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Fall 2014 - Pharm Cardio > HTN > Flashcards

HTN Flashcards

1
Q

What is normal BP?

A

<80 diastolic

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2
Q

What is the BP for prehypertension?

A

120-139 systolic, 80-89 diastolic

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3
Q

What is the BP for Stage 1 HTN?

A

140-159 systolic, 90-99 diastolic

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4
Q

What is the BP for Stage 2 HTN?

A

> 160 systolic, >100 diastolic

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5
Q

According to JNC, what are the major cardiovascular dz risk factors?

A
  • HTN, DM, dyslipidemia
  • tobacco use
  • obesity, physical inactivity
  • age (>55 men, >65 women)
  • familial hx of premature CVD (MI or sudden death)
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6
Q

What are some causes of HTN?

A
  • sleep apnea
  • drug induced
  • chronic kidney dz
  • renovascualr dz
  • pheochromocytoma
  • coarctation of the aorta
  • thyroid or parathyroid dz
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7
Q

What are some medications that may increase BP?

A
  • NSAIDs
  • cocaine, amphetamines
  • sympathomimetics (decongestants)
  • oral contraceptives
  • corticosteroids
  • erythropoietin
  • cyclosporine, tacrolimus (anti-rejection meds)
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8
Q

What are some examples of target organ damage from CVD?

A
  • heart: LVH, angina, prior MI, heart failure
  • brain: TIA or stroke
  • nephropathy
  • peripheral arterial dz
  • retinopathy
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9
Q

What is the BP goal for a pt over 60?

A

<150/90

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10
Q

What is the BP goal for a pt under 60?

A

<140/90

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11
Q

What is the BP goal for a pt over 18 with chronic kidney dz?

A

<140/90

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12
Q

What is the BP goal for a pt over 18 with DM?

A

<140/90

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13
Q

What lifestyle changes are recommended to reduce cardiovascular risk?

A
  • heart healthy diet: veggies, fruits, whole grains, limited sodium
  • regular exercise
  • achieve and maintain healthy weight
  • avoid tobacco
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14
Q

Decreasing BP by 5-6 mmHg leads to what reduction in stroke and CHD?

A
  • Stroke: 42% reduction

- CHD: 14% reduction

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15
Q

What anti-HTN treatment is recommended for general nonblack, including those with DM?

A
  • thiazide diuretic
  • CCB
  • ACE-I
  • ARB
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16
Q

What anti-HTN treatment is recommended for general black, including those with DM?

A
  • thiazide diuretic

- CCB

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17
Q

What anti-HTN treatment is recommended for anyone >18 with chronic kidney dz?

A

ACE-I or ARB

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18
Q

What is the main goal of HTN treatment?

A

attain and maintain goal BP

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19
Q

What 2 types of anti-HTN meds should NOT be used together in the same patient?

A

ACE-I and ARB

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20
Q

If goal BP is not reached within one month of treatment, what should you do?

A
  • increase the dose of the initial drug

- OR add a second drug

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21
Q

What 4 things might cause resistant HTN?

A
  • improper BP measurement
  • volume overload (excess Na, volume retention from kidney dz, inadequate diuretic therapy)
  • medication (nonadherence, inadequate dose, drug interactions)
  • associated conditions (obesity, excess EtOH, secondary HTN)
22
Q

What types of interventions might improve adherence for HTN treatment?

A
  • identify problems w/ drug tolerance and switch
  • address increased urination with diuretics
  • use generics or combo products to decrease cost
  • educate pt about importance of BP control
23
Q

What is considered a hypertensive urgency?

A

DBP > 130 but no target organ damage

24
Q

What is considered a hypertensive emergency?

A

DBP > 130 and target organ damage present

25
What is the goal of treatment in a hypertensive urgency?
- reduce DBP to 100 within 24 hours | - can use oral agents
26
What is the goal of treatment in a hypertensive emergency?
- reduce DBP to 110 within 30 minutes then to 100 within 12-24 hours - requires IV drug therapy
27
MOA of Thiazide Diuretics
Work at distal tubule to: - increase Na excretion - decrease plasma volume and cardiac output - decrease extracellular fluid volume - some decrease peripheral resistance over time
28
MOA of K+ Sparing Diuretics
- weak effects at collecting duct and distal tubule - conserve potassium - spironolactone is an aldosterone antagonist
29
MOA of Loop Diuretics
- more potent diuretic effects at loop of Henle | - more effective than thiazides in heart failure
30
Adverse Effects of Thiazide Diuretics
- hypokalemia, hypomagnesemia - hyperglycemia, hyperuricemia - effective in renal insufficiency - may cause mild cholesterol and TG increase
31
AE of K+ Sparing Diuretics
- used mainly in combo with thiazides to offset K+ loss - may cause hyperkalemia - gynecomastia in aldosterone antagonists like spironolactone
32
AE of Loop Diuretics
-more potent effects than thiazides on K+ and Mg2+ loss, overdiuresis and metabolic alkalosis
33
MOA of ACE-I
- block formation of angiotensin II, which is a vasoconstrictor - decrease aldosterone (decreases Na retention) - increase bradykinin (vasodilation)
34
MOA or Angiotensin II Receptor Blockers
- cause vasodilation | - decrease Na+ retention
35
MOA of Direct Renin Inhibitors
- vasodilation | - decrease Na+ retention
36
AE of ACE-I
- may cause hyperkalemia - cough, HoTN, rash, angioedema - may cause acute renal failure - CI in pregnancy
37
AE or ARBs
- hyperkalemia | - HoTN, angioedema
38
AE of Direct Renin Inhibitors
- diarrhea - cough, angioedema - do not use during pregnancy
39
MOA of Calcium Channel Blockers as a Class
- block intracellular reflux of Ca = prevent vascular smooth muscle contraction - vascular smooth muscle relaxation and vasodilation
40
Effect of Dihydropyridine CCBs on Contractility and Peripheral Vasodilation
- contract: minimal effect - | - peripheral vaso: significant effect +++
41
Effect of Diltiazem Non-dihydropyridine CCBs on Contractility and Peripheral Vasodilation
- contract: medium effect - - | - peripheral vaso: medium effect ++
42
Effect of Verapamil Non-dihydropyridine CCBs on Contractility and Peripheral Vasodilation
- contract: sig negative effect - - - | - peripheral vaso: medium effect ++
43
AE of CCBs
- HA, dizziness, peripheral edema - eczema in elderly - should be avoided in pts with HF
44
AE of Dihydropyridine
-may cause tachycardia
45
AEs of Non-Dihydropyridines
-diltiazem and verapamil slow down heart rate so avoid use in pts with bradycardia, heart block or sinus node dz
46
MOA of Beta Blockers
- decrease HR and cardiac output | - decrease BP
47
AE of Beta Blockers
- may aggravate asthma - CI in pts w/ bradycardia, heart block, sinus node dz - may cause fatigue, insomnia, depression, nightmares, bradycardia
48
What is methyldopa used for?
-HTN control in pregnancy
49
How does clonidine work?
-stimulate alpha 2 receptors to decrease peripheral sympathetic activity and BP
50
What type of HTN drugs are hydralazine and minoxidil?
direct vasodilators

Fall 2014 - Pharm Cardio (9 decks)

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