Hypertension Flashcards Preview

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Flashcards in Hypertension Deck (83):
1

Hyzaar

losartan + HCTZ

2

Zestoretic

lisinopril + HCTZ

3

Benicar HCT

olmesartan + HCTZ

4

Diovan HCT

valsartan + HCTZ

5

Edarbyclor

azilsartan + chlorthalidone

6

Lotensin HCT

benazepril + HCTZ

7

Atacand HCT

candesartan + HCTZ

8

Avalide

irbesartan + HCTZ

9

Quinaretic; Accuretic

quinapril + HCTZ

10

Micardis HCT

telmisartan + HCTZ

11

Lotrel

benazepril + amlodipine

12

Exforge

valsartan + amlodipine

13

Tekturna HCT

aliskiren + HCTZ

14

Chlorpres

clonidine + chlorthalidone

15

Tenoretic

atenolol + chlorthalidone

16

Ziac

bisoprolol + HCTZ

17

Byvalson

nebivolol + valsartan

18

Maxzide; Dyazide

triamterene + HCTZ

19

Tribenzor

olmesartan + amlodipine + HCTZ

20

Which HTN meds are contraindicated in pregnancy?

ACEi, ARB, DRI

21

What are the recommended first line agents to treat HTN during pregnancy?

labetalol
nifedipine extended release
methyldopa

22

Where and how do thiazide diuretics work?

Distal convoluted tubule
Inhibit Na+ reabsorption
Cause increased excretion of Na+, Cl, and water

23

Diuril

chlorothiazide
thiazide diuretic

24

Microzide

hydrochlorothiazide
thiazide diuretic

25

Zaroxolyn

metolazone
thiazide diuretic

26

Side effects of thiazide diuretics

Hypokalemia
Hypomagnesemia
Hyponatremia
Hypercalcemia
Hyperuricemia
Elevated lipids
Hyperglycemia

27

Dihydropyridine CCBs MOA

Inhibit Ca ions from entering vascular smooth muscle and myocardial cells.

Causes peripheral arterial vasodilation, decreases stroke volume and blood pressure and coronary artery vasodilation.

Causes reflex tachycardia, headache, flushing, and peripheral edema.

28

IV DHP CCBs

nicardipine
clevidipine

29

Norvasc

amlodipine

30

Adalat CC
Procardia XL

nifedipine ER

31

Cardene IV

nicardipine

32

DHP CCB Warnings and side effects

Hypotension

*immediate release nicardipine is not for chronic hypertension and sould not be used for acute BP reduction*

peripheral edema, dizziness, flushing, headache, palpitations/tachycardia, gingival hyperplasia

33

Which DHP CCBs are considered the safest if a CCB must be used for heart failure with reduced ejection fraction?

amlodipine and felodipine

34

Storage and administration requirement for Cardene IV

Must be protected from light

35

Cleviprex

clevidipine

lipid emulsion 2kcal/mL
milky white color
maximum time of use after vial puncture is 12 hours

36

Non-dihydropyridine CCBS MOA

Used to control heart rate in certain arrhythmias and sometimes used for HTN and angina.

Inhibit Ca ions from entering vascular smooth muscle and myocardial cells, but are more selective for myocardium. They decrease blood pressure through negative inotropic and chronotropic effects.

Inotropic = force
Chronotropic = rate

37

Cardizem
Cartia XT
Diltzac
Dilt-XR
Taztia XT
Tiazac

diltiazem

38

Calan
Covera HS
Verelan

verapamil

39

Side effects and warnings for DHP CCBs

sinus bradycardia, AV block, hypotension, heart failure.

edema, headache, dizziness, constipation, gingival hyperplasia

40

All CCBs are major substrates of _______.

CYP 3A4

41

____________ and ____________ are substrates of P-gp and moderate inhibitors of 3A4.

diltiazem and verapamil

42

Action of aldosterone

Increases blood volume thus blood pressure through Na+ and water retention.

43

Can patient be rechallenged with RAAS inhibitor if they develop angioedema?

NO. Angioedema can be fatal. If any patient develops angioedema with any RAAS inhibitor other agents in this class are contraindicated.

44

ACE inhibitor MOA

Block conversion of Ang I to Ang II resulting in decreased vasoconstriction and decreased aldosterone secretion.

Also block degradation of bradykinin

45

ACE inhibitors have been shown to slow the progression of _________ disease.

kidney disease in patients with albuminuria due to diabetes, hypertension, or other causes of CKD.

