Hypertensive Pharm Flashcards
(88 cards)
1
Q
Lisinopril
A
(Vestril, Prinivil)
ACE inhibitor
2
Q
Quinipril
A
Accupril
ACE-inhibitor
3
Q
Ramapril
A
Altace
ACE-inhibitor
4
Q
Benzapril
A
Lotensin
ACE-inhibitor
5
Q
Enalapril
A
Vasotec
ACE-inhibitor
6
Q
Aliskiren
A
(Tekturna)
Direct Renin Inhibitor
7
Q
Candesartan
A
(Atacand)
ARB
8
Q
Losartan
A
(Cozaar)
ARB
9
Q
Valsartan
A
(Diovan)
ARB
10
Q
Telmisartan
A
(Micardis)
ARB
11
Q
Olmesartan
A
(Benicar)
ARB
12
Q
Irbesartan
A
(Avapro)
ARB
13
Q
Hydrochlorothiazide
A
(Hydrodiuril)
Thiazide diuretic
14
Q
Clorthalidone
A
(Diuril)
Thiazide diuretic
15
Q
Indapamide
A
(Lozol)
Thiazide diuretic
16
Q
Metolazone
A
(Zaroxylyn)
Thiazide diuretic
17
Q
Furosemide
A
(Lasix)
Loop diuretic
18
Q
Torosemide
A
(Demadex)
Loop diuretic
19
Q
Bumetanide
A
(Bumex)
Loop diuretic
20
Q
Spironolactone
A
(Aldactone)
Aldosterone antagonist
Also potassium sparing
21
Q
Eplerenone
A
(Inspra)
Aldosterone antagonist
22
Q
Triamterene
A
(Dyazide or Maxide when combined with HCTZ)
Potassium sparing
23
Q
Nifedipine
A
(Procardia, Adalat)
Dihydropyridine CCBs
24
Q
Felodipine
A
(Plendil)
Dihydropyridine CCBs
25
Amlodipine
(Norvasc)
| Dihydropyridine CCBs
26
Verapamil
(Calan)
| Non-Dihydropyridine CCBs
27
Diltiazem
(Cardizem, Tiazac)
| Non-dihydropyridine CCBs
28
Atenolol
(Tenormin)
| Cardiospecific Beta Blockers
29
Bisprolol
(Zebeta)
| Cardiospecific Beta Blockers
30
Metoprolol tartate
(Lopressor)
| Cardiospecific Beta Blockers
31
Naldol
(Corgard)
| Non-Selective Beta Blockers
32
Propanolol
(Inderal)
| Non-Selective Beta Blockers
33
Minoxidil
Peripheral Vasodilators
34
Hydralazine
(Apresoline)
| Peripheral Vasodilators
35
Methyldopa
Central Alpha-2 Agonists
36
Clonidine
(Catapres)
| Central Alpha-2 Agonists
37
Prazosin
(Minipress)
| Alpha Blockers
38
Doxazosin
(Cardura)
| Alpha Blockers
39
Terazosin
(Hytrin)
| Alpha Blockers
40
Carvedilol
(Coreg)
| Mixed Alpha/Beta Blockers
41
Labetalol
(Trandate)
| Mixed Alpha/Beta Blockers
42
Metoprolol succinate
(Toprol)
| Cardiospecific Beta Blockers
43
Nicardipine hydrochloride
F
44
Nitroglycerin
Hs
45
Labetalol hydrochloride
F
46
Hydralazine hydrochloride
G
47
Esmolol hydrochloride
D
48
Sodium nitroprusside
S
49
Pregnancy potential?
no ACE/ARB
50
gout, hyponatremia, SSRI, or urinary incontinence
CCB, ACE/ARB
51
no gout, hyponatremia, SSRI, or urinary incontinence
thiazide, CCB, ACE/ARB
52
Consider these popuations when choosing a drug:
- pregnant
| - older than 80 y.o.
