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Pharmacology Exam 2 > Hypertension > Flashcards

Hypertension Flashcards

(106 cards)

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1
Q

Where are beta 1 receptors located?

A

In the heart (responsible for pulse)

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2
Q

Where are beta 2 receptors located?

A

In the bronchioles and blood vessels (responsible for vasodilation)

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3
Q

What is the minimum MAP needed to perfuse the brain?

A

> 65

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4
Q

Equation CO

A

CO = SV x HR

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5
Q

What is stroke volume (SV)?

A

amount ejected with each ventricular beat

influences pulse pressure

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6
Q

What is ejection fraction (EF)?

A

Fraction of end diastolic volume (EDV) ejected with a ventricular beat
(related to contractility)

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7
Q

What are changes in the HR by an increase or decrease in firing of SA node?

A

chronotrophy

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8
Q

What are changes in conduction velocity at the AV node and influences the PR interval on EKG?

A

dromotrophy (how fast)

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9
Q

What happens if there is a sudden decrease in preload?

A

baroreceptor reflex activation resulting in reflex tachycardia and angina

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10
Q

What is known as the force of the contraction?

A

inotropy

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11
Q

What mineral concentration effects inotropy?

A

calcium

increased calcium increases force of contraction

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12
Q

What is responsible for minute to minute BP regulation?

A

baroreceptors

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13
Q

The goal of HTN management is to protect which four organs?

A

eyes
brain
heart
kidneys

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14
Q

Which Rx meds can worsen control of BP?

A

stimulants for ADHD
tricyclic antidepressants (TCA)
venlafaxine (Effexor)
Desvenlafaxine (Pristiq)

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15
Q

Hypertensive urgency vs emergency

A

both have bp >180/110
Urgency DOES NOT target organ damage and hospital admission can be considered
Emergency DOES target organ damage and admitted for management

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16
Q

*Chlorthalidone, chlorothiazide, hydrochlorothiazide, indapamide and metolazone - Class?

A

Thiazide Diuretic

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17
Q

*Thiazide Diuretic - MOA

A

inhibits reabsorption of Na and water by blocking Na/Cl co-transporter on the luminal side of the tubule = decreased plasma volume –> decreased preload

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18
Q

*Can Thiazide Diuretics be used as mono therapy?

A

yes, in early HTN

1st line

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19
Q

Thiazide diuretics - side effects

A

hypokalemia
hyperuricemia –> gout
hyponatremia
metabolic acidosis

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20
Q

*Amiloride (Midamore) and Triamterene (Dyrenium) - class?

A

potassium sparing diuretics

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21
Q

*Potassium sparing diuretics - MOA

A

decrease in membrane permeability to Na by inhibiting epithelial sodium transport at the late distal tubule = bloks the Na and keeps the K

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22
Q

Are potassium sparing diuretics used as mono therapy?

A

usually not

used with thiazide diuretic to off set hypokalemia potential

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23
Q

*Eplerenone (Inspra) and spironolactone (aldactone) - class?

A

Aldosterone antagonists

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24
Q

*Aldosterone antagonists - MOA

A

competitively binds to mineralcorticoid receptor in the distal tubule to prevent the intracellular gene transcription necessary to up regulate the critical components for Na and water reabsorption.

