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Flashcards in Hypertension Deck (104):
1

normal BP

<80

2

pre hypertension

120-139/80-89

3

stage I HTN

140-159/90-99

4

stage II HTN

>160/>100

5

which drugs can cause secondary HTN

corticosteroids, anorexiants/decongestants, thyroid hormone excess, OCPs, NSAIDs/COX-2, occasionally TCA's and venlafaxine, excessive licorice

6

goal BP- no diabetes, no kidney diseases

<140/90

7

goal BP- diabetes or kidney disease

<130/80

8

first choice patient with stage I HTN without compelling indications

Thiazide

9

first choice for patient with stage II HTN without compelling indications

2 drug combo: ACEI, ARB, BB, or CCB

10

first choice HTN tx pt has heart failure

ACEI plus BB

11

first choice HTN tx pt has CAD

ACEI plus BB

12

first choice HTN tx pt has diabetes

ACEI or ARB

13

first choice HTN tx pt has CKD

ACEI or ARB

14

first choice HTN tx pt has recurrent stroke

ACEI plus thiazide

15

first choice HTN tx pt has isolated systolic HTN

thiazide

16

what does excessive body sodium do in the body

increases vascular resistance (increases vessel rigidity, fluid retention, and epi and norepi release

17

this diuretic has a potent diuretic effect but low hypertensive effect

furosemide

18

this class inhibits luminal NaCl transport in the distal tubule of the kidney

thiazide

19

short term effects: sodium and water excretion (decreases plasma volume)

HCTZ

20

long term effects: decrease peripheral vascular resistance

HCTZ

21

this class loses efficacy as renal function declines, not generally used if creat clearance is <30 mL/min

thiazide diuretics

22

can use this class for HTN, CHF, nephrogenic diabetes insipidus, and to prevent kidney stones due to hypercalciuria

thiazide diuretics

23

Adverse effects: HYPOkalemia, hyperuricemia, hypomagnesemia, impaired carb tolerance, and HYPERglycemia

thiazide

24

this class changes urine ionic content: increases the loss of Na, K, and water

thiazide

25

adverse effects: hyperlipidemia, hyponatremia (our goal), allergies, weakness, fatigue, parasthesias, impotence, photosensitivity

thiazide

26

this drug is usually combined with loop diuretics for patients with HF who are refractory to loop diuretics alone (given 30 min before lasix)

metolazone

27

this drug requires close monitoring, can cause volume depletion and hypokalemia

metolazone

28

this class acts on the ascending LOH at the chloride pump (can potentially cause a 25-30% reduction in Na content of urine)

loops

29

this class is the most potent diuretic. can be used on pts with renal insufficiency that have failed thiazide

loops

30

this class can increase renal blood flow. Can relieve pulmonary congestion, decrease LV filling pressures before diuresis occurs

loops

31

class causes changes in urine ionic content: increases loss of Na, K ,water, and calcium

loops

32

this class is used for edema (heart failure), hypercalcemia, hyperkalemia, and acute renal failure

loops

33

adverse effects include: hyperuricemia, hyperglycemia, hypovolemia, hypotension, potassium and magnesium depletion, allergic reactions, and ototoxicity

loops

34

this drug is a synthetic steroid antagonist of aldosterone. It inhibits Na resorption and K secretion in collecting tubules

spironolactone

35

this drug is effective as an antiHTN, but limited use due to hyperkalemia

spironolactone

36

Can be used to treat primary and secondary aldosteronism. Also, it can blunt the potassium wasting tendencies of other diuretics

spironolactone

37

Adverse effects include gynocomastia, menstrual irregularities, hyperkalemia, and hyperchloremic metabolic acidosis

spironolactone

38

this drug directly inhibits sodium flux through the ion channels of the collecting tubule

triamterene

39

therapeutic uses: blunt K wasting tendencies of other diuretics, HTN. It is a weak diuretic alone, and is usually combined with thiazides

triamterene

40

adverse effects include hyperkalemia, hyperchloremic metabolic acidosis, and kidney stones

triamterene

41

all diuretics interact with this class of drug

NSAIDs

42

cholestyramine and sucralfate decrease the absorption of this diuretic

furosemide (loop)

43

Drug interactions include ACE I, digoxin, and diabetic medications

loop and thiazide diuretics

44

potassium sparing diuretics interact with this drug class

ACEI

45

this class blocks the conversion of angiotensin I to angiotensin II, resulting in vasodilation of vascular smooth muscle

ACEI

46

this class reduces PVR without a reflexive increase in CO, HR, or contractility

ACEI

47

this class stimulates the synthesis of vasodilatory prostaglandins. It decreases aldosterone, H20, and Na retention. Inhibits breakdown of bradykinin

ACEI

48

DO NOT USE in pregnancy or renovascular HTN

ACEI

49

Adverse effects: dry cough, altered taste, rashes, fever, hyperkalemia, elevations in SCr and BUN, hypotension and first dose syncope, and angioedema

ACEI

50

this class blocks the angiotensin II receptors competitively inhibiting angiotensin II binding to AT1 receptors. Blocks pressor and aldosterone-releasing effects causing vasodilation and decreased PVR

Angiotensin II antagonists

51

this class inhibits angiotensin II generated from all pathways, but DO NOT stimulate the synthesis of vasodilatory compounds

ARBs

52

This class is indicated for HTN and CHF. It is renal protective in patients with DM and may be considered first line

ARBs

53

DO not use in pregnancy or renal artery stenosis

ARBs

54

ADRs: rash, altered taste, hyperkalemia, elevated SCr BUN

ARB

55

this ARB reduces uric acid

losartan

56

this class causes reduction in HR, contractility, BP, and suppresses sympathetic nervous system activity

