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Rx Prep > HTN - Quiz 3 > Flashcards

HTN - Quiz 3 Flashcards

(131 cards)

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1
Q

What is the difference between primary and secondary HTN?

A

Primary: unknown with combination of RF
Secondary: identifiable underlying cause

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2
Q

HTN includes the activation of ___ and ___?

A

SNS and RAAS

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3
Q

Describe the components of the RAAS system?

A
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4
Q

Drugs that can increase BP?

A

Increased sympathomimetic activity: ADHD drugs, recreational, antidepressants
Increased sodium and water retention: NSAIDs, immunosuppressants, systemic steroids
Increased blood viscosity: ESAs
Oral contraceptives, VGEF inhibitors

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5
Q

How is HTN diagnosed?

A

Based on the average of at least 2 readings on 2 separate occasions

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6
Q

What is normal BP?

A

<120/80

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7
Q

What is elevated BP?

A

SBP 120-129 and DBP <80

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8
Q

What is stage 1 HTN?

A

SBP 130-139 or DBP 80-89

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9
Q

What is stage 2 HTN?

A

SBP≥140 or DBP ≥90

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10
Q

Lifestyle management for HTN?

A
  1. Weight loss
  2. DASH diet
  3. Potassium intake
  4. Reduced sodium intake (<1500 mg QD)
  5. Physical activity
  6. Limited alcohol (≤1 drink QD for women, ≤2 drinks QD for men)
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11
Q

Natural products used for HTN?

A
  1. Garlic oil
  2. Fish oil
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12
Q

What are the preferred regimens for adherence?

A

QD regimens or combo products

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13
Q

When do you treat stage 1 HTN?

A

SBP 130-139 or DBP 80-89 and one of the following:
1. Clinical CVD
2. 10 yr ASCVD risk ≥10%
3. Hasn’t met BP goals after 6 months of lifestyle mods

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14
Q

When do you treat stage 2 HTN?

A

SBP≥140 or DBP ≥90

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15
Q

What is BO goal?

A

<130/80

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16
Q

What are the preferred drug classes?

A
  1. THiazides
  2. DHP CCB
  3. ACE
  4. ARBs
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17
Q

Preferred agents for CKD?

A
  1. ACEI
  2. ARBs
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18
Q

When do you start a second drug?

A

BP >20/10 above goal

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19
Q

What anti-HTN has fetal toxicity?

A
  1. ACEI
  2. ARBs
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20
Q

Anti-HTN used for pregnancy?

A
  1. Labetalol
  2. Nifedipine ER
  3. Methyldopa
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21
Q

Medication given to those at risk for preeclampsia?

