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Flashcards in Hypertension Deck (178):
0

What's the most common SE caused by BB?

Fatigue (and sometimes sexual problems)

1

What's the most common SE caused by diuretics?

Increase urination

2

What's the most common SE caused by ACE-I?

Cough

3

What's the most common SE caused by CCB, esp if high doses are used?

Edema

4

What's normal BP according to classification of BP in adults according to JNC 7?

< 120/80 mmHg

5

What's pre-HTN according to classification of BP in adults according to JNC 7?

120-139/80-89

6

What's stage 1 HTN according to classification of BP in adults according to JNC 7?

140-159/90-99

7

What's stage 2 HTN according to classification of BP in adults according to JNC 7?

>= 160/100

8

What's the compelling tx for HTN pt with HF?

ACE-I, ARB, BB, Diuretic, Aldosterone antagonist

9

What's the compelling tx for HTN pt with S/P MI?

ACE-I, BB, Aldosterone antagonist

10

What's the compelling tx for HTN pt with High risk of CAD?

ACE-I, BB, Diuretic, CCB

11

What's the compelling tx for HTN pt with DM?

ACE-I, ARB, BB, Diuretic, CCB

12

What's the compelling tx for HTN pt with CKD?

ACE-I, ARB

13

What's the compelling tx for HTN pt with recurrent stroke prevention?

ACE-I, Diuretic

14

Drugs that can cause/ worsen HTN?

ACTH, Alcohol (excessive), Amphetamines, Appetite suppressants

Caffeine, Calcineurin antagonists (Cyclosporine), Corticosteroids

Decongestants (e.g Pseudoephedrine)

Erythropoietin Stimulating Agents, Estrogen

Herbals (bitter orange, ephedra (ma-huang), ginseng, Guarana, SJW)

Mirabegron (Myrbetriq)

NSAIDs

Oncology drugs (Bevacizumab (Avastin), Sorafenib (Nexavar))

SNRIs (Duloxetine and Venlafaxine - at higher doses)

Thyroid hormone (if given too much)

15

According to JNC 8, whats the BP goal in general population (w/o DM or CKD) < 60 yrs? All ages, DM present? All ages, CKD present?

< 140/90mmHg

16

According to JNC 8, whats the BP goal in general population (w/o DM or CKD) >= 60 yrs?

< 150/90mmHg

17

What's the recommended initiation drug for non-black (all ages, DM present)?

Thiazides or ACE-I or ARB or CCB

Alone or in combo

18

What's the recommended initiation drug for blacks (all ages, DM present)?

Thiazides or CCB

Alone or in combo

19

What's the recommended initiation for ALL ages, all races, with CKD present?

ACE-I or ARB

Alone or in combo with other drug class

20

What's defined as high risk in HTN pts?

DM

CKD

Known CAD or CAD equivalent (carotid artery dx, PAD, abdominal aortic aneurysm)

10yr Framingham risk score > 10%

21

What's the BP goal for general CAD prevention based on AHA guidelines? Drug of choice?

< 140/90

Any drug or combo

22

What's the BP goal for high CAD risk based on AHA guidelines? Drug of choice?

< 130/80

ACE-I or ARB or CCB or Thiazide diuretic or combo

23

What's the BP goal for stable angina based on AHA guidelines? Drug of choice?

< 130/80

BB and ACE-I or ARB

24

What's the BP goal for unstable angina/NSTEMI based on AHA guidelines? Drug of choice?

< 130/80

BB (if pt is hemodynamically stable) and ACE-I or ARB

25

What's the BP goal for STEMI based on AHA guidelines? Drug of choice?

< 130/80

BB (if pt is hemodynamically stable) and ACE-I or ARB

26

What's the BP goal for LVD based on AHA guidelines? Drug of choice?

< 120/80

ACE-I or ARB and BB and Aldosterone Antagonist and Thiazide or loop diuretic and hydralazine/Isosorbide dinitrate (black pts)

27

Should lifestyle modifications be encouraged if needed?

Yes!

28

Lifestyle modifications wrt WEIGHT that should be encouraged in HTN?

Maintain normal BMI and waist circumference

29

Lifestyle modifications wrt EATING that should be encouraged in HTN?

Recommend DASH (dietary approaches to stop HTN) eating plan

Which is high in fruits and vegetables and recommended low-fat dairy products with reduced saturated and total fat

30

Lifestyle modifications wrt SODIUM INTAKE that should be encouraged in HTN?

Limit Na to =< 2.4 gm/day

Lower may be beneficial

31

Lifestyle modifications wrt PHYSICAL ACTIVITY that should be encouraged in HTN?