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25
Teaching - why avoid salt subs for many anti-hypertensives?
high in K
26
Good drug choice if Chem 7 shows high Na and low K...
Spironolactone
27
Aldosterone antagonists - side effects
hyperkalemia gynecomastia (spironolactone - 10%) metabolic acidosis
28
Eplerenone (Inspra) - DDI
CYP450 substrate - caution with inhibitors (if a DDI increases eplerenone, hyper k can worsen)
29
Aldosterone Antagonists - contraindications
K >5.5 CrCl <50 for HTN concurrent CYP450 inhibitors
30
*ACE inhibitors - MOA
inhibits ACE -->reduces formation of ATII | after load and preload are reduced and acts mainly as a functional vasodilator
31
*Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril)…-Class?
ACE inhibitors
32
*ACEI or ARB in pregnancy?
No - D
33
Why are Thiazide diuretics not effective with low CrCl?
the drug has to get to the renal tubule to work and if CrCl<30 it will not
34
*ACEI and ARB - DDI
NSAIDS with decrease effectiveness of ACEI because prostaglandin blocking will constrict tubules and Jg cells will compensate by increase renin, increase aldosterone and decrease effectiveness.
35
*ACE inhibitors vs ARB - side effects
hypotension, angioedema (emergency b/c airway could close), hyperkalemia only ACE has dry, non-productive cough (b/c accumulation of bradykinin is irritating)
36
*Angiotensin Receptor Blockers (ARB) - MOA
inhibits the ability of ATII to bind to the AT subtype 1 receptor --> vasoconstriction, vascular remodeling (important in HF) Very specific (AT1 subtype) Same MOA as ACE inhibitors except does not inhibit bradykinin
37
*Candesartan, Eprosartan, Irbesartan…-class?
ARB | "-artan"
38
Why do new cardiac drugs have a T:P>50?
QD dosing
39
Can ACEI and ARB be used as mono therapy?
Yes because do not cause "pseudo" tolerance as with other vasodilators
40
*Tekturna (Aliskiren) - class?
The only renin inhibitor | no clinically relevant benefits over other classes so not 1st line
41
*Renin inhibitor in Pregnancy?
No - D
42
*Acebutolol, Atenolol, Bisoprolol, Esmolol, Metoprolol, Nebivolol - class?
beta blocker - B1 selective | "A-M"
43
*Nadolol, Pindolol, Propranolol - class?
beta blocker non selective B1 and B2
44
*Beta blockers - MOA (brain)
decrease sympathetic NS outflow - protects sudden cardiac death
45
*Beta blockers - MOA (heart)
effect phase 4 depolarization decrease O2 demand so improves ischemia decreases force of contraction
46
*Beta blockers - MOA (vessels)
inhibits B2 receptors - vasoconstriction inhibits alpha1 and alpha2 - vasodilation *better at HR control than BP
47
*Beta blockers - MOA (kidneys)
inhibits B1 receptors --> reduces renin --> reduces Na
48
*Beta blockers - side effects
``` bradycardia AV heart block (prolonged PR interval) bronchospasm in hyperactive airway disease fatigue depression decreased sexual function Mask hypoglycemia b/c won't get tachy ```
49
*Beta blockers in pregnancy?
YES :)
50
*Diltiazem and Verapamil - class?
Non-DHP CCB | act on heart and periphery
51
*Amlodipine, Nicardipine, Nifedipine, Nimodipine…-class?
Dihydropyridine (DHP) CCB | act on periphery
52
*CCB - MOA
inhibits Ca entry by blocking channels in the SA and AV nodes -->decreased HR -->decreased force of contraction decreases O2 demand
53
*CCB for HF?
No! does not protect against sudden death because no remodeling *Contraindicated
54
*CCB - 2 drugs with DDI because sub/inhib CYP3A4
Diltiazem and Verapamil
55
*CCB - side effects
``` bradycardia reflex tachy AV heart block constipation *lower extremity edema* ```
56
CCB in WPW?
caution! can worsen condition because has accessory pathways around AV node and can cause increased pulse because bypasses
57
*Which 2 Mixed Beta Blockers require tedious titration?
Esmolol and Carvedilol
58
*Clonidine and Methyldopa - class?
Alpha 2 receptor agonist
59
*Preferred HTN treatment in pregnancy
Methyldopa
60
*Alpha 2 receptor agonist - MOA?
work in CNS to decrease sympathetic outflow onto the heart, blood vessels and kidneys Reduce preload and after load
61
*Alpha 2 receptor agonist - side effects
sedation erectile dysfunction *rebound HTN and tachy if abruptly stopped
