HTN Flashcards
(114 cards)
1
Q
BP is a ____ for CV risk
A
surrogate marker
2
Q
cause of HTN in most patients is ___
A
unknown; primary (essential) HTN
3
Q
HTN that has an identifiable cause
A
secondary cause
4
Q
Mean arterial pressure =
A
cardiac output x total peripheral resistance
5
Q
hormonal factors involved in HTN
A
renin, angiotensin, aldosterone, bradykinin (RAAS)
6
Q
pharmacotherapy now begins at SBP>___ or DBP > ___
A
130; 80
7
Q
130 is the new ___
A
pharmacotherapy140
8
Q
first line approach for HTN
A
thiazide diuretics
9
Q
thiazide diuretics
A
chlorothialidone
hydroclorithiazide
10
Q
indapamide is effective for
A
CrCl <30mL/min
11
Q
metolazone is effective for
A
CrCl <30 mL/min
12
Q
hypotensive effect of thiazide diuretics > ___
A
half life (extra renal factors involved)
13
Q
chlorothalidone half life
A
45-60h
14
Q
HCTZ half life
A
8-15h
15
Q
give thiazides in the AM to minimize ___
A
nocturnal diuresis
16
Q
thieve diuretics are not effective if CrCl
A
30
17
Q
use thiazides with caution on:
A
patients >65
females
patients with low or borderline low serum Na+
18
Q
Do not exceed ____ HCTZ
A
25-50mg
19
Q
do not exceld ___ chlorthalidone
A
25mg/d
20
Q
ACEIs block ___
A
RAAS mediated conversion of AT to ATII (potent constrictor)
21
Q
ACEI prevent ___
A
LV hypertrophy
22
Q
ACEI is first line in compelling indications
A
left ventricular dysfunction
CKD
DM
secondary prevention of ischemic stroke
23
Q
All ACEIs but ___ can be dosed once daily
A
catopril
24
Q
at higher doses of ACEI some patents require ___ doses
A
twice daily
25
All ACEI's increase ___
serum K
26
GFR decreases in patients on ___
ACEI
27
SCr increases of ___ on ACEI
30% (from Scratch baseline <3mg)
28
Absolute SCr increases of ___ on ACEI are OK
<1mg
29
greater increases (>1mg) in SCr with ACEI warrant ___
discontinuation or dose reduction
30
angioedema of ACEI is more pronounced in
AA
| smokers
31
___ precludes any future ACEI
angioedema
32
20% of ACEI users develop __
persistent, dry cough
33
if pt develops the ACE cough, may require switching to ___
ARB
34
do NOT use ACEI in combo with ___ or ___
ARABs or aliskiren (Tekturna)
35
common ACEI
Enalapril
| Lisinopril
36
usual dose of enalapril
5-40mg/d
| 1-2 x per day
37
usual dose of lisinopril
10-40mg/d
| QD
38
unlike ACEI, ARBs do not block ___
bradykinin metabolism
39
ARBs cause little, if any ____
bradykinin-induced cough
40
beneficial effects of bradykinin are not present with ARB use
myocardial remodeling
| regression of myocyte hypertrophy & fibrosis
41
why shouldn't you use ACEIs and ARBs together
increased risk of hyperkalemia
42
lowest incidence of SEs in all hypertensive
ARB
43
do not use ___ in pregnancy
ARB
44
commonly used ARBs
losartan
| valsartan
45
CCBs are divided into two classes:
dihydropyridines (vasodilators)
| nondihydropyridines (rate controllers)
46
dihydropyridine CCBs may cause reflex ___
tachycardia due to potent vasodilation
47
tachycardia with dihydropyridines is more pronounced with ___
1st gen DHP (nifedipine)
48
tachycardia with DHP is much less pronounced with
newer agents (malodipine)
49
IR nifedipine is associated with
increased adverse CV events (AMI in angina patients), so NOT approved in HTN
50
DHPs that have once daily dosing
amlodipine
felodipine
nifedipine LA
nisoldipine
51
common DHPs
```
amlodipine
felodipine
isradipine
nicardipine
nifedipine
nisoldipine
```
52
ACE inhibitors are category ___,
X
53
available Non DHP CCBs
verapamil
| Diltiazem
54
Verapamil causes ___
constipation
55
combo therapy for BP
strong encouraged for patients with sage 2 HTN
| usually provides better BP control with fewer SEs
56
loop duiretics
fursemide
bumetandine
ethacrinic acid
torsemide
57
loop diuretics are typically reserved for patients with ___
CrCl <30mL/min
58
give BID doses of loop diuretics in AM and afternoon to minimize ___
nocturnal diuresis (avoid HS administration)
59
potassium sparing diuretics are weak ___
antiHTN agents
60