Engage in regular aerobic physical activity such as brisk walking (at least 30 min per day, most days of the week)

32

Lifestyle modifications wrt ALCOHOL consumption that should be encouraged in HTN?

Women - 1 drink/day

Men - 2 drinks/day

33

Lifestyle modifications wrt SMOKING that should be encouraged in HTN?

Smoking cessation

34

What should be controlled in HTN pts to reduce cardiovascular dx risk?

Control BG and Lipids

35

When's Furosemide (loop diuretic) mostly used?

Heart failure

36

What may happen if Furosemide (loop) is used long-term? Supplement to use while on furosemide?

They can lower bone density

K supplements

37

Where do thiazides work on nephron?

Distal convoluted tubule of nephron (inhibit Na reabsorption)

38

Where do loops work on nephron?

Ascending loop by blocking Na reabsorption

39

List agents under Thiazdes?

Chlorothiazide (Diuril)

Chlorthalidone (Thalitone)

Hydrochlorothiaze (Microzide - capsule; Oretic - tablet)

Indapamide

Metolazone (Zaroxolyn)

Methylclothiazide

40

What's the brand name of Chlorthalidone (Thiazide diuretic)?

Thalitone

41

What's the brand name of Hydrochlorothiazide capsule and tablet (Thiazide diuretic)?

Capsule - Microzide

Tablet - Oretic

42

What's the point at which not much clinical benefit is seen in both Chlorthalidone (Thalitone) and Hydrochlorothiaze (Microzide - capsule; Oretic - tablet)?

> 25-50mg/ day

Though, max is 100mg/d

43

SEs of Thiazides?

Hypokalemia (can be avoided by regular intake of K rich foods)

Hyponatremia, Hypomagnesemia

Hyperuricemia (increase UA)

Elevated lipids (increase CH and TG)

Hyperglycemia

Hypercalcemia

Dizziness

Photosensitivity

Rash

44

Which Thiazide is effective in pts with reduced renal fxn?

Metolazone

45

List loop diuretics agents (used mainly in HF)

Furosemide (LASIX) PO, IV

Bumetanide PO, IV

Torsemide (Demadex) PO, IV

Ethacrynic acid (Edecrin) PO, IV

46

What's the brand name of Furosemide PO, IV (loop diuretics)?

Lasix

47

What's the oral loop dose equivalency of Furosemide (Lasix)?

40mg

48

What's the oral loop dose equivalency of Bumetanide?

1mg

49

What's the oral loop dose equivalency of Torsemide (Demadex)?

20mg

50

What's the oral loop dose equivalency of Ethacrynic (Edecrin)?

50mg

51

What's the warning associated with loop diuretics?

Sulfa allergy

Doesn't apply to Ethacrynic acid (Edecrin)

52

Which loop diuretics does the sulfa allergy not apply to?

Ethacrynic acid (Edecrin)

53

SEs of loop diuretics?

Orthostatic hypotension

Hypokalemia, reduced Na, Mg, Cl, Ca

Metabolic acidosis

Hyperuricemia

Elevated lipids (increase CH and TG)

Hyperglycemia

Photosensitivity

Ototoxicity, including hearing loss, tinnitus and vertigo

54

What's the difference btw effect of Thiazide and loop on Ca?

Thiazide => hypercalcemia

Loop=> hypocalcemia

55

Which loop causes the most Ototoxicity?

Ethacrynic acid (Edecrin)

56

List potassium-sparing diuretics

Amiloride (Midamor)

Triamterene (Dyrenium)

Spironolactone (Aldactone)

Eplerenone (Inspra)

57

What's the brand name of Triamterene + HCTZ?

Maxzide

Maxzide-25

Dyazide

58

What's the brand name of Eplerenone?

Inspra

59

CI to potassium-sparing diuretics?

Renal impairment (CrCl < 30ml/min)

Hyperkalemia

Eplerenone concomitant use of strong 3A4 inhibitors

60

SEs to potassium-sparing diuretics?

Hyperkalemia

Increased serum creatinine

61

SEs specific to Spironolactone (Aldactone)?

Gynecomastia

Breast tenderness

62

Monitoring of potassium-sparing diuretics?

Check K before starting and frequently thereafter

BP

SCr/BUN

63

In what class of people is angioedema for the use RAAS inhibitors most common?

Black pts

64

T/F? If a person has had angioedema with any 1 of these agents, ACE-I, ARB or Aliskiren, then all others are CI?

T

Bcuz angioedema can get fatal very quickly

Counsel to report any swelling of lips, mouth, tongue, face or neck immediately

65

Are RAAS inh (ACE-I, ARB or Aliskiren) CI in pregnancy?

