrolimus and Theophyline Caution with use with BB-increases chances of heart block
83
Nifedipine metabolism is inhibited by...
large quantities of grapefruit juice
84
Side effects of CCBs
dizziness, flushing, HA, gingival hyperplasia, peripheral edema, mood changes, bradycardia verapamil: constipation
85
What should you monitor in pts on CCBs?
LFTs, BP, ECG, HR
86
What CCB is safe in pts with severe HF?
Amlodipine
87
Name 2 direct vasodilators
Hydralazine, Minoxidil
88
Minoxidil, a direct arterial vasodilator, can also be used for...
Male pattern baldness in both males and females
89
direct arterial vasodilator MOA
direct arterial smooth muscle relaxation Activates baroreceptors with compensatory increase in sympathetic outflow: increase HR, CO and renin release
90
What are the side effects of direct arterial vasodilators
can precipitate angina in pts with CAD Hydralazine: dose dependent lupus like sxs
91
In pts with heart failure, direct arterial vasodilators should be given with?
Isosorbide-dinitrate
92
Name a carbonic anhydrase inhibitor
Acetazolamide
93
Acetazolamide use
glaucoma, motion sickness, edema with alkalosis
94
Contraindications for acetazolamide?
metabolic acidosis, sedation, paresthesias
95
Name an osmotic diuretic
Mannitol
96
Osmotic diuretic uses
solute overload in rhabdomyolysis, brain edema with coma, acute glaucoma
97
Osmotic diuretic MOA
osmotically extracts water from the tissue into the blood
98
Side effects of osmotic diuretics?
hyponatremia followed by hypernatremia, HA, nausea, vomiting
99
Name 2 ADH agonists
desmopressin, vasopressin
100
ADH agonist uses?
primary diabetes insipidus
101
ADH agonists MOA
agonists at the VI and V2 ADH receptors, activate insertion of aquaporin water channels in collecting tubule

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