A

Daily low-dose aspirin after first trimester

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22
Q

Lisinopril/HCTZ

A

Zestoretic

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23
Q

Losartan/HCTZ

A

Hyzaar

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24
Q

Olmesartan/HCTZ

A

Benicar HCT

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25
Valsartan/HCTZ
Diovan HCT
26
Benazepril/Amlodipine
Lotrel
27
Valsartan/Amlodipine
Exforge
28
Atenolol/Chlorthalidone
Tenoretic
29
Bisoprolol/HCTZ
Ziac
30
Triamterene/HCTZ
Maxzide-25
31
Chlorthalidone
Thalitone
31
MOA for thiazides?
Inhibit sodium reabsoprtion in the DCT leading to the increased excretion of sodium, chloride, water, and potassium
32
HCTZ
Hydrodiuril
33
Dose of chlrothalidone?
12.5-25mg QD
34
Dose of HCTZ?
12.5-50mg QD
35
Chlorothiazide
Diuril
36
CI for thiazides?
Sulfonamide hypersensitivity * Exacerbations of SLE, gout, dyslipidemia, diabetes
37
ADRs of thiazides?
Decreased: K, Mg, Na Increased: Ca, UA, LDLD, TG, BG Photosensitivity
38
Administration of thiazides?
1. Take early in the morning to avoid nocturia
39
What is the only thiazed available as IV?
Chlorothiazide
40
What thiazide is considered the most effective at lowering BP due to longer DOA and increased potency?
Chlorothalidone
41
MOA of DHP CCBs?
More selective for vascular smooth muscle causing peripheral arterial vasodilation
42
ADRs of DHP CCBs?
1. Peripheral edema 2. HA 3. Palpitations 4. Flushing 5. Reflex tachycardia 6. Gingivial hyperplasia 7. Hypotension
43
Amlodipine
Norvasc
44
Nicardipine
Cardene IV
45
Nifedipine
Procardia XL, Adalat CC
46
Clevidipine
Cleviprex
47
IV DHP CCBs
Nicardipine, Clevidipine
48
DHP CCB drug of choice in pregnancy? HFrEF?
Nifedipine ER (Procardia XL) Amlodipine
49
CI of clevidipine?
Allergy to soy and eggs
50
ADRs specific to clevidipine?
1. Hypotension 2. Reflex tachycardia 3. Infections 4. Hypertriglyceridemia
51
How many kcal are in clevidipine?
2kcal/mL
52
How should you administered clevidipine?
Use strict aseptic technique due to infection risk; maximum time of use after vial puncture is 12 hrs
53
MOA of non-DHP CCBs?
Control HR in arrhythmias * Sometimes used for HTN and chronic stable and vasospastic angina
54
Examples of thiazides?
1. Chlorthalidone 2. HCTZ 3. Chlorothiazide 4. Indapamide 5. Metolazone
55
DHP CCB examples?
1. Amlodipine 2. Nicardipine 3. Nifedipine 4. Clevidipine
56
Non-DHP examples?
1. Diltiazem 2. Verapamil
57
Diltiazem
Cardizem, Tiazac
58
Verapamil
Calan SR
59
ADR of Non-DHP CCBs?
1. HF may worsen 2. Bradycardia 3. Constipation (verapamil) 4. Gingival hyperplasia
60
Enzyme that metabolized Non-DHP?
CYP3A4 * They are inhibitors as well
61
Statins that are metabolized by CYP3A4? Which are safe with Non-DHP?
Simvastatin, lovastatin, atorvastatin, fluvastatin Pitavastatin, pravastatin, rosuvastatin
62
MOA of ACEIs?
Blocks the conversion of AngI to AngII to decrease vasoconstriction and aldosterone secretion
63
Why is coughing a sx of ACEIs?
Blocks the degradation of bradykinins
64
CI of ACEis?
1. Risk for angioedema 2. Within 36hrs of entresto
65
ADR of ACEis?
1. Angioedema 2. Hyperkalemia 3. Hypotension 4. Renal impairment (bilateral renal artery stenosis) 5. Cough
66
Types of ACEIs?
1. Benazepril 2. EnalaprilLisinopril 3. Quinapril 4. Ramipril
67
Benazepril
Lotensin
68
Enalapril
Vasotec
69
Enalaprilat
Vasotec IV
70
Lisinopril
Zestril
71
Quinapril
Accupril
72
Ramipril
Altace
73
MOA of ARBs?
Block AngII form binding to AT1 receptor on vascular smooth muscle preventing vasoconstriction, prevents aldosterone secretion
74
How are the benefits of using ARBs over ACEIs?
1. Less cough 2. Less angioedema 3. No washout period with Entresto
75
Types of ARBs?
1. Irbesartan 2. Losartan 3. Olmesartan 4. Valsartan
76
Irbesartan
Avapro
77
Losartan
Cozaar
78
Olmesartan
Benicar
79