Yes

D/c drugs as soon as pregnancy is detected

66

List ACE-I agents

Benazepril (Lotensin)

Captopril (Capoten)

Enalapril, Enalaprilat IV injection (Vasotec)

Fosinopril

Lisinopril (Prinivil, Zestrin)

Moexipril (Univasc)

Perindopril (Aceon)

Quinapril (Accupril)

Ramipril (Altace)

Trandolapril (Mavik$

67

What's the brand name of Benazepril (ACE-I)?

Lotensin

68

What's the brand name of Enalapril, Enalaprilat IV injection (ACE-I)?

Vasotec

69

What's the brand name of Lisinopril (ACE-I)?

Prinivil

Zestril

70

What's the brand name of Quinapril (ACE-I)?

Accupril

71

What's the brand name of Ramipril (ACE-I)?

Altace

72

Howz Captopril (Capoten) taken?

1 hr before meals

73

How's Moexipril (Univasc) taken?

On an empty stomach

74

Black box warning of ACE-I/ ARB/ Aliskiren (direct renin inh)?

D/c as soon as pregnancy is detected

75

CI of ACE-I/ ARB?

Angioedema

Bilateral renal artery stenosis

Can't used concurrently with Aliskiren in pts with DM

76

In what grp of pts can't ACE-I/ARB be used concurrently with Aliskiren?

Pts with DM

77

SEs of ACE-I/ ARB/ Aliskiren (direct renin inh)?

Cough

Hyperkalemia

Angioedema (d/c drug if it occurs)

Hypotension

78

Which SEs are specific to Captopril (Capoten) use - ACE-I?

Taste perversion

Rash

79

Monitoring of ACE-I/ ARB/ Aliskiren (direct renin inh)?

BP

K

Renal fxn

80

Pregnancy cat of ACE-I/ ARB/ Aliskiren (direct renin inh)?

D

81

List ARB agents

Valsartan (Diovan)

Losartan (Cozaar)

Irbesartan (Avapro)

Candesartan (Atacand)

Olmersartan (Benicar)

Telmisartan (Micardis)

Eprosartan (Teveten)

Azilsartan (Edarbi)

82

What's the brand name of Valsartan? ARB

Diovan

83

What's the brand name of Losartan? ARB

Cozaar

84

What's the brand name of Olmesartan? ARB

Benicar

85

MOA of direct renin inhibitor?

Directly inhibits renin, which is responsible for conversion of angiotensin to angiotensin I, a potent vasoconstrictor, thereby reducing BP

86

List agent under direct renin inhibitor

Aliskiren (Tektuma)

87

CI to Aliskiren (direct renin inh) use?

Don't use concurrently with ACE-I or ARBS in pts with diabetes

Angioedema

Bilateral renal artery stenosis

88

Effect of all RAAS inh on K?

All increase risk of HYPERkalemia

89

Which BB indicated for HTN only?

Nebivolol

90

BB with intrinsic sympathomimetic activity (ISA)?

CAPP

Carteolol

Acebutolol

Penbutolol

Pindolol

91

Place in therapy for BB with intrinsic sympathomimetic activity (ISA) - CAPP?

Pts with excessive bradycardia who need BB therapy

Don't reduce HR as much as other beta-blockers

92

List Beta-1 selective agents

AMEBBA

Atenolol

Metoprolol

Esmolol

Bisoprolol

Betaxolol

Acebutolol

93

Which BB has more CNS SEs? Why?

Propranolol

Has high lipid solubility (lipophilic) and crosses BBB

94

Which BB should be with food?

Carvedilol, even CR version

95

Is Carvedilol CR same as Carvedilol IR?

CR is less bioavailable than IR

96

What's the 1st line tx for HTN in pregnancy?

Labetalol

Nifedipine

Methyldopa

97

Whys Propranolol used in stage fright?

Can cover up sx of shakiness, palpitations and anxiety (with hyperglycemia)

Occurs mostly in non-selective bb

98

List bb selective agents?

AMEBBA

Acebutolol (Sectral)

Atenolol (Tenormin)

Betaxolol

Bisoprolol (Zebeta)

Metoprolol tartate (Lopressor)

Metoprolol Succinate ext-release (Toprol XL)

99

What's the brand name of Atenolol? (Beta1-selective blockers)?

Tenormin

100

What's the brand name of Metoprolol tartrate? (Beta1-selective blockers)?

Lopressor

101

What's the brand name of Metoprolol succinate ext-release? (Beta1-selective blockers)?

Toprol XL

102

Most common SE of Beta1-selective blockers?

