Second line HTN meds Flashcards Preview

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Flashcards in Second line HTN meds Deck (66):
1

Give some examples of loop diuretics that you dose BID

Furosemide
Bumetanide
Ethacrinic acid

2

Who are loop diuretics usually reserved for?

CrCl < 30 mL/min

3

How do you avoid nocturnal diuresis with loop diuretics?

Give BID doses in AM and afternoon
Avoid HS administration

4

Are potassium sparing diuretics strong anti-HTN meds?

No, they are weak

5

When do you use potassium sparring diuretics?

For an additive effect in combo w/ a thiazide or loop

6

When are potassium sparing diuretics useful?

In pts w/ low serum K

7

What might potassium sparing diuretics cause in what specific poupulation?

Hyperkalemia in pts w/ CKD/DM

8

What are some examples of potassium sparing diuretics?

Triamterene
Amiloride

9

What are the examples of triamterene with HCTZ?

Dyazide
Maxzide

10

What are examples of aldosterone antagonist diuretics?

Spironolactone (w/ or w/o HCTZ)
Eplerenone

11

What is a side effect of aldosterone antagonist diuretics?

Gynecomastia

12

Give some examples of beta blockers.

Atenolol
Bisoprolol
Metoprolol
Carvedilol
Acebutolol

13

What is the standard dosing for beta blockers?

Q 24 hours

14

What are beta blockers w/ intrinsic sympathomimetic activity useful for?

Useful if beta blockers cause bradycardia

15

What are direct renin inhibitors contraindicated with??

ACEIs and ARBs
Pregnancy

16

When are alpha 1 blockers used?

In pts w/ BPH

17

What is Doxazosin and how many times per day is it dosed?

Alpha 1 blocker
Once

18

When do you instruct pts to take their first dose of alpha 1 blockers? Why?

Take first dose before bedtime
Minimizes dizziness and postural hypotension

19

How can you give out clonidine?

Tabs
Transdermal patches (replaced weekly)

20

How quick is the onset of clonidine? And is it long or short acting?

Fast onset (20-60 mins)
Short acting

21

When is clonidine usually used?

Resistant HTN

22

What are the SEs of clonidine?

Significant anticholinergic SEs

23

What happens if you abruptly cease clonidine? How do you avoid this?

Possible rebound HTN
Taper doses gradually as DCing

24

What is the first line agent for pregnancy induced HTN?

Methyldopa

25

Is methyldopa used for much more than pregnancy induced HTN?

No

26

In what forms do we give methyldopa?

Injection
Tablets

27

What is hydralazine?

A direct vasodilator

28

What do you use hydralazine with and why?

Diuretics and beta blockers to minimize water retention and reflex tachycardia

29

What are some SEs of hydralazine and why?

Lupus like syndrome at high doses

30

What is minoxidil?

A direct vasodilator

31

What do you takes minoxidil with?

Take w/ loop diuretic and bet blocker w/ hydralazine

32

What are two popular vasodilators?

Sodium nitroprusside
Nitroglycerine

33

What is nitroprusside the mainstay tx for?

Most HTN emergencies

34

What is a precaution with nitroprusside?

Renal dysfunction

35

What is nitroprusside metabolized to?

Cyanide

36

What is a problem with renal insufficiency and nitroprusside?

Cyanide is converted to thiocyanate and this accumulates w/ renal insufficiency

37

What do you need to do to monitor pts with renal issues and nitroprusside?

Need to monitor levels if used for > 4 days

38

What do you add to the IVBP if using nitroprusside? And at what point?

Sodium
@ 2nd bag

39

What does sodium do for nitroprusside?

accelerates enzyme degradation of cyanide to thiocyanate making it much less toxic

40

What do you use nitroglycerine for?

Acute myocardial infarction
Stroke

41

What are some precautions for nitroglycerine? How do you deal with that?

Development of tolerance
Increase IV administration rate

42

When is nitroglycerine contraindicated?

Concurrent use of phosphodiesterase 5 inhibitors

43

What is epinephrine?

Pressor of last resort

44

What is a possible issue with epinephrine?

Digital necrosis

45

What is norepinephrine used for?

Severe hypotension

46

What is a possible issue with norepinephrine?

Digital necrosis

47

What is the low dose of dopamine?

1-3 mcg/kg/min
Mainly DA effects

48

What is the intermediate dose of dopamine?

3-10 mcg/kg/min
DA + beta effects

49

What is the high dose of dopamine?

> 10 mcg/kg/min
Mainly alpha effects

50

Do you use dopamine or norepinephrine first?

Norepinephrine

51

What is the primary activity of dobutamine?

Mainly beta 1 activity

52

What does dobutamine do?

Increases cardiac output w/ little vasoconstriction

53

What is dobutamine?

An inotrope w/ vasodilator properties

54

What is phenylepherine?

Potent alpha agonist with weak beta agonist activity

55

Where is phenylepherine vasoconstrictive?

Arterioles and nasal mucosa

56

When is phenylepherine a useful alternative?

In those unable to tolerate tachycardia from dopamine or norepinephrine

57

What is the MOA of vasopressin?

Increases water permeability of renal tubule

58

How does vasopressin increase water permeability of renal tubule?

Increases H2O resorption from tubular lumen

59

What does the increase H2O resorption from tubular lumen do?

Results in decreased urine volume and increased osmolarity

60

How do you administer vasopressin?

@ 0.04 units/min
*fixed rate*

61

What might greater doses of vasopressin do?

Cause cardiac arrest

62

When is vasopressin typically used?

Added on in addition to the use of other pressors

63

Which loop diuretic do you only dose daily?

Torsemide

64

Which loop diuretic can you dose TID?

Ethacrinic acid

65

What is Prazosin and how many times per day is it dosed?

Alpha 1 blocker
2-3

66

What is Terazosin and how many times per day is it dosed?

Alpha 1 blocker
1-2