Valsartan
Diovan
80
ADRs specific to ARBs?
1. Sprue-like enteropathy (olmesartan) 2. Diarrhea with weight loss
81
What is the only renin inhibitor?
Aliskiren
82
Aliskirin
Tekturna
83
Electrolyte imbalance associated with RAAS inhibitors?
Hyperkalemia
84
Where do K-sparing diuretics act?
Late DCT and collecting duct
85
When are K-sparing diurectics used?
Preferred add-on drugs for resistant HTN
86
K-sparing diuretics examples?
1. Spironolactone 2. Triamterene 3. Ailoride 4. Aplerenone
87
Spironolactone
Aldactone
88
Triamterene
Dyrenium
89
Eplerenone
Inspra
90
CI for K-sparing?
1. Hyperkalemia >5.5 2. Severe renal impairment 3. Addison's dx
91
ADRs of K-sparing?
1. Hyperkalemia 2. Increase sCr 3. DZ
92
Why do Spironolactone have unique ADRs?
Non-selective antagonsist * Gynecomastia * Breast tenderness * Impotence
93
When are beta-blockers recommended for HTN?
1. Post-MI 2. Stable angina 3. HF
94
Beta blockers used for HFrEF?
1. Bisoprolol 2. Carvedilol 3. Metoprolol succinate
95
Beta-1 sective blockers?
1. Atenolol 2. Metoprolol 3. Esmolol 4. Bisoprolol 5. Betaxolol 6. Acebutolol | AMEBBA
96
Atenolol
Tenormin
97
Esmolol
Brevibloc
98
Metoprolol
Lopressor, Toprol XL
99
BBW for beta-1 selective blockers?
Don't DC abruptly (taper dose)
100
ADRs of beta-1 selective blockers?
1. Bradycardia 2. Hypotension 3. CNS effects (fatigue, dz, depression) 4. impotence 5. exacerbate Raynauds 6. Exacerbate asthma, COPD 7. Mask hypoglycemia
101
How do you administer metoprolol?
Taken with or immediately following food * Metoprolol tartrate IV to PO (1:2.5) * Toprol XL can be cut in half
102
How is nebivolol different from other beta 1 selective blockers?
Has nitric oxide vasodilation
103
Types of non-selective beta blockers?
1. Propranolol 2. Naolol
104
Nebivolol
Bystolic
105
Propranolol
Inderal LA, XL
106
Nadolol
Corgard
107
CI for nonselective beta blockers?
Bronchial asthma
108
Indications for propranolol?
Highly lipid solubility * Migraine prophylaxis -> CNS ADRs * Portal HTN
109
Non selective beta blockers and alpha-1 blockers?
Carvedilol (Coreg) Labetalol (Normadyne)
110
Administration of carvedilol?
Take all forms with food
111
MOA of a2 agonists?
Stimulates presynaptic a2 adrenergic receptors in the brain that decreases sympathetic outflow of NE
112
Carvedilol
Coreg
113
Labetalol
Normodyne
114
Types of a2 agonsits?
1. Clonidine 2. Guanfacine 3. Methyldopa
115
Clonidine brand names
Patch: Catapress TTS QW Kapvay: ADHD
116
Guanfacine brand names?
ER (Intuniv) IR
117
ADRs of clonidine and guanfacine?
1. Rebound hypertension (must taper) 2. Dry mouth 3. Somnolence 4. Fatigue 5. DZ 6. Constipation 7. Bradycardia 8. Hypotension 9. Impotence Patch: skin rash, pruritus, erythema
118
How do you administer clonidine patch?
QW * Remove MRI
119
CI of methyldopa?
MOAI Hemolytic anemia
120
ADR of methyldopa?
1. DILE
121
Direct vasodilators used for HTN?
1. Hydralazine 2. Minoxidil
122
ADRs of hydralazine?
1. DILE 2. Peripheral edema 3. HA 4. Palpitiations 5. Reflex tachycardia
123
ADRs of minoxidil?
1. Potent VD 2. Harigrowth 3. Tachycardia 4. Fluid retention
124
When are alpha blockers used for HTN?
Men with BPH and HTN
125
What is HTN crisis?
>180/120 that is life threatening
126
DX states that can lead to HTN emergency?
1. acute target organ damage 2. Encephalopathy 3. Stroke 4. AKI 5. ACS
127
How do you treat HTN emergency?
1. IV medications 2. Decrease BP by no more than 25% (within 1st hr), then stable, decrease to 160/100 in next 2-6hrs
128
How do you treat HTN urgency?
1. Short acting PO meds 2. Decrease BP gradually over 24-48hrs
129
IV HTN medications for emergencies?
1. Clevidipine 2. Enalaprilat 3. Esmolol 4. Hydralazine 5. Labetalol 6. Nicardipine 7. Nitroglycerin 8. Nitroprusside
130
Anti-HTN that has a ghost tablet?
Procardia XL

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