HTN Flashcards Preview

Fall 2014 - Pharm Cardio > HTN > Flashcards

Flashcards in HTN Deck (50):
1

What is normal BP?

<80 diastolic

2

What is the BP for prehypertension?

120-139 systolic, 80-89 diastolic

3

What is the BP for Stage 1 HTN?

140-159 systolic, 90-99 diastolic

4

What is the BP for Stage 2 HTN?

>160 systolic, >100 diastolic

5

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

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

6

What are some causes of HTN?

-sleep apnea
-drug induced
-chronic kidney dz
-renovascualr dz
-pheochromocytoma
-coarctation of the aorta
-thyroid or parathyroid dz

7

What are some medications that may increase BP?

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

8

What are some examples of target organ damage from CVD?

-heart: LVH, angina, prior MI, heart failure
-brain: TIA or stroke
-nephropathy
-peripheral arterial dz
-retinopathy

9

What is the BP goal for a pt over 60?

<150/90

10

What is the BP goal for a pt under 60?

<140/90

11

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

<140/90

12

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

<140/90

13

What lifestyle changes are recommended to reduce cardiovascular risk?

-heart healthy diet: veggies, fruits, whole grains, limited sodium
-regular exercise
-achieve and maintain healthy weight
-avoid tobacco

14

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

-Stroke: 42% reduction
-CHD: 14% reduction

15

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

-thiazide diuretic
-CCB
-ACE-I
-ARB

16

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

-thiazide diuretic
-CCB

17

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

ACE-I or ARB

18

What is the main goal of HTN treatment?

attain and maintain goal BP

19

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

ACE-I and ARB

20

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

-increase the dose of the initial drug
-OR add a second drug

21

What 4 things might cause resistant HTN?

-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

What types of interventions might improve adherence for HTN treatment?

-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

What is considered a hypertensive urgency?

DBP > 130 but no target organ damage

24

What is considered a hypertensive emergency?

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