53
Thiazide diuretics:
- hydrochlorothiazide (hydrodiuril)
- chlorthalidone (diuril)
- indapamide (lozol)
- metolazone (zaroxolyn)
54
DRI's:
aliskiren (tekturna)
55
Loop Diuretics:
- Bumetanide (bumex)
- Torsemide (demadex)
- furosemide (lasix)
56
Potassium Sparing:
Spironolactone (aldactone)
| Triamterene: dyazide and maxide w/ HCTZ
57
Alodsterone Antagonists:
Spironolactone (aldactone)
| eplerenone (inspra)
58
ACE's: (4)
lisinopril (vestril, prinivil)
ramipril (altace)
quinnipril (accupril)
benzapril (lotensin)
59
ARB's: (6)
```
candesartan (atacand)
telmisartan (micardis)
irbesartan (avapro)
olmesartan (benicar)
valsartan (diovan)
losartan (cozaar)
```
60
CCB's: (3)
amlodipine (norvasc)
felodipine (plendil)
nifedipine (procardia, adalat)
61
non-CCB's: (2)
verapimil (calan)
| diltiazem (cardizem; tiazac)
62
Beta blockers: cardiospecific (3) and nonselective (2)
```
cardiospecific (3):
- metoprolol succinate (toprol XL)
- metoprolol tartate (Lopressor)
- Bisoprolol (zebeta)
nonselective (2):
- naldol (Corgard)
- propanolol (inderal)
```
63
Mixed alpha and beta blockers: (2)
Labetalol (trandate)
| Carvedilol (coreg)
64
Alpha-1 blockers: (3)
terazosin (hytrin)
prazosin (minipress)
doxazosin (cardura)
65
Central alpha-2 agonists: (3)
clonidine (catapress)
methyldopa (aldomet)
guanfacine (tenex)
66
Peripheral vasodilators: (2)
hydralazine (aspresoline)
| minoxidil
67
HTN in pregnancy preferred drugs:
labetalol, methyldopa, diltiazem
68
Chronic HTN in pregnancy:
>140/90 before 20 weeks gestation, pre-pregnancy, or 12 weeks post-pregnancy
69
Gestational HTN/Pregnancy-induced HTN:
>140/90 after 20 weeks gestation w/o proteinuria, which resolves 12 weeks post-pregnancy
70
Preeclampsia in pregnancy:
>140/90 after 20 weeks gestation w/ proteinuria
- MC: nulliparious women, multiple fetuses, fam hx, or h/o HTN or renal dz
- definitive tx: delivery
- restrict activity, bed rest, and close monitoring
71
Initial steps in Hypertensive ER:
- loss of BP autoregulation
| - abrupt rise in systemic vasculature resistance
72
sodium nitroprusside use:
Most HT emergencies; caution w/ high ICP's, azotemia, or in CKD
73
nicardipine hydrochloride use:
Most HT emergencies, except acute HF; caution w/ coronary ischemia
- MC to drop BP in pt. w/ a cerebral bleed
74
esmolol hydrochloride use:
aortic dissection; perioperative; cardiac cause; not acute HF
75
nitroglycerin use:
Coronary ischemia or HF; venous vasodilator and great for fluid overload
76
hydralazine hydrochloride use:
ecclampsia; MC w/ pregnancy; not a drip so not good for titration meds
77
labetalol hydrochloride use:
- Most HT emergencies, except acute HF
| - BB w/ alpha-blockade
78
Treatment guidelines in hypertensive emergency:
reduce MAP no more than 10-20% over minutes to 1 hour w/ IV meds; reduce 5-15% over 23 hrs in ICU under close monitoring of IV meds; over next days to weeks w/ oral meds for BP lowering
79
Just placing these HTN emergent pts in a quiet room to rest caused:
BP to fall 20/10 in or more in 1/3rd of patients
80
Hypertensive emergent w/u:
- serum chemistries to detect AKI
- UA to detect hematuria, proteinuria, RBC or RBC casts
- CBC/peripheral blood smear if new onset
- cardiac enzymes x 3
- imaging: CXR; non-contrast CT
- tox screen, preg screen, and endocrine testing
81
Hypertensive emergent PE:
- eyes: hemorrhages, exudates, papilledema
- CV: CP, JVD, preipheral edema, crackles on auscultation, dyspnea, acute severe back pain
- CNS: agitated, delirius, visual deficits, focal signs, sz; n/v if increased ICP
- abdominal: masses or bruits
82
Hypertensive emergency: ACS complication and tx
- ACS, includes MI: Tx if SBP>160 or DBP>100 (reduce by 20-30%)
- nitroglycerin and beta-blockers
- C/I: thrombolytics if BP >185/100
83
Hypertensive emergency: AHF complication and tx
*goal SBP <140mmHg
(1) loop diuretic IV often administered 1st if pt. volume overloaded
(2) nitroglycerin or nitroprusside to reduce afterload (vasodilators)
(never beta blocker-depresses cardiac contractility or hydralazine- increases cardiac work by vasodilating)
84
Hypertensive emergency: sympathetic overactivity
- cocaine toxicity, amphetamines
- pheo
- severe autonomic dysfx: cord injury; GBS
- Beta-blocker alone is C/I
85
ischemic stroke pt. recieving IV or intraarterial fibrinolysis w/ tpa tx goal:
BP goal <185 or <110
86
acute ischemic stroke tx goal:
tx only if SBP >220 or DBP >120
| - preferred drugs: labetalol or nicardipine
87
acute aortic dissection tx goal:
rapidly lower SBP to 100-120 within 20 minutes
- preferred tx: narcotic analgesics (morphine sulfate); BB (esmolol, labetalol); vasodilators (nitroprusside)
- avoid BB w/ cardiac tamponade or aortic regurgitation
88
SAH or ICH tx goal:
further bleeding risk vs. risk for ischemia
- ~160mmHg
- preferred nicardipine, esmolol, or labetalol
