Questions Flashcards by Erin Frank

JNC normal BP

< 120 and < 80

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JNC PreHTN

120-139 or 80-89

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JNC Stage 1 HTN

140-159 or 90-99

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JNC Stage 2 HTN

>160 or >100

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How should you treat stage 1 HTN?

Thiazide

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How should you treat stage 2 HTN?

Thiazide + ACEi

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What is target BP for HTN treatment?

< 140/90

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Name risk factors associated with HTN

Male, smoker, glucose 102-125, obesity, FH, age (men > 65), dyslipidemia

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How to treat african americans with HTN

CCB and diuretic

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How to treat pregnant women with HTN

methyldopa, BB, vasodilators

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How to treat children/adolescents with HTN

lower doses, same drugs as adults

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JNC recommendations for combination choice

BP >20/10 above treatment goal, includes a diuretic, caution in elderly - combinations can mask side effects

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How does hexamethonium work?

block Ach at nicotinic receptors at sympathetic and parasympathetic autonomic ganglia, reduce arteriolar and vasomotor tone, can paralyze you = DIE!

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Name the effects of the ganglionic blockade

Sympathetic: arterioles and veins, Parasympathetic: heart, GI tract, bladder

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How does reserpine work?

NT reuptake blockade - can lead to sedation, tremors - only used in 3rd world countries

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How does guanethidine work?

inhibits NE release - can cause HOTN - GONE!

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What do alpha-1 receptors mediate?

vasoconstriction

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What do Beta-1 receptors mediate?

tachycardia (BB work here)

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What do Beta-2 receptors mediate?

vasodilation, bronchodilation

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How can BP be affected by the SNS?

Blocking beta-1 receptors, blocking peripheral alpha-1 receptors, triggering central alpha-2 receptors

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What happens after blocking beta-1 receptors?

reduce HR and renin release

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What happens after blocking peripheral alpha-1 receptors?

vasodilation, decreased peripheral resistance

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What happens when you trigger central aplhpa-2 receptors?

reduce sympathetic outflow of heart

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How do BB work?

reduce renin, decrease beta-1 activation = decreased CO

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Who do you use BB in?

younger pts, pts with cardiac disease

Are BB effective at primary prevention of HTN?

How are BB excreted/metabolized?

Renally (adjust if CrCl \<35), Hepatic - first pass effect with oral drugs

What are side effects of BB?

can penetrate BBB - lethargy, confusion, nightmares, bradycardia, hypotension, AV conduction block, bronchoconstriction, hypoglycemia, increased LDL, decreased HDL

Name the 3 BB you need to know

Metoprolol ER (Lopressor), Carvedilol (Coreg), Nebivolol (Bystolic)

Name a non-selective BB

Propanolol

Name a selective BB

Metoprolol

Name a BB that aids in alpha-1 blockade

Labetolol. Carvedilol

Name a BB that will increase NO levels

Nebivolol

What is the MOA for alpha blockers

reduce peripheral resistance

What is the body's response to HOTN?

increased HR, CO, fluid retention, reflex tacycardia

ADR for alpha blockers

first dose syncope, peripheral edema, non-selective can cause urinary incontinence, HA, nasal congestion

Who would use alpha-blockers?

younger pts

What is the class drug for alpha blockers?

Doxazosin (cardura)

What is an alternative use for alpha blockers?

BPH

How do alpha stimulants work?

???

What alpha stimulant can be used as a tablet or patch?

Clonidine - ADHD, psychosis, RLS, ulcerative colitis, tha shakes from addiction

Side effects of alpha stimulants

dry mouth, bradycardia, orthostatic HOTN, sedation, abrupt withdrawal can cause HTN crisis

Name the 3 alpha stimulants

Clonidine, Catapres TTS, methyldopa

What is the MOA for direct vasodilators?

increase NO levels

Side effects for direct vasodilators

the usual + pericarditis --\> tamponade, increased O2 demand --\> exacerbate angina, some sodium and water retention

When can you prescribe a direct vasodilator?

when 3 anti-hypertensives including a diuretic have failed

What are the direct vasodilators you need to know?

Minoxidil AKA rogaine, hydralazine

How does hydralazine work?

open K channels causing increased NO

Side effects of hydralazine

reflex tachycardia - give with BB, HA, lupus like syndrome, short half life so frequent dosing

What is a hypertensive emergency?

\>220/140

What is a hypertensive urgency?

\>180/110

Which anti-hypertensive drug contains cyanide?

sodium nitroprusside

What is target therapy for hypertensive emergency and urgency?

30% below their current number - reduced risk of stroke

What are the effects of CCB?

vasodilation, decreased contractility

What are the 3 classes of CCB?

Dihydropyridines, phenylalkylamines, benzothiazepine

Name a drug from each class of CCB.

Dihydropyridine: Amlodipine, Nicardipine, Phenylalkylamine: Verapamine, Benzothiazepine: Diltiazem

Name 2 CCBs that are once a day

Amlodipine, Felodipine

Which CCB is shown to decrease mortality?

Amlodipine

Which CCB is used to treat hypertensive emergency?

Nicardipine

Which CCB most effects cardiac contractility?

verapamil

Which CCB most effects HTN?

nicardipine

Which CCB most effects both HTN and cardiac contractility?

Diltiazem

Which CCBs have vasular side effects?

dihydropyridines (amlodipine)

Which CCBs have side effects on cardiac contractility?

non-dyhydropyridines

Can you use CCB in mild-moderate renal failure?

yes

What is a major disadvantage of CCB?

many drug interactions: BB: additive effects, CYP3A4 inhibitors increase CCB

What is the MOA of ACEi?

decreased AngII and increased bradykinin = vasodilation

Which anti-hypertensive decreases NSAID effects?

ACEi - increased prostaglandins

Name 3 ACEi

Lisinopril, Captopril, Ramipril

T or F: decreased mortality is a class effect of ACEi

TRUE

Who cannot use ACEi?

pregnant women, people with bilateral renal artery stenosis, previous angioedema

Name a short acting ACEi

captopril

Name 2 long-acting ACEi

Lisinopril, Ramipril

Name an injectable ACEi

Enalaprilat

Most common side effects of ACEi

cough, hyperkalemia, renal impairment

What is the MOA of ARBs?

block AngII binding to receptors

Name 2 ARBs

Losartan, valsartan

What are advantages of ARBs?

once a day dosing, can treat diabetic nephropathy, less dry cough, can be interchanged for HTN or HF

What are disadvantages of ARBs?

Bradykinin levels fall = less vasodilation, no injectable forms

What is the MOA for renin antagonists?

Aliskiren has negative effects on renin, blocks angiotensinogen to AngI

Who should use renin antagonsists?

patients who benefit from ACEi or ARBs and are now refractory

Give 3 combination therapies for HTN

ACEi + thiazide, ARB + thiazide, ARB + CCB