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SHPCPJEN5 > HTN2 > Flashcards

HTN2 Flashcards

1
Q

Thiazides increase and decrease what electrolytes

What pregnancy category

A

↓Na
↓Cl
↓K
↓Mg
↑
&

↑Ca
↑Uric acid

Thiazides also increase glucose and lipids. Can cause sexual dysfunction, sulfa rash , photosensitivity

Pregnancy category B

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2
Q

Loops and electrolytes

A

↓Na
↓Cl
↓K
↓Mg ↓
↑
&

↓Ca
↑Uric

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3
Q

Loops vs thiazides and Ca

A

Thiazides increase calcium

Loops decrease calcium

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4
Q

Epogen tacrolimus ( prograf ) , cyclosporine are increase BP

A

T

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5
Q

Normal BMI

A

18.5 to 24.9

Goal of BMI < 25 if you have HTN

Physical activity
< 2 drinks per day for men < 1 for women

Increase potassium 4.7 per day in DASH
Decrease sodium < 2.4

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6
Q

Black patient with CAD

A

CCB or thiazide diuretic initially mono therapy

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7
Q

Low risk CAD HTN med

Goal BP

A

Thiazide ace arb CCB ( most often DHP like amlodipine )

BB not recommended for intial tx of uncomplicated HTN

< 130/ <80

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8
Q

Patient with ( not low risk ) CAD and HTN

A

Meds: BB first line ( improve outcomes )

BB improve outcomes in angina, systolic HF and after a heart attack

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9
Q

CFH BB meds

Goal BP

A

Goal <130 / 80 if possible < 120 < 80

1) low dose BB
2) ACE I / ARB
3) entresto ( Neprilysin inhibitor ( sacubitril ) + valsartan )
4) aldosterone antagonist ( aldactone & inspra )

Loops for CHF symptoms

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10
Q

Non- dihydropyridines

A

Verapamil + diltiazem

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11
Q

Dihydropyridines

A

Amlodipine

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12
Q

Thiazides work on part of nephron

A

Proximal DCT
HCTZ ( microzide)
Chlorothiazide ( diuril)

And thiazide like dirutiecs
Chlorthalidone
Indapamide ( Lozol )
Metolazone ( zaroxyln)

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13
Q

Loops work on what part of nephron?

A

Thick ascending limb of loop of henle

Bumex - bumetanide
Ethacyric acid ( edecrin)
Furosemide ( lasix )
Torsemide ( demadex)

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14
Q

K+ sparing diuretics work on what part of nephron?

A

Distal DCT & works on collecting ducts

Amiloride ( Midamor )
Triamterene ( dyrenium )
Spironolactone ( aldactone )
Eplerenone ( inspra )

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15
Q

What cr cl is thiazide ineffective?

A

CrCl < 30

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16
Q

DDI thiazide and lithium?

A

Decrease Na and that will increase lithium : Li toxicity

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17
Q

DDI thiazide and digoxin?

A

Decreases K + and Mg : that will causes digoxin toxicity

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18
Q

Allopurinol and HCTZ?

A

Hypersensitivity risk increased

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19
Q

Chlorthalidone benefit vs HCTZ

A

Longer acting than HCTZ and more potent

Once a day dosing

HCTZ can be qd to bid dosing

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20
Q

What is the only loop without a sulfa group

A

Edecrin

Ethacrynic acid

Drawback edecrin causes more ototoxcity than other loops

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21
Q

What is the only loop with a sulfa group

A

Edecrin

Ethacrynic acid

Drawback edecrin causes more ototoxcity than other loops

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22
Q

Bumex
max dosing
1 mg

1mg bumex = __ furosemide

A

bumetanide
10 mg max per day

Comes IV IM and oral

1mg oral bumetanide = 40 mg oral furosemide
1mg IV bumetanide = 20 mg IV furosemide

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23
Q

Potassium sparing diuretics

A

Amiloride ( midamor )
Triamterene ( Dyrenium )

Spironolactone ( aldactone ) —-[ aldosterone antagonist ]
Eplerenone ( Inspra ) ————- [ aldosterone antagonist ]

24
Q

Potassium sparing diuretics are usually not used alone

A

T

Used with thiazides( ↓K) , loop diuretics ( ↓K ) or digoxin to reduce chance of hypokalemia