use potassium sparing diuretics in combo with ___
thiazide or loop
61
PSDs are useful in ___
patients with low serum K+
62
PSDs may cause ___
hyperkalemia in patients with CKD and diabetes
63
PSDs
triamterene
| amiloride
64
triamterene in combination with HCTZ:
dyazide
| maxzide
65
aldosterone antagonist diuretics
spinolactone (aldactone)
spinolactone/HCTZ
Eplerenone
66
spinrolactone can cause ___
10% gynecomastia
67
eplerenone rarely causes ___
gynecomastia
68
cardioselective beta blockers
Atenolol
Bisoprolol
Metoprolol (Toprol) (dosed Q24)
69
secondary agentsBB
carvedilol phosphate (Coreg CR) Q24h
70
secondary BB wiht intrinsic sympathomimetic activity
acebutolol (useful if beta blockers are causing bradycardia)
71
Do not use direct renin inhibitors with ___
ACEIs or ARBs
72
direct renin inhibitors category __
X
73
a1 blockers are typically used in patients with ___
BPH
74
a1 blockers
doxazosin
prazosin
terazosin
75
take first dose of a1 blocker before ___
bedtime (minimizes dizziness and postural hypotension)
76
centrally acting agents
clonidine (Catapress)
Tabs
Transdermal patch (replace weekly)
77
centrally acting agents
clonidine (Catapress)
| Methyldopa
78
centrally acting agents are ___ acting and ___ onset
short acting, fast onset (onset 20-60min)
79
centrally acting agents are often used in ___
resistant hyeprtension
80
centrally acting agents have significant __
anticholinergic side effects
81
abrupt cessation of centrally acting agents may cause ___
rebound HTN (taper doses gradually to d/c)
82
first line agent for pregnancy induced HTN
methyldopa
83
dosage forms of methyldopa
PO and IV
methyldopate injection
tablets
84
direct vasodilators
hydralazine (apresoline)
| minoxidil (loniten
85
use hydralazine with __ nd ___ to minimize water retention and reflex tachycardia
diuretic and BB
86
take minoxidil with a ___
loop diuretic and BB as with hydralazine
87
vasodilators (nitrous oxide dependent)
sodium nitroprusside
| nitroglycerin (NTG)
88
mainstay of treatment for most hypertensive emergencies
nitroprusside
89
precautions using nitroprusside
renal dysfunction
90
nitroprusside is metabolized to ___ which accumulates with ___
cyanide; renal insufficiency
91
in HTN emergency, add sodium ___ to IVBP (staring 2nd bag)
thiosulfate
92
sodium thiosulfate accelerates _____
enzyme degradation fo cyanide to thiocyanate (much less toxic)
93
use of nitroglycerine
acute MI
| stroke
94
precautions of nitroglycerin
development of tolerance
| Increase IV administration rate
95
C/I of nitroglycerin
concurrent use of phosphodiesterase 5 inhibitors
96
pressor of last resort
epinephrine
97
epinephrine causes severe ___
vasoconstriction which may cause digital necrosis
98
norepinephrine may cause ___
digital necrosis
99
norepinephrine is used for ___
severe hypotension
100
low dose dopamine
"renal dose"
| 1-3mcg/kg/min (mainly DA effects)
101
intermediate dose dopamine
3-10mcg/kg/min (DA + B effects)
102
high dose dopamine
>10mcg/kg/min (mainly alpha effects)
103
dopamine vs norepinephrine: consider ___
norepinephrine (levophed) first
104
dobutamine is mainly ____
B1 activity, little B2 or A activity
105
dobutamine increases ___
CO with little vasoconstriction
106
dobutamine is an ___
inotrope with vasodilatory properties
107
phenylephrine is a potent ___ with weak ___
alpha agonist; weak beta agonist activity
108
phenylephrine is ___ in arterioles and nasal mucosa
vasoconstrictive
109
phenyleppherine is useful alternative in those ___
unable to tolerate tachycardia from dopamine or norepinephrine
110
MOA of vasopressin
increases water permeability of renal tubule
| increases water resorption from tubular lumen
111
Vasopressin results in
decreased urine volume and increased osmolality
112
administer ___ of vasopressin
0.04 units/min (fixed rate)
113
greater doses of vasopressin cause ___
cardiac arrest (hence, fixed rate dose)
114
vasopressin is usually ___ in addition to use of other pressors
added on
