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OSCE Study Guide > Hypertension and Heart-related meds > Flashcards

Hypertension and Heart-related meds Flashcards

1
Q

Pharmacologic therapy and guideline for: DM w/ ACR <30mg/day

A

ACEI or ARB or DHP CCB or thiazide

ADA

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2
Q

Pharmacologic therapy and guideline for: DM w/ACR ≥30mg/day

A

ACEI or ARB +/- DHP CCB +/- thiazide

ADA

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3
Q

Pharmacologic therapy and guideline for: CKD

A

ACEI or ARB

JNC8, KDIGO

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4
Q

Pharmacologic therapy and guideline for: CAD

A

BB + ACEI or ARB + thiazide +/- nitrate +/- CCB +/- aldosterone antagonist
AHA/ACC/ASH

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5
Q

Pharmacologic therapy and guideline for: HF

A

ACEI or ARB or ARB/neprilysin inhibitor + BB +/- aldosterone antagonist +/- diuretic +/- hydralazine/isosorbide dinitrate if black
ACC/AHA/HFSA

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6
Q

Pharmacologic therapy and guideline for: Recurrent stroke prevention

A

Diuretic +/- ACEI

AHA/ASA

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7
Q

Pharmacologic therapy and guideline for: Black

A

Thiazide or DHP CCB

JNC8

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8
Q

Pharmacologic therapy and guideline for: Non-black

A

Thiazide or ACEI or ARB or DHP CCB

JNC8

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9
Q

What class and dosage is Chorthalidone

A

Thiazide/Thiazide like diuretics

12.5 - 25mg PO QAM

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10
Q

What class and dosage is Hydrochlorothiazide

A

Thiazide/Thiazide like diuretics

12.5 - 25mg PO QAM

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11
Q

What class and dosage is Metolazone

A

Thiazide/Thiazide like diuretics

2.5 - 5mg PO QAM

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12
Q

What class and dosage is Indapamine

A

Thiazide/Thiazide like diuretics

1.25 - 2.5mg PO QAM

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13
Q

What class and dosage is Furosemide

A

Loop diuretics

20 - 40mg PO BID

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14
Q

What class and dosage is Bumetamide

A

Loop diuretics

0.5 - 4mg PO QAM or BID

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15
Q

What class and dosage is Torsemide

A

Loop diuretics

5 - 10mg PO QAM

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16
Q

What class and dosage is Amiloride

A

Potassium-sparing diuretics
5mg PO QAM
10mg PO QAM not monotherapy
CrCl 10-50ml/min- 50% of dose, CrCl <10ml/min- avoid use

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17
Q

What class and dosage is Triamterene

A

Potassium-sparing diuretics
37.5mg PO QAM
75mg PO QAM not monotherapy
CrCl <50ml/min- avoid use, Severe hepatic impairment- CI

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18
Q

Things to remember about Thiazide/Thiazide-like diuretics

A

Potassium-wasting
NSAID may diminish diuretic effects

Thiazide-type diuretics are a good 1st line choice in HTN
Specifically chlorthalidone

Good choice if patient has had a stroke (in combination with an ACEI)
Allow up to 4 weeks for full efficacy

Avoid diuretics, especially thiazides, if a patient has gout

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19
Q

Things to remember about Loop diuretics

A

Potassium-wasting (more than thiazide)
NSAID may diminish diuretic effects

Good choice if patient has had a stroke (in combination with an ACEI)
Allow up to 4 weeks for full efficacy

May have BID dosing, Taking AM and in the afternoon to avoid nocturia

Loops are a more potent diuretic and preferred if edema present especially CKD and HF patients or when GFR < 30 ml/min/1.73

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20
Q

Things to remember about potassium-sparing diuretics

A

Potassium sparing diuretics are weak diuretics, but can be used in combination with other diuretics to address hypokalemia
Not taking by itself
Increased potassium with ACEI, ARB, DRI, potassium supplements

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21
Q

Drugs that act on the RAAS

A

ACEI
ARB
DRI (Aliskiren or brand name Tekturma)

22
Q

Lisinopril dosing

A

5-10-40mg PO daily

23
Q

Losartan dosing

A

Cozaar

25-50-100mg PO daily

24
Q

Olmesartan dosing

A

Benicar

5-20-40mg PO daily

25
Q

Valsartan dosing

A

Diovan

80-160-320mg PO daily

26
Q

Monitor for diuretics

A

Monitor BP, HR, SrCr, Na+, K+ 4 weeks after initiation or dose titration and every 3-6 months thereafter

