Where in the nephron do the following medications work? 1. Acetazolamide 2. Loops 3. Thiazides 4. K+ sparing

1. PCT 2. Thick ascending LOH 3. DCT 4. CCD

HTN Flashcards by Alexandria Arnett

What is the recommended treatment for HTN w/CAD?

Beta blocker AND ACEI/ARB

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Which diuretic causes increase vs decrease in calcium?

Thiazide increases calcium
Loops decrease calcium

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How soon do you monitor after starting or changing BP med?

1 month

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How do you calculate MAP?

SBP + (2 x DBP) / 3

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What is the first line HTN med for 18-75 y.o with CKD?
What about in dialysis/ESRD?

ACEI/ARB

Thiazide/CCB - this is because ACEI/ARB have nephroprotective effects but once they need dialysis there is no benefit and it may actually be doing harm.

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What medications are preferred for HTN in pregnancy?
What to avoid?

Methyldopa, nifedipine, labatalol

ACEI/ARB/DRI

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If a patient was just diagnosed with stage 1 HTN and has ASCVD of 12%, what is the basic recommendation?

Lifestyle modification and start 1 medication

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What are 5 examples of secondary HTN?

Endocrine (cushing’s, pheochromocytoma, thyroid)
Vascular disease
Renal diseases
Sleep apnea
Medications

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Where in the nephron do the following medications work?

Acetazolamide
Loops
Thiazides
K+ sparing

PCT
Thick ascending LOH
DCT
CCD

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How do RAAS antagonists work?

Decrease volume by decreasing aldosterone = increase Na+ excretion
Decrease BP by decreased angiotensin = vasodilation

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What are some OTC/herbs that can increase BP?

Ephedra, ma huang, licorice (aldosterone agonist), bitter orange, decongestants, yohimbe

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What meds help with morbidity and mortality in CHF?

Low dose BB
ACEi/ARB
Entresto
Aldosterone antagonists

Loops ONLY help with CHF symptoms

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Which diuretics can be used in CrCl < 30?

All Loops and metolazone (thiazide-like)

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Which allergy would cause caution with thiazides?

Sulfa

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What are three thiazide/loop drug interactions?

Lithium increases due to the decrease in Na+

Digoxin increases due to decreases K+ and Mg2+

Allopurinol hypersensitivity due to increase in uric acid

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Which thiazide-like diuretic is the most potent?

Chlorthalidone

Long-acting thus given QD

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Which loop diuretic does not have a sulfa component?

Ethacrynic acid (Edecrin)

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Bumetanide

Brand
Indication
ROA
MAX
Oral and IV conversion to furosemide

Bumex

Edema

IM/IV/PO

10mg/day

1mg oral bumex = 40mg oral lasix
1mg IV bumex = 20mg IV lasix

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Which loop diuretic causes the most ototoxicity?

Ethacrynic acid (Edecrin)

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Amiloride

Brand
MOA
Indications

Midamor

Potassium-sparing

To prevent hypokalemia since it has weak effects on BP

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Triamterene

Brand
MOA
Indication

Dyrenium
Potassium-sparing
Edema

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Spironolactone

Brand
MOA
Indication
Dose for HTN

Aldactone / Carospir oral suspension

Aldosterone antagonist

Edema, HTN, hypoK+, CHF ; off-label for acne and hirsutism in women

50-100mg QD/BID

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Eplerenone

Brand
MOA
Indication
Dose for HTN
Dose for CHF

Inspra

Aldosterone antagonist

HTN, CHF after MI

50mg QD

25mg QD

What can be an alternative diuretic for patients with gout and/or DM ?

Spironolactone

It doesn’t affect glucose or uric acid levels

Which beta blocker can cause drug-induced lupus and what is the brand name?

Acebutolol (Sectral)

Atenolol Brand Food interaction Dosed

Tenormin Orange/apple juice and green tea can decrease levels by 40% so counsel to separate by 4 hours 25-100mg QD

Betaxolol - Brand Bisoprolol - Brand Esmolol - Brand and indication

1. Kerlone 2. Zebeta 3. Brevibloc ; IV used for SVT/ HTN emergency/ intraop/post op tachycardia/HTN

Propranolol Brand Food counseling Indications

Inderal. innopran, Hemangeol IR - Take WITH food ER - Take with or without food Post-MI, tachyarrythmia, HTN, stable angina, migraine prevention, essential tremor, pheochromocytoma, hemangioma

What are the three BB's that have the highest rate of orthostatic hypotension? Which one is a CYP2D6 substrate?

