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Pharmacology Exam 2 > Hypertension > Flashcards

Flashcards in Hypertension Deck (106):
1

Where are beta 1 receptors located?

In the heart (responsible for pulse)

2

Where are beta 2 receptors located?

In the bronchioles and blood vessels (responsible for vasodilation)

3

What is the minimum MAP needed to perfuse the brain?

>65

4

Equation CO

CO = SV x HR

5

What is stroke volume (SV)?

amount ejected with each ventricular beat
(influences pulse pressure)

6

What is ejection fraction (EF)?

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

7

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

chronotrophy

8

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

dromotrophy (how fast)

9

What happens if there is a sudden decrease in preload?

baroreceptor reflex activation resulting in reflex tachycardia and angina

10

What is known as the force of the contraction?

inotropy

11

What mineral concentration effects inotropy?

calcium
(increased calcium increases force of contraction)

12

What is responsible for minute to minute BP regulation?

baroreceptors

13

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

eyes
brain
heart
kidneys

14

Which Rx meds can worsen control of BP?

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

15

Hypertensive urgency vs emergency

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

16

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

Thiazide Diuretic

17

*Thiazide Diuretic - MOA

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

18

*Can Thiazide Diuretics be used as mono therapy?

yes, in early HTN
1st line

19

Thiazide diuretics - side effects

hypokalemia
hyperuricemia --> gout
hyponatremia
metabolic acidosis

20

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

potassium sparing diuretics

21

*Potassium sparing diuretics - MOA

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

22

Are potassium sparing diuretics used as mono therapy?

usually not
used with thiazide diuretic to off set hypokalemia potential

23

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

Aldosterone antagonists

24

*Aldosterone antagonists - MOA

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.

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