27
Q

Side effects of ACEI

A

Hyperkalemia
Angioedema (more common than ARB)
Cough
Increased SCr

28
Q

Side effects of ARB

A

Hyperkalemia
Angioedema
Increased SCr

29
Q

Things to know about ACE and ARB

A

ACEI or ARB good 1st line option in HTN

Very good choice if patient has:
_ CKD or DM w/ACR >30mg/day
_ Hx stroke (in combination with thiazide)
_ Hx MI, CAD, HFrEF (in combination with a BB)

30
Q

Diltiazem dosing

A

Cardizem, Cartia
XR: 120-240-360mg PO daily
SR: 60-120-180mg PO BID

31
Q

Verapamil dosing

A

Calan, Verelan, Isoptin
XR: 180mg (240-480 mg max) PO daily
SR: 120-180mg (240-360mg max) PO daily

32
Q

Amlodipine dosing

A

Norvasc

2.5-5-10mg PO daily

33
Q

Side effects for DHP CCB

A

Hypotension
Flushing
Headache
Peripheral edema

34
Q

Side effects for NDHP CCB

A 
DHP CCB side effect too, but mostly 
AV Block (Conduction disturbances)
Bradycardia
Nausea
Constipation
35
Q

Monitoring for CCB

A

Monitor BP and HR within 2-4 weeks of dose change or initiation, then every 6 months or as clinically indicated. Education regarding ADRs with specific agent chosen at least at baseline and dose change.

36
Q

What class and dosage is Spirolactone?

A

Aldosterone antagonist

12.5-25-50mg PO daily

37
Q

Side effects of Spirolactone

A 
Gynecomastia
Hyperkalemia
Dizziness
Increased SCr
Other "steroid" ADR
38
Q

What class and dosage Hydralazine?

A

Direct vasodilator

10-100mg (Max 300mg/day) PO 2-4x/day

39
Q

Side effect of Hydralazine

A

Edema, tachycardia, orthostatic hypotension, BP

40
Q

What class and dosage Cavedilol?

A

Non-selective BB with a-activity

IR: 6.25-25mg PO BID

41
Q

What class and dosage Metoprolol tartrate

A

Selective BB

IR: 25-50-200mg PO BID

42
Q

What class and dosage Metoprolol succinate

A

Selective BB

XL: 50-100-200mg PO daily

43
Q

Side effects of BB

A 
Dizziness, orthostatic hypotension
Fatigue
Erectile dysfunction (less with vasodilatory BBs)
Decreased exercise tolerance
Bradycardia/AV block
Hyperglycemia (β2 mediated)
44
Q

Monitoring of BB

A

Main monitoring is HR (bradycardia) and BP within 2-4 weeks after initiation or dose change. Educated regarding pertinent ADRs at least at initiation and dose change.

45
Q

What class and dosage Clonidine

A

Central a2-agonist

0.1-0.2mg PO BID (Max benefit: 1.2mg/day)

46
Q

Side effects of central a2-agonist

A

Bradycardia, dizziness, drowsiness, DRY MOUTH, fluid retention, erectile dysfunction, orthostasis, depression, constipation, urinary retention
Caution in elderly!
Often used with diuretic to diminish fluid retention, especially methyldopa

47
Q

Monitoring of central a2-agonist

A

BP, HR, and ADRs in 1-2 weeks after initiation or dose change. Educated regarding pertinent ADRs at least at initiation and dose change

48
Q

What class and dosage Prazosin

A

a1-blocker

1-20mg PO BID or TID

49
Q

What class and dosage Terazosin

A

a1-blocker

1-5mg PO QHS

50
Q

What class and dosage Doxazosin

A

a1-blocker

1-2mg PO daily

51
Q

Side effects of a1-blocker

A

“First-dose” effect (dizziness, faintness, orthostasis within 1-3 hours after first dose or dose changes), orthostatic hypotension, edema, dizziness, vivid dreams, depression

Caution in elderly!

Patient education: Take first dose at bedtime and rise slowly from sitting or laying positions

52
Q

Monitoring for a1-blocker

A

BP, HR, and ADRs in 1-2 weeks after initiation or dose change. Educated regarding pertinent ADRs at least at initiation and dose change

OSCE Study Guide (6 decks)

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