Reduced HR

Hypotension

Fatigue

Dizziness

103

Monitoring of Beta1-selective blockers?

HR

BP

104

How should bb be stopped?

Must taper

105

Which metoprolol is taken with food?

Metoprolol tartrate (Lopressor)

106

Are IV doses of Beta1-selective blockers equivalent to PO doses?

No

107

Which bb is both B-1 selective blocker and Nitric Oxide-Dependent vasodilation?

Nebivolol (Bystolic)

108

What's the brand name of Nebivolol? (B-1 selective blocker and Nitric Oxide-Dependent vasodilation)

Bystolic

109

SEs of Nebivolol (Bystolic)? (B-1 selective blocker and Nitric Oxide-Dependent vasodilation)

Headaches

Fatigue

110

List non-selective bb (B1 & B2)

Carteolol

Nadolol (Corgard)

Penbutolol (Levatol)

Pindolol

Propranolol (Inderal LA, InnoPran XL)

Timolol

111

What's the brand name of Propranolol? (Non-selective bb)

Inderal LA

InnoPran XL

112

List bb that are non-selective alpha- and beta-blocker

Carvedilol (Coreg, Coreg CR)

Labetalol (Trandate)

113

Brand name of Carvedilol (non-selective alpha- and beta-blocker)?

Coreg

Coreg CR

114

Brand name of Labetalol (non-selective alpha- and beta-blocker)?

Trandate

115

How should all forms of Carvedilol be taken?

With food

116

Types of CCBs?

Dihydropyridines

Non-dihydropyridines

117

Where does dihydropyridine work?

Periphery

118

List dihydropyridine CCBs

Amlodipine (Norvasc)

Felodipine (Plendil)

Isradipine ER (daily) and IR (BID)

Nisoldipine ER (Sular)

Nisoldipine ER

Nicardipine ER (Cardene SR)
Nicardipine IR (Cardene) TID
Nicardipine IV (Cardene)

119

Brand name of Amlodipine (dihydropyridine CCBs)?

Norvasc

120

Brand name of Nifedipine ER (dihydropyridine CCBs)?

Adalat CC

Procardia XL

Afeditab CR

121

Brand name of Nicardipine IV (dihydropyridine CCBs)?

Cardene

122

SEs of Dihydropyridine CCBs?

Peripheral edema

Headache

Flushing

Tachycardia/reflex

Gingival hyperplasia

123

Monitoring of Dihydropyridine CCBs?

Peripheral edema

124

Which Dihydropyridine CCBs is used in inpatient acute care?

Clevidipine (Cleviprex)

125

Non-Dihydropyridine CCBs?

Inhibit Ca2+ ions from entering the "slow" channels or voltage-sensitive areas of vascular smooth muscle and myocardium = VD

126

List Non-Dihydropyridine CCBs agents

Diltiazem

Verapamil

127

SEs of Non-Dihydropyridine CCBs?

Edema

Headache

AV block

Bradycardia

Hypotension

Arrhythmias

HF

Constipation (more verapamil)

Gingival hyperplasia

128

Uses of Clonidine?

Most commonly used for resistant HTN and in pts who can't swallow

129

List agents under Centrally-Acting Alpha2 Agonist

Clonidine (Catapres; Catapres-TTS patch$

Guanabenz

Guanfacine (Tenex)

Methyldopa

130

Brand name of Clonidine (Centrally-Acting Alpha2 Agonist)?

Catapres

Catapres-TTS patch

131

SEs of Centrally-Acting Alpha2 Agonist?

Bradycardia

Dry mouth

Drowsiness

Sedation

Lethargy

Hypotension

Depression

Psychotic rxns

Nasal stuffiness

Sexual dysfxn

132

How often is Clonidine patch (Catapress-TTS) applied?

Weekly

133

List direct vasodilators agents

Hydralazine

Minoxidil

134

SEs of direct vasodilators (Hydralazine and Minoxidil)?

Headache

Reflex tachycardia

Palpitations

Anorexia

Rare - lupus-like syndrome

135

List alpha blockers agents

Prazosin (Minipress)

Terazosin (Hytrin)

Doxazosin (Cardura, Cardura XL)

136

What's the brand name of Terazosin (Alpha blockers)?

Hytrin

137

What's the brand name of Doxazosin (Alpha blockers)?

Cardura

Cardura XL

138

What's the brand name of Amlodipine + Benazepril? Classes?

Lotrel

ACE-I and CCB

139

What's the brand name of Lisinopril + HCTZ? Classes?

Prinzide

Zestoretic


ACE-I and Diuretic

140

What's the brand name of Losartan + HCTZ? Classes?

