First line HTN meds Flashcards Preview

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Flashcards in First line HTN meds Deck (55):
1

What is BP?

Surrogate marker for CV risk

2

What is the cause of HTN in most pts?

Primary/essential HTN

3

What is HTN w/ an identifiable cause?

Secondary HTN

4

What is the MAP formula?

Cardiac output x Total peripheral resistance

5

What hormonal aspects are involved in HTN?

Renin
Angiotensis
Aldosterone
Bradykinin

6

When does pharmacotherapy start for HTN?

SBP > 130
DPB > 80

7

What do the new guidelines mean for HTN pts?

Lots more need meds

8

What is the 1st line agent for HTN?

Thiazide diuretics

9

What are examples of thiazide diuretics?

Chlorthalidone
Hydrochlorthizade

10

Which thiazide diuretics are effective for CrCl <30?

Indapamide
Metolazone

11

Is the hypotensive effect of thiazide diuretics longer or shorter than the half life?

Longer
*not sure why

12

What is the half life of chlorthalidone?

45-60 hours

13

What is the half life for hydrochlorthiazide?

8-15 hours

14

What time of day do you give thiazides and why?

AM
Minimize nocturnal diureses

15

Are chlorthalidone and hydrochlorthizaide effective at CrCl<30?

No

16

For what populations do you use thiazides with caution in?

Pts > 65
Females
Pts w/ low or borderline low serum Na+

17

What is the max of hydrochlorthiazide and chlorthalidone?

HCTZ: 25-50 mg
C: 25 mg

18

What do ACEIs do?

Block RAAS-mediated conversion of AT to ATII (potent constrictor)

19

What do ACEIs prevent?

LV hypertrophy

20

When are ACEIs 1st line?

LV dysfunction
CKD
DM
Prevention of ischemic stroke

21

How many times daily are ACEIs dosed? What is an exception?

1/day

Catopril

22

At higher doses of which ACEI meds do pts require BID dosing?

Enalapril
Benazepril
Moexipril

23

What do ALL ACEIs do?

Increase serum K+

24

What is an SE of ACEIs?

GFR decrease

25

What happens to SCr when on ACEI that does not call for DC?

Increase of 30% or absolute increase of < 1 mg/dL

26

What happens if SCr increases more than previously listed while on ACEIs?

Discontinuation or dose reduction

27

What populations is the SE of angioedema more prevalent?

African Americans
Smokers

28

What does angioedema do w/ ACEIs?

Precludes any future ACEIs

29

What % of pts develop dry, persistent cough?

20%

30

What does the ACEI cough warrant?

Switching to an ARB

31

When are ACEIs completely contraindicated?

Pregnancy
Category X

32

What do you not combine w/ ACEIs?

ARBs
Aliskiren

33

How is Enalapril administered, what is the dose, and how often (ACEI)?

IV, PO
5-40 mg
1-2/day

34

What is the dosing of Lisinopril and how often is it given?

10-40 mg
1/day

35

Do ARBs block bradykinin metabolism?

No

36

What does the lack of bradykinin metabolism do to make ARBs more preferable for some pts?

Little to no bradykinin induced cough

37

What are ARBs missing due to continued bradykinin metabolism?

Myocardial remodeling
Regression of myocyte hypertrophy and fibrosis

38

Should you use ACEIs and ARBs together?

No duh

39

Why shouldn't you use ACEI and ARBs together?

Increased risk of hyperkalemia

40

When can you not use ARBs?

Pregnancy

41

What is the rate of SEs with ARBs?

The lowest incidence of SEs of all hypertensives

42

Give two examples of ARBs
Is there generic availability?

Losartan
Valsartan
Yes

43

What are the two classes of calcium channel blockers?

Dihydropyridines
Non-dihydropyridines

44

Are dihydropyridines vasodilators or rate controllers?

Vasodilators

45

Are non-dihydropyridines vasodilators or rate controllers?

Rate controllers

46

What is a SE of dihydropyridine CCB?

Reflex tachycardia due to potent vasodilation

47

With what agents is CCB reflex tachycardia more likely?

More pronounced w/ 1st generation DHP

48

With what agents is reflex tachycardia less likely?

Much less pronounced with newer agents

49

What is IR nifedipine associated with?
What is an example? What does this mean?

Increased adverse CV advents
Ex: AMI in angina pts
Means not approved for HTN

50

What are some examples of dihydroperidine that are dosed once per day?

Amlodipine
Felodipine
Nifedipine LA
Nisoldipine

51

What are some examples of non-dihydropyridine CCBs?

Verapamil
Diltiazem

52

What is a negative SE of verapamil?

Constipation

53

When is combination therapy recommended for HTN?

Stage 2 HTN pts

54

What is an advantage of combination BP pharmacotherapy?

Better BP control w/ fewer SEs

55

What are some examples of dihydroperidine that are dosed twice per day?

Isradipine
Nicardipine SR