25
Loop diuretic DDI with lithium ?
Yes increase lithium toxicity bc decrease sodium Loop also has a DDI with digoxin —> digoxin toxicity is exacerbated by hypokalemia
26
Sprinolactone chemically resembles some sex steroids
T it’s anti androgenic Can cause gynecomastia in men Menstrual irregularity in women
27
Spironolactone does not affect glucose or uric acid
T HCTZ does ( increases both ) Loops do ( Increases both glucose and uric acid ) Therefore can be used as alternative diuretic in gout and patients with DM
28
Eplerenone
Inspra Dont used in CrCl < 30 Dont use if k > 5.5 It is a Cyp3a4 substrate GPAC inhibitors - if strong inhibitor start at 25mg QD normally 50 mg qd max 50. Bid SRCOP inducers
29
MAPLES
IV bb Metoprolol Atenolol ( injection form d/c in US ) Propranolol Labetolol Esmolol Sotalol ( only indicated for arrhythmia )
30
Acebutol
BB Spectral Can cause drug induced lupus +ANA test
31
Atenolol and orange apple green tea
Decreases levels by 40%. Separate by 4 hours
32
Nadolol
Corgard Decrease dose in renal function Separate by OATP inhibitors
33
Nadolol
Corgard
34
Medication for infantile hemagiomas ( benign tumors of vascular endothelium ( most common tumors of childhood ) )
Hemangeol oral solution : propranolol
35
Beta blocker with alpha 1 and beta 1 activity
Carvedilol Coreg Labetalol ( trandate)
36
What kind of BB is better tolerated for COPD patients ?
Beta 1 selective MANBABES Metoprolol Atenolol Nebivolol Bisoprolol Acebutol Betaxolol Esmolol
37
When do you use BB?
CHF: BB ace/arb, arni, aldosterone antagonist Post myocardial infarction: BB, ACE/ARB, aldosterone antagonist Angina pectoris : BB, CCB atrial fibrillation rate control : BB, NDH CCB Portal HTN : BB decrease pressure and decrease risk of bleeding from esophageal varicose : non selective BB
38
Cardinal met the bishop
Carvedilol Metoprolol XL Bisoprolol BB Drugs used in CHF
39
Cardinal met the bishop
Carvedilol Metoprolol XL Bisoprolol BB Drugs used in CHF
40
BB side effects
BLOCKER Bradycardia/ brochospasm Lipid increase/ libido decrease Orthostatic Hypotension —> dizziness Conduction abnormalities—> AV block K- K( C)onstriction of peripheral vasculature ( raynaud’s) K- k increase hyperkalemia Exhaustion / emotional depression Reduced recognition of hypoglycemia
41
Difference between DHP and NON DHP regarding specific area of activity
DHP more specifically work on smooth muscle cells around vessels —> vasodilation Non DHP ( VERAPamil diltiazem ) more specific for cardiac muscle cells ( more negative ionotrope and negative chronotropic effects )
42
Verapamil vs diltiazem Both of these have caution what what disease states?
Both CCB non DHP Verapamil: most effects on the heart , less on vessels Diltiazem : affects both heart and vessels ( arteries ) CHF Heart blocks Additive bradycardia / AV blocks with BB Severe hepatic dysfunction Pregnancy C
43
Verapamil and dilt are both Cyp 3a4 inhibitors
GPAC C is for CCB ( NON DHP ) and clarithromycin erythromycin ( marolides except azithro)
44
DOC for arterial spasm Raynauds Prinzmetal’s angina
Raynauds: nifedipine, amlodipine, Isradipine, felodipine Prinzemetal’s angina : nifedipine, diltiatzem, verapamil
45
Qbrelis is an oral solution of what medicaiton?
Lisinopril
46
Only ace I that is IV
Enalapril Enalaprilat , vasotec IV
47
ACE SE’s on electrolytes
Hyperkalemia Hyponatremia No effects on gluocose, lipids, uric acid , asthma COPD
48
What is SCr max with ace I
SCR > 3 mg/dl —— if diabetic ——> then SCr > 2.5 mg /dl CrCl < 30 Are both max. Increases risk of hyperkalemia
49
ACE I and pregnancy
RAAS antagonists are preg D
50
ACE I and lithium DDI
Hyponatremia so can increase lithium —-> lithium toxicity
51
ACE I and allopurinol
maybe chance potential for allergic or hypersensitivity reactions to allopurinol Risk D Azathiopurine / 6MP toxicity too ( risk C ) : ACEI may enhance the myelosuppresive effect of Azathiopurine
52
This alpha 1 blocker may cause a sulfa allergy?
Tamsulosin
53
Alpha 2 SE Brand
Clonidine ( catapres ; kapvay er forADHD ) & guanfacine ( tenex, intuniv ) SE: dry mouth, constipation, fatigue, sexual dysfunction, orthostatis , decrease mental concentration , rebound HTN , Bradycardia, depression
54
Methyldopa
Possible alpha 2 agonists Used in pregnancy and preeclampsia PO tabs and IV Mild antihypertensive with a slow onset of action ( 3-6 hours ). Many women will not achieve BP goals or are bothered by its sedative effect at high doses. SE can cause drug induced LUPUS ( just like Acebutol( sectral) BB ) & hydralazine ( apresoline ) BMS, hemolytic anemia, hepatitis
55
Hydralazine
MOA: vasodilator ( increases cGMP causes vasodilation ) —-reflex tachy —angina watch out ./ and orthostatic hypotension Apresoline Can be used in pregnancy LUPUS like syndrome

SHPCPJEN5 (8 decks)

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