Hyzaar

ARB and diuretic

141

What's the brand name of Valsartan + HCTZ? Classes?

Diovan HCT

ARB and diuretic

142

What's the brand name of Olmesartan + HCTZ? Classes?

Benicar

ARB and diuretic

143

What's the brand name of Bisoprolol + HCTZ? Classes?

Ziac

BB and diuretic

144

What's the brand name of Triamterene + HCTZ? Classes?

Dyazide, Maxzide

Diuretic and diuretic

145

What's HTN urgency?

BP (gen >= 180/110-120) w/o acute target organ damage

146

Tx of HTN urgency?

Oral med with onset of action of 15-30 mins

Reduce BP gradually over 24-48 hr

147

What's HTN emergency?

BP (gen >= 180/110-120) + acute target organ damage (such as encephalopathy, MI, unstable angina, pulmonary edema, eclampsia, stroke, aortic dissection)

148

Tx of HTN emergency?

Reduce MAP by no more than 25% (within mins to 1 hr)

If stable, to 160/100-110 mmHg within the next 2-6 hrs

Use IV meds

149

List drugs used in HTN urgencies

Captopril (Capoten)

Clonidine (Catapres)

Labetalol (Trandate)

150

What's the dose of Captopril (Capoten) and SEs used in HTN urgencies?

Captopril (Capoten) 25mg, repeat in 1-2 hrs PRN

Hypotension, high K, angioedema

151

What's the dose of Clonidine (Catapres) and SEs used in HTN urgencies?

Clonidine (Catapres) 0.1-0.2mg, repeat in 1-2 hrs PRN

Hypotension, drowsiness, sedation, dry mouth etc

152

What's the dose of Labetalol (Trandate) and SEs used in HTN urgencies?

Labetalol (Trandate) 100-400mg, repeat in 2-3 hrs PRN

Hypotension, heart block, bronchoconstriction

153

Drugs used in HTN emergencies?

Clevidipine (Cleviprex) - DHP-CCB

Sodium Nitroprusside (Nitropress) - Arteriole & Venous VD

Nicardipine (Cardene) - DHP-CCB

Fenolodopam (Corlopam) - Dopamine-1 receptor agonist

NTG - venous vasodilator

Enalaprilat (Vasotec IV) - ACE-I

Hydralazine - Arteriole vasodilator

Labetalol (Trandate) - Alpha&beta blocker

Esmolol (Brevibloc) - bb

154

Look at pt counseling on pg 573 and 574

Look!

155

What's in the drug Exforge?

Amlodipine + Valsartan

156

What BP med is C/I with Sodium Polystyrene Sulfonate (Kayexalate)? Why?

ACE-I, ARBs and DRI

These meds increase potassium (cause hyperkalemia)... SPS (Kayexalate) is used to treat hyperkalemia

157

MOA of Clonidine?

Alpha-2 AGONIST => reduces norepinephrine release

158

List BP meds not used with grapefruit/ grapefruit juice?

Cardizem LA (Diltazem)

Calan SR (Verapamil)

Dilt-XR (Diltazem hydrochloride extended release)

159

SE of Clonidine?

Can worsen Constipation, Depression, Fatigue

160

Effect of Diltazem and Verapamil on hepatic metabolism of other drugs?

CYP 3A4 inhibitor

161

How should BP be lowered in HTN emergency?

10-15% in next hr

162

What's the new SE of Olmesartan (added in 2013, in addition to ARB SE)?

Sprue-like enteropathy

163

Which SE is unique to Verapamil?

Constipation

164

Is cough a common SE of ARBs?

No!

Cough is ACE-I

165

What makes up Lotrel?

Amlodipine and Benazepril

166

What makes up Exforge?

Amlodipine and Valsartan

167

What makes up Lotensin HCT?

Benazepril and HCTZ

168

What makes up Prinzide (also called Zestoretic)?

Lisinopril and HCTZ

169

What makes up Hyzaar?

Losartan and HCTZ

170

What makes up Micardis HCT?

Telmisartan and HCTZ

171

What makes up Diovan HCT?

Valsartan and HCTZ

172

What makes up Benicar HCT?

Olmesartan and HCTZ

173

What makes up Ziac?

Bisoprolol and HCTZ

174

What makes up Dyazide (also called Maxzide)?

Triamterene and HCTZ

175

What's the conversion of Carvedilol IR to Carvedilol CR?

3.125mg BID (Coreg) = 10mg daily (Coreg CR)

176

Which BP med is considered safe in pregnancy?

HCTZ

177

What BP med is the drug of choice for HTN patient with aortic dissection?

Beta-blocker

Decks in NAPLEX Class (73):