62
What is the most commonly prescribed Thiazide diuretic?
hydrochlorathiazide (HCTZ)
63
HCTZ - Pregnancy?
Yes - B
64
Why might Chlorthalidone be more effective than HCTZ?
longer T1/2 more potent greater lowering of BP maybe less cardiac events
65
Digoxin - what needs to be monitored?
Levels b/c narrow TI
66
What 2 classes are known substrates of CYP2D6?
Beta Blockers (anti-hypertensive) and antiarrhythmics
67
Which 2 populations are at greatest risk for being a poor metabolizer of CYP2D6?
Blacks and Asians
68
How does amiodarone increase risk for hyperthyroidism?
contains a large amount of iodine. Get baseline TSH and repeated levels q 6-12 mos.
69
Licorice contains glycyrizzhic acid and can cause...
``` hypertension hypokalemia hypervolemia Na retention edema ```
70
Garlic for HTN - dosing
Kwai (garlic powder) 600-900 mg/day
71
Beta blockers - inhibit sympathetic or parasympathetic NS?
sympathetic
72
BP goal for non-DM or chronic kidney disease (CKD)
<140/90
73
BP goal if DM or CKD
<130/80
74
Garlic for HTN - MOA
inhibits ACE increases NO (some pts reduce BP by >20%)
75
Why can diabetics still sweat on beta blockers?
postganglionic sympathetic nerve fibers secrete Ach (most sympathetic responses are related to norepinephrine)
76
Which beta blocker do patients tend to feel worse before better?
Carvedilol (Coreg) 10-14 days
77
Garlic - effect on blood vessels
dilates (lowers BP)
78
Which aldosterone antagonist has more DDI (CYP450)?
Eplerenone
78
Treatment secondary hypertension r/t hyperaldosteronism and what labs would you see?
Aldosterone antagonist | Lab: high na, low k
78
Why do thiazides diuretics potentially cause more hyponatremia?
Work on the last place for reabsorption - distal tubule
78
What does aldosterone do?
Changes the cell membrane so more Na can be reabsorbed.
78
What does angiotensin do?
Vasoconstricts and remodels
78
What enzyme facilitates conversion of angiotensin I to II?
ACE
78
Why are thiazide diuretics useful in osteoporosis?
Improves Ca reabsorption
79
Which diet is recommended for hypertension?
DASH
80
ACEI or ARB as mono therapy?
Yes, very good
81
Why are ACEI or ARB less effective as mono therapy in AAs?
Make less renin (combo therapy is not an issue)
82
How do ACEI and ARB confer "renal protective effects" in diabetics?
Decrease glomerular filtration pressures --> Block angio 2 vasoconstriction and decreases pressure.
83
Why does ARB not have cough as ADE if MOA is same as ACEi?
Same but does not inhibit bradykinin --> buildup causes cough in ACEI.
84
Are renin inhibitor used as first line?
No advantage over ACEI and ARB. Only one drug (aliskiren) | Same ADE, preg,etc.
85
Why is it beneficial to reduce remodeling of the myocardium?
Leads to angina | Disorganized myocardial fibers make contraction less effective
86
Which classes of anti hypertensives reduce remodeling?
ACEI ARB BB Not DHP CCB (dilt and verapamil)
87
Preferred class for HF?
Beta blockers
88
Are BB effective as BP lowering?
No, better at rate control b/c don't have the beta 2 vasodilation effect.
89
What happens when renin is released?
Release aldosterone --> Na/water reabsorption and increase plasma volume.
90
What are the only 3 BB FDA approved for HF?
Bisoprolol Metoprolol succinctness Carvedilol
91
Which non selective BB is hydrophilic (renal), long T 1/2 (qd dosing)?
Nadolol Be careful in renal pts
92
Which non selective BB is lipophilic (liver), has more DDI, short t1/2?
Propranolol Careful in cirrhosis and decreased hepatic function.
93
Can you crush metoprolol succinctness (toprol XL)?
No, but can break on scored line.
94
CCB - phase if action
Dromotropy
95
BB phase of action
Inotrophy
96
Which DHP CCB can be used as a tocolytic?
Nifedipine.
97
Clonus one, guanfacine, methyldopa - class?
Alpha 2 receptor agonist
98
Non stimulant options for ADHD (alpha 2 Receptor agonist)
Clonidine | Guanfacine
99
Which alpha 2 receptor agonist can be used for opiate/benzo/ethos withdrawal?
Clonidine
100
Which alpha 2 agonist can cause hemolytic anemia?
Methyldopa

Pharmacology Exam 2 (9 decks)

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