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HTN Flashcards

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1
Q

bp goal for everyone

A

< 130/80

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2
Q

aa

A

thiazides and CCBs

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3
Q

CKD

A

ace or arb

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4
Q

dialysis

A

thiazide or CCBs, nothing left to preserve

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5
Q

gen population 1st line tx

A

thiazide, ace, arb, ccb

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6
Q

mean arterial pressure (MAP)

A

systolic + 2(diastolic) / 3

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7
Q

bp can be reduced by

A
  1. volume of fluid or
  2. dilate the vessels (- inotrope, - chonotrope)
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8
Q

decrease volume via kidneys

A

diuretics (ex. thiazide, loops, k sparing)
electrolyte disturbances

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9
Q

meds that increase bp

A
  1. estrogen
  2. corticosteroids (nsaids, COX2)
  3. SNRI’s
  4. migraine meds
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10
Q

lifestyle modifications for weight loss

A
  1. lose weight
  2. sodium intake <2.4 g a day
  3. dash diet
  4. less alcohol
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11
Q

bb ONLY for pts with

A

heart disease, not recommended for initial tx of uncomplicated htn

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12
Q

HTN in patients with CAD

A
  1. BB with ace/arb
    good for patients with:
  2. angina
  3. post MI
  4. after heart attack
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13
Q

HTN in patients with CHF

A
  1. low dose BB
  2. ace/arb
  3. entresto (sacubitril + arb (valsartan)
  4. aldosterone antagonist
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14
Q

diruretics for htn

A

thiazides

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15
Q

duretics for hf

A

loops

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16
Q

crcl <30

A

use loops or metolazone (zaroxolyn)

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17
Q

thiazides (proximal DCT)

A

hydrochlorothiazide (microzide)
chlorothiaizde (diuril)

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18
Q

thiazide like diuretics (proximal DCT)

A

chlorthalidone
indapamide (lozol)
metolazone (zaroxolyn)

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19
Q

loops (thick asc loop of henle)

A

bumetanide (bumex)
ethacrynic acid (edecrin)
furosemide (lasix)
torsemide (demadex)

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20
Q

k sparing diuretics (distal dct and collecting ducts)

A

amiloride (midamor)
triamterene (dyrenium)
spironolactone (aldactone)
eplerenone (inspra)

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21
Q

thiazide side effects

A

↓ nacl
↓ k
↓ mg

↑ glucose
↑ uric acid
↑ ca

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22
Q

caution with thiazides

A

DM
gout
preg category B
sulfa allergy
sexual dysfunction

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23
Q

drug interactions with thiazides

A

risk of lithium toxicity due to ↓ na
risk of digoxin toxicity due to↓ k and↓ mg
risk of allopurinol hypersensitivity