46

Ang II constricts the __________ arterioles to a greater extent than the _______ arterioles causing _________________.

Constricts the efferent arteriole constriction more than afferent arteriole constriction causing increased perfusion pressure (workload) in the glomerulus.

47

How do ACE inhibitors protect the kidneys?

By blocking vasoconstriction of efferent arteriole caused by Ang II resulting in decreased glomerular filtration pressure (workload).

48

How do ACE inhibitors work in heart failure?

Protect the myocardium from remodeling effects of Ang II.

49

Boxed warning for ACE inhibitors and ARBs

Injury and death to developing fetus when used in 2nd and 3rd trimesters.

Discontinue as soon as pregnancy is detected

50

Contraindications for ACE inhibitors and ARBs

History of angioedema

Use with aliskiren in patients with diabetes (ACE inhibitors)

51

Warnings for ACE inhibitors

Angioedema
Cough
Hyperkalemia
Hypotension
Renal impairment

**Avoid use in bilateral renal artery stenosis**

52

Monitoring for ACE inhibitors and ARBs

blood pressure
potassium
renal function
signs/symptoms of angioedema

53

Warnings for ARBs

Angioedema
Hyperkalemia
Hypotension
Renal impairment

Olmesartan: sprue-like enteropathy (severe chronic diarrhea with substantial weight loss can occur months to years after drug initiation).

54

Lotensin

benazepril

55

Vasotec

enalapril

56

Epaned

enalapril oral solution

57

Prinivil
Zestril

lisinopril

58

Qbrelis

lisinopril oral solution

59

Accupril

quinapril

60

Altace

ramipril

61

ARB MOA

Block Ang II from binding to Angiotensin II type-1 (AT1) receptor on vascular smooth muscle, preventing vasoconstriction.

Shown to slow the progression of renal disease and heart failure for similar reasons as ACE inhibitors.

62

Avapro

irbesartan

63

Cozaar

losartan

64

Benicar

olmesartan

65

Diovan

valsartan

66

RAAS Drug Interactions

Hyperkalemia - look for other drugs that can increase K+

Use of aliskiren in combination with a RAAS agent is specifically contraindicated in patients with diabetes and should be avoided with eGFR <60mL/min

Can decrease lithium renal clearance and increase risk of lithium toxicity.

67

Potassium-sparing diuretics traditionally used in combination with ___________ to counteract the _________ losses seen with ________ diuretics.

hydrochlorothiazide

potassium

thiazide

68

Spironolactone MOA

Non-selective aldosterone receptor blocker
Also blocks androgen

69

Eplerenone MOA

Selective aldosterone receptor blocker that does NOT exhibit endocrine side effects.

70

Potassium-sparing diuretics MOA

Compete with aldosterone at receptor sites in distal convoluted tubule and collecting ducts to increase Na+ and water excretion while conserving K+ and H+ ions.

71

Aldactone

spironolactone

25-100mg in 1-2 divided doses
Heart failure: 12.5-25mg daily, MDD 50mg

72

Inspra

eplerenone

50mg daily or BID
Heart failure: 25-50mg daily

73

Maxzide
Dyazide

triamterene + HCTZ

74

Dyrenium

triamterene

75

Side effects of spironolactone

gynecomastia
breast tenderness

76

Monitoring for Potassium sparing diuretics

blood pressure
electrolytes
Check potassium before initiating and frequently thereafter
Renal function
Fluid status

77

Diuretics can ________ lithium renal clearance and _______ risk of lithium toxicity.

Decrease clearance

Increase risk of toxicity

78

Eplerenone is a major substrate of ____. Use with strong _____ inhibitors is contraindicated.

3A4

79

Strong 3A4 inhibitors

Ketoconazole
Itraconazole
Clarithromycin
Ritonavir

80

Beta blockers are no longer recommended as _______ line agents for uncomplicated hypertension unless the patient has a comorbid condition for which beta-blockers are recommended first-line including ___, __________, and ______.

No longer recommended as first line agents.

post-MI
stable ischemic heart disease
heart failure

81

Beta blocker MOA

Decrease blood pressure by competitively blocking beta-1 and beta-2 adrenergic receptors resulting in decreases in heart rate and myocardial contractility.

82

Alpha-1 blocking properties....

Decreases peripheral vasoconstriction

83

ISA

intrinstic sympathomimetic activity