Nebivolol - CYP2D6 substrate Carvedilol Labetalol

Carvedilol Brand Food counseling MOA HTN dose CHF dose

Coreg Take WITH food Alpha 1 and beta 1 activity 6.25mg BID 3.125mg BID

Beta-1 selective beta blockers? What patients would prefer this?

MAN-BABE Metoprolol Atenolol Nebivolol Bisoprolol Acebutolol Betaxolol Esmolol Patients with COPD

Beta blockers that come in IV?

MAPLES Metoprolol Atenolol Propranolol Labetalol Esmolol Sotalol

Which beta blockers are preferred in CHF?

Carvedilol Metoprolol XL (NOT IR) Bisoprolol

What is the counseling point for Diltiazem IR? What about dilacor XR/ Diltia XT? Taztia XT and Tiazac?

Before meals at bedtime Take on empty stomach Are capsules and can be opened/sprinkled

What is the difference in effect between verapamil and diltiazem?

Verapamil has most effects on the heart and less on vessels Diltiazem affects both heart and vessels

When should you be cautious with non-DHP CCB?

CHF Heart block Additive bradycardia Severe liver dysfunction pregnancy

PGX of verapamil and diltiazem?

They are 3A4 substrates and inhibitors

What are the two DHP CCB's that come IV?

Nicardipine and clevidipine

When do you take nifedipine on empty stomach?

ER formulations

Clevidipine Brand ROA Indication Dosage form Contraindications

Cleviprex IV only BP control in hospital Lipid emulsion Soy/egg allergies.

What is the DOC for Raynaud's? DOC for Prinzemetal's angina?

Nifedipine, amlodipine, felodipine, or isradipine Nifedipine, diltiazem, verapamil

When do you use nimodipine?

Oral solution for subarachnoid hemorrhage

T/F: CCB's can increase serum lipids/glucose

False

Which ACEI's are given on empty stomach? Which is the only TID one? Which is the only IV one? Which is the only that comes in capsules? What is the shortest acting? Which one is safest for renal impairement? List brand. names for all above.

Captopril and moexipril (Univasc) Captopril (Capoten) Enaloprilat (Vasotec) Rampiril (Altace) Captopril (that's why it's the only TID one) Fosinopril

When should a ACEI/ARB be prescribed for DM patients?

All DM patients who have any level of proteinuria REGARDLESS if they have high BP or not.

Aliskriren Brand MOA Max dose Indication Pregnancy? ADE Food interactions What 4 medications can increase aliskiren levels significantly?

Tekturna Direct renin inhibitor 300mg/day HTN only Category D Diarrhea Orange/apple/grapefruit juice so separate by 4 hours and avoid high FAT Cyclosporine, itraconazole, ketoconazole, atorvastatin

Which alpha 1 blocker is for HTN only? How is it dosed? Which for BPH only? Which two are for both?

Prazosin (minipress) - BID/TID because its short acting Doxazosin extended release Doxazsin (cardura) and terazosin (hytrin)

What are the food counseling points for : Tamsulosin Alfuzosin ER Sildosin

30 minutes after same meal each day After same meal each day and swallow whole With meals

What are the four formulations of clonidine and what are they used for?

Catapress tablets for HTN Catapress PATCH WEEKLY for HTN Kapvay ER tabets for ADHD Duraclon Epidural for pain management in cancer patients

Other than clonidine, what are two other alpha 2 agonists for HTN?

Guanfacine and methyldopa

ADE of alpha 2 agonists

Dry mouth, constipation, orthostasis, rebound HTN, sedation, bradycardia, depression

Reserpine MOA Indications ADE

Peripheral adrenergic antagonist - central monoamine depleting agent HTN and schizophrenia OH and depression

Hydralazine Brand ROA Pregnancy? MOA ADE

Apresoline PO/IV Can be used parentally Increases cGMP = arterial vasodilation Reflex tachycardia, lupus-like syndrome

Aprocitentan brand MOA Indication Safety test

Tryvio Endothelin receptor antagonist (vasodilator) Resistant HTN Confirm negative pregnancy test prior, monthly, and 1 month after discontinuation

What's the difference between HTN emergency and urgency?

Both are with high numbers >180/>120 but urgency is no symptoms whereas emergency shows end target organ damage symptoms

Sodium Nitroprusside Brand MOA Onset Compatibility When to discard ADE

Nitropress Direct acting aterial and venous dilator Rapid onset D5W - wrap in aluminum After 24H or discoloration (if it turns blue it has been broken down all the way to cyanide) N/V/H, cyanide ir thiocyanate toxicity (especially in those with renal.liver dysfunction)

Fenoldopam Mesyllate Brand MOA Indication

Corlopam IV Selective DA-1R agonist Renal HTN emergencies