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24
Q

chlorothalidone

Study These Flashcards
A

longer acting and more potent than hydrochlorothiazide

25
bumetanide (bumex)
for edema 1 mg oral bumetanide = 40 mg oral furosemide 1 mg iv bumetanide = 20 mg iv furosemide
26
ethacrynic acid (edecrin)
for edema causes more ototoxicity than other loops can give in pts with sulfa allergy
27
furosemide (lasix) and torsemide (Demadex) indication
edema and HTN with fursemide IV/IM, protect from light
28
loop slide effects
↓ nacl ↓ k ↓ mg ↓ ca ↑ glucose ↑ uric acid sexual dysfunction rash lupus ototoxicity
29
ALL aldosterone antagonists
spironolactone (aldactone) eplerenone (inspra) taz/tazmin (has drosperenone - analog of spironolactone)
30
amiloride (midamor) and triampterene (dyrenium) indication?
edema
31
spironolactone and eplerenone indication?
spironlactone: HTN, edema, CHF, off label: acne and hirtuism in women eplerenone: HTN, chf after MI
32
spironolactone and eplerenone dosage for htn and hf?
HTN: 50 mg qd to start, 50 mg BID max HF: 12.5-25 mg qd to start, 50 mg qd max
33
side effects of k sparing diuretics?
hyperkalemia, spironolactone: gynecomastia
34
meds that decrease testosterone cause gynecomastia, which are?
spironolactone, ketoconazole, and cimetidine (tagamet)
35
spironolactone does not affect?
glucose or uric acid
36
k sparing diuretics are always additives
to thiazides/loops to prevent hypokalemia
37
beta blockers
- acebutolol (sectral) - can cause drug induced lupus (+ ANA test) - atenolol (tenormin) - orange juice, apple juice, and green tea decrease effects of drug by 40%, take within 4 hours of each other - betaxolol (kerlone) - renal elimination - bisoprolol (zebeta) - esmolol (brevibloc) - iv can be used for SVT, HTN emergency, tachycardia, HTN - metoprolol: lopressor is metoprolol tartrate (w food) and toprol xl is metoprolol succinate. IV available - nadolol (corgard) - same as atenolol - penbutolol (levatol_ - pindolol - propanolol (hemangeol, inderal la/xl, innopran x) - sotalol (betaspace) - for ventricular arrythmias, do not sub betaspace for betaspace af -nebivolol (bystolic) - nitric oxide - carvedilol (coreg) - with food. start 3.125 mg BID for HF and 6.25 mg BID for HTN - labetolol (trandate)
38
propanolol IR vs ER?
IR: empty stomach ER: with or without food do not sub er for ir on mg for mg basis
39
beta 1 selective BB
MAN BABE metoprolol atenolol nebivolol betaxolol acebutolol bisoprolol esmolol beta 1 blockers are better for COPD patients
40
beta blockers that come in IV
MAPLES metoprolol atenolol (injection not available in the US) propanolol labetolol esmolol sotalol - only for arrhythmias
41
ISA's intrinsic sympathomimetic activity
decreases hr less acebutolol penbutolol pindolol
42
when to use BB CHF?
BB, ace/arb, diuretics, aldosterone antagonists
43
when to use BB post MI
BB, ace/arb, aldosterone antagonists
44
when to use BB angina pectoric
BB, CCB
45
when to use BB Afib or flutter
ABCD A - amiodarone or dronedarone (multaq) B - BB C - non CCB's D - digoxin
46
bb used in chf
1. carvedilol 3.125 mg =10 mg ER 6.25 mg = 20 mg ER 12.5 mg = 40 mg ER 25 mg = 80 mg ER take with food 2. metoprolol succinate - they can be scored 3. bisoprolol (zebeta)
47
bb side effects
B bradycardia, bronchospasm L decrease libido, increase lipids O orthostatic hypotension C av block K raynauds phenomenon (TX with ccb) E exhaustion/emotional depression
48
BB contraindicated in
ergots
49
non - dihydropyridine CCB diltiazem
diltiazem - cardizem, cardizem CD, cardizem LA, dilt xr, cartia xt, tiazac, taztia xt, matzim la
50
non - dihydropyridine CCB verapamil
calen, calen sr, isoptin sr, verelan, verelan pm
51
CCBs
amlodipine (norvasc) - does not affect the heart felodipine (pendil) - always er, dont crush or chew nisoldipine (sular) - always er, dont crush or chew isradipine (dynacirc) - BID nicardipine - cardene - IV nifedipine - procardia xl, atalat cc (DECREASES BP MORE THAN ANY OTHER CCB) nimodipine - nimotop nymalize - oral (ONLY FOR SUBARACHNOID HEMMORHAGE) clevidipine - cleviprex - iv emulsion
52
taztia xt, and tiazac
caps may be opened and sprinkled
53
verelan and verelan PM
caps may be opened and sprinkled
54
verapamil affects diltiazem affects both of these drugs can also cause ____ and not be used in patients with ____
heart (can cause constipation) heart and vessels they are negative inotrope and chronotrope effects bradycardia/av block; hf patients
55
nifedipine er
empty stomach
56
celvidipine (cleviprex)
milky appearing lipid emulsion do not exceed > 1000 mL in 24 hours due to lipid load CI in soy or egg allergy same with dipovan/propofol
57
if its drug induced, it will always be
bilateral edema
58

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