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UBSPPS PHM601 Flashcards Renal-Primary Prevention > HTN > Flashcards

HTN Flashcards

(58 cards)

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1
Q

How do you treat primary HTN?

A

Medically managed, cannot be attributed to another cause

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2
Q

How do you treat secondary HTN?

A
  1. Treat underlying diseases (primary aldosteronism, obstructive sleep apnea etc.)
  2. Remove any medications causing HTN if possible (ex: SNRIs, TCA & MAIOs)
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3
Q

Stage 1 HTN BP readings:

A

130-139/80-89 mm Hg

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4
Q

Stage 2 HTN BP readings:

A

> 140/>90 mm Hg

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5
Q

Hypertensive crisis BP readings:

A

> 180/>120 mm Hg

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6
Q

Black patients with HTN but NO CKD or HF should be treated with which first line class(es) of anti-HTN?

A

Thiazide-type diuretics OR CCB
(ACEi/ARB don’t work as well!)

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7
Q

Safe anti-HTN in pregnant patients (3)

A
  1. Labetalol
  2. Nifedipine ER
  3. Methyldopa
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8
Q

Beta blockers to be used in pts with HTN and indication of HFrEF? (3)

A
  1. Carvedilol
  2. Metoprolol succinate
  3. Bisoprolol
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9
Q

Chlorthalidone (Hydroton) Dosing?

A

12.5-25 mg Daily

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10
Q

Hydrochlorothiazide (Hydrodiuril) Dosing?

A

25-50 mg Daily

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11
Q

Thiazide and thiazide-like diuretic mechanism of action

A

Inhibits Na and Cl reabsorption in the distal convoluted tubule leading to increased excretion of Na, Cl, H2O, and K

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12
Q

Thiazide and thiazide-like diuretic monitoring

A

Electrolyte and renal function 2-4 weeks after initiating or changing therapy

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13
Q

Adverse Effects of Thiazide diuretics?

A

Hyper: Calcemia, uricermia, glycemia
Hypo: volemia, natremia, kalemia, magnesemia

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14
Q

Major DDI for NON-DHP CCBs?

A

CYP3A4 (Adjust dose for simvastatin and lovastatin)

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15
Q

Amlodipine (Norvasc) Dose?

A

2.5-10mg Daily (DHP)

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16
Q

Nifedipine ER (Procardia) Dose?

A

30-120 mg Daily (DHP)

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17
Q

Diltiazem ER (Cardizem) Dose?

A

120-360mg Daily (Non-DHP)

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18
Q

ACEi contraindications?

A
  1. Pregnancy
  2. Angioedema history
  3. Bilateral renal artery stenosis
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19
Q

ACEi and ARBs major adverse effect

A

Hyperkalemia

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20
Q

Lisinopril (Prinivil/Zestril) dosing

A

10-40 mg Daily

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21
Q

Losartan (Cozar) dosing?

A

50-100 mg in 1-2 divided doses

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22
Q

Valsartan (Diovan) dosing?

A

80-320 mg daily

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23
Q

Direct Renin Inhibitor (DRI) adverse effects

A

Hyperkalemia

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24
Q

Aliskiren (Tekturna) dosing?

Study These Flashcards
A

150-300 mg daily

25
Beta Blockers adverse effects
Bradycardia, Bronchospasm, heart block, worsening HF
26
What must be done when discontinuing a beta blocker?
Taper down dose
27
Metoprolol Succinate (Toprolol XL) dose
50-200mg daily (cardioselective)
28
Bisoprolol (Zebeta) dose
2.5-10mg daily (cardioselective-)
29
Carvedilol (coreg) dose
12.5-50mg over two divided doses (alpha and beta blockade)
30
Thiazide and thiazide-like use in patients with gout
OK if uric acid is within normal range, avoid is uric acid elevated
31
DHP CCB Mechanism of Action
Inhibits Ca ions from entering vascular smooth muscle and myocardial cells leading to peripheral arterial and coronary artery vasodilation
32
Non-DHP CCB Mechanism of Action
Inhibits Ca ions from entering vascular smooth muscle and myocardial cells (more selective for the myocardium) leading to vasodilation, negative inotropy, and negative chronotropy
33
ACEi mechanism of action
Decreases angiotensin-II production leading to vasodilation and decreased aldosterone secretion
34
ARB mechanism of action
Blocks angiotensin-II activity at the angiotensin receptor n vascular smooth muscle preventing vasoconstriction
35
DHP CCB onset of action
Up to one week to see the full BP effect
36
DHP CCB that should be avoided in HTN
Nifedipine IR - increased hypotension, MI, and death!
37
DHP CCB AE
Peripheral edema, headache, dizziness
38
Non-DHP CCB should be avoided in which disease state?
HFrEF
39
Which class of drugs requires a wash-out before ANRI (Entresto) initiation, and for how long?
ACEi - 36 hours Does NOT apply to ARBs
40
Serum creatinine increase EXPECTED with ACEI/ARB?
Less than or equal to 35%
41
Direct renin inhibitor mechanism of action
Inhibits renin leading to an overall decrease in angiotensin II
42
Beta-blocker mechanism of action
Inhibits B1/B2 receptors leading to a decrease in inotropy and chronotropy
43
Alpha1-blocker mechanism of action
Blocks alpha-1 adrenergic receptors leading to peripheral vasodilation
44
Central Alpha-2 agonist mechanism of action
Stimulates central alpha2 adrenergic receptors leading to a decrease in sympathetic outflow (norepinephrine), leading to vasodilation and decrease inotropy/chronotropy
45
Loop diuretic mechanism of action
Inhibits Na, K, Cl reabsorption in the thick ascending loop of henle
46
Potassium sparing diuretic mechanism of action
Competitive inhibition of epithelial sodium channels in the collecting duct of the nephron, leading to a decrease in sodium reabsorption and increase in potassium reabsorption
47
Mineralocorticoid receptor antagonist mechanism of action
Competitive antagonist of the mineralocorticoid receptor which decreases reabsorption of Na and increases reabsorption of K Eplerenone = selective Spironolactone = non-selective
48
Direct vasodilators
Direct vasodilation of arteries
49
Alpha1 blocker adverse effects
Syncope, orthostatic hypotension
50
Doxazosin (Cardura) dose
1-16 mg daily
51
Central alpha2-agonists method of discontinuation
Slow taper to avoid rebound hypertension
52
MRA adverse effects
Spironolactone: gynecomastia, breast tenderness, impotence - if these occur, switch to eplerenone!
53
Which anti-hypertensives require renal/electrolyte monitoring in 2-4 weeks after initiation? (6)
1. ACEi/ARB 2. Thiazides and thiazide-type diuretics 3. Direct renin inhibitors 4. Loop diuretics 5. Potassium sparing diuretics 6. Mineralocorticoid receptor antagonists
54
What is a normal blood pressure?
< 120 / < 80 mm Hg
55
What is an elevated BP?
120-129/ < 80 mm Hg
56
What is the general blood pressure goal for patients?
< 130/80 mm Hg
57
What occurs in HTN emergency that does not occur in HTN urgency?
End organ damage! Look for things like elevated SCr, LFTs, etc!
58
Treatment approach for HTN urgency
Timing: Lower BP slowly in 24-48 hours of presentation Agent: ORAL anti-HTN Location: No ICU

UBSPPS PHM601 Flashcards Renal-Primary Prevention (12 decks)

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