Beta blockers

57

therapeutic uses include ischemic heart disease, heart failure, dysrhythmias, and HTN

BB

58

this class of BB shows partial agonist activity- less reduction in resting HR, CO, and BP

intrinsic sympathomimetic activity (ISA)

59

contraindications include severe asthma, severe bradycardia, heart block, and overt HF

BB

60

Adverse effects include fatigue, lethargy, insomnia, depression, bronchoconstriction, cold extremities, sexual dysfunction, decrease HDL increase LDL, bradycardia. Abrupt withdrawal may precipitate MI

BB

61

block the inward movement of Ca by binding to L-type calcium, resulting in smooth muscle relaxation and arteriolar dilation

CCB

62

Therapeutic effects include coronary and peripheral vasodilation, negative inotropic and chronotropic effects. Alleviate coronary vasospasm

CCB

63

Used in HTN, ischemic heart disease, and dysrhythmias

CCB (dysrhythmias are non-dihydropyridinies only)

64

this drug is indicated for angina, HTN, supraventricular tachyarrhythmias, and migraines. Effects both cardiac and vascular smooth muscle

verapamil

65

this CCB effects cardiac and vascular smooth muscle but has less negative inotropic effects than verapamil, so fewer SEs

diltiazem

66

these CCBs have a great affinity for vascular cells IN THE PERIPHERY and does not effect cardiac contractility

dihydropyridines

67

these CCBs are beneficial for decreasing PVR but may induce reflex tachycardia

dihydropyridines

68

second generation dyhydropyridines- very effective and widely used

amlodipine and felodipine

69

this class of CCB can cause hypotension, dizziness and peripheral edema

dihydropyridines

70

this class of CCB can cause hypotension, dizziness, constipation, bradycardia, and exacerbation of HF

non-dihydropyridines

71

these drugs have no effect on blood sugar or lipids

CCB

72

this class is contraindicated in hypotension and immediate release in CV indications in adult pts due to cardiac ischemia

dihydropyridines

73

this class is contraindicated in severe bradycardia, hypotension, heart block, or overt HF. Careful in patients taking beta blockers (can cause AV block or heart failure)

non-dihydropyridines

74

this drug increases plasma digoxin levels

verapamil

75

this class lowers MAP by causing relaxation of both arterial and venous smooth muscle. Causes minimal changes in CO, renal blood flow, and GFR

alpha 1 receptor antagonists

76

this class is primarily used for BPH. Not used much for HTN (inferior to diuretics, postural hypotension, and first dose syncope)

alpha 1 receptor antagonists

77

caution in pts with poorly controlled angina w/o beta blocker and incontinence

alpha 1 receptor antagonists

78

ADRs: first dose syncope, dizziness, HA, postural hypotension, weakness, nausea, palpitations

alpha 1 receptor antagonists

79

alpha 2 agonist- causes inhibition of NE causing vasodilation. reduce activity of vasomotor center in the brian (reduced symp activity, vasodilation)

clonidine

80

this drug does not decrease renal BF or GFR- agent of choice for pts with chronic renal disease

clonidine

81

Indicated in HTN, drug withdrawl, and side effects associated with neuroleptics

clonidine

82

ADRs: dry mouth, sedation, depression, hypotension, sexual dysfunction, urinary retention, constipation, and dizziness. ABRUPT withdrawal can cause severe HTN

clonidine

83

analogue of levodopa- gets converted to methylnorepinepherine centrally decreases adrenergic outflow from the CNS. (acts as an alpha 2 agonist to decrease symp outflow)

methyldopa

84

agent of choice in HTN pts with chronic renal disease and pregnancy

methyldopa

85

this class directly acts on vascular smooth muscle, primary arterioles to decrease tone. Involves a decrease in calcium entry and mobilization of intracellular calcium stores

hydralazine

86

this is used for moderate to severe HTN- needs to be given with diuretic acid and a sympatholytic drug

hydralazine

87

ADRs include HA, nausea, anorexia, palpitations. Higher doses produce high incidence of symptoms that resemble lupus erythematosus

hydralazine

88

this class can be used as monotherapy or combo with diuretics or ARBs

aliskiren

89

this class inhibits generation of angiotensin I- preventing the formation of angiotensin II and reducing activation of all AT receptors

aliskiren

90

this drug does not inhibit bradykinin breakdown like ACEI

aliskiren

91

contraindicated in pregnancy- risk of fetal death or injury. DC ASAP (cat C in first trimester, D in second and third)

aliskiren

92

ADRs include angioedema, diarrhea, HA, cough, and an increase in SrCr

aliskiren

93

competitive inhibitor of CYP3A4. Interacts with atorvastatin and ketoconazole. Decreased efficacy of furosemide

aliskiren

94

DOC for HTN in pregnancy

methyldopa or labetalol (hydralazine if IV)

95

isolated systolic HTN

SBP > 140, DBP <90

96

goal treatment of iso systolic HTN

SBP< 140

97

DOC iso systolic HTN

thiazide diuretic

98

severely elevated BP without end organ damage

hypertensive urgency

99

severely elevated BP associated with acute and ongoing organ damage in the brain, kidneys, heart, eyes, or vascular system. (end organ damage; DBP usually >/= 130)

hypertensive emergency

100

Treat hypertensive urgency

(hours to days) clonidine, captopril, labetolol

101

treat hypertensive emergency

(minutes to hours) IV nitroprusside

102

this is a prodrug that decompensates to NO, causing vasodilation. Dilates both arteries AND veins (reduced TPR and venous return)

nitroprusside

103

this drug has an immediate onset of action (1-2 minutes). Can cause HA, dizziness, nausea, and palpitations

nitroprusside

104

metab of this drug results in cyanide production. Can administer thiosulfate to counteract

nitroprusside