Week 7:BP Flashcards
1
Q
What is a surrogate maker for cardiovascular risk?
A
BP
2
Q
What is it called when cause of htn is unknown (>90%)?
A
primary (essential) htn
3
Q
What is it called when there is an identifiable cause of htn?
A
secondary htn
4
Q
What is the equation of MAP (Mean arterial pressure)?
A
CO x TPR
5
Q
What are the hormonal factors involved in HTN?
A
renin
angiotensin
aldosterone
bradykinin (RAAS)
6
Q
When does pharmacotherapy begin according to JNC9?
A
SBP>130 or DBP >80
7
Q
_____ is the new 140.
A
130
8
Q
What is the result of the new JNC9 criteria?
A
many more individuals requiring pharmacotherapy
9
Q
What is the primary diuretic first line for htn (class effect)?
A
thiazide diuretics
10
Q
What are examples of thiazide diuretics?
A
chlorthalidone (hygroton)
Hydrochlorthiazide (HCTZ)
11
Q
What thiazide diuretics are effective for CrCl <30?
A
Indapamide (lozol)
Metolazone (zaroxylyn)
12
Q
Why is the hypotensive effect longer than the half life for thiazide diuretics?
A
extra renal factors involved?
13
Q
What is the half life of chlorthalidone?
A
45-60 hours
14
Q
What is the half life of HCTZ?
A
8-15 hours
15
Q
When should thiazides be given? why?
A
in the AM to minimize nocturnal diuresis
16
Q
WHen should thiazides be used with caution?
A
> 65
females
pts with low or borderline low serum Na+
17
Q
What is the maximum dose that should not be exceeded for HCTZ and chlorthalidone?
A
25-50mg HCTZ
25mg/day chlorthalidone
18
Q
What is the MOA of ACEIs?
A
block RAAS-mediated conversion of AT I to AT II (potent constrictor)
19
Q
What is the effect of ACEIs on the heart?
A
prevent LV hypertrophy
20
Q
What are the first line indications for ACEIs?
A
left ventricular dysfunction
chronic kidney disease
DM
secondary prevention of ischemic stroke
21
Q
What ACEI is NOT once daily dosing?
A
captopril
22
Q
What is the effect of ACEIs on serum?
A
increase serum K+
23
Q
How is GFR affected in pts on ACEIs?
A
GFR decreases
24
Q
How is SCr affected in pts on ACEIs?
A
Screaming increases of 30% OR absolute increases of <1mg/dL are OK
25
What should be done if changes in SCr are not ok?
warrant discontinuation or dose reduction
26
A SE of ACEIs in <1% is angioedema, most common.... (2)
African Americans and smokers
27
What are common side effects of ACEIs?
angioedema precludes any further ACEIs
| 20% of patients development persistent, dry cough
28
When are ACEIs contraindicated?
```
in pregnancy (category X)
do NOT use in combo with ARBS or Aliskiren (tekturna)
```
29
What is the usual dose of enalapril (vasotec)?
PO, IV
5-40mg
1-2 doses
30
What is the usual dose of lisinopril?
10-40mg
| Daily
31
How are ARBs different compared to ACEIs?
ARBs do not block bradykinin metabolism therefore little if any bradykinin-induced cough
32
What benefits are not present in ARBs that IS present with ACEIs?
beneficial effects of bradykinin are not present with ARB use such as myocardial remodeling and regression of myocyte hypertrophy & fibrosis
33
Why shouldn't ACEIs and ARBs be given together?
increased risk of hyperkalemia
34
What antihypertensive has the lowest incidence of SEs?
ARBs
35
Can ARBs be used in pregnancy?
NO
36
What are the common available ARBs?
losartan 50-100mg
1-2 times daily
Valsartan 80-320mg daily
37
What are the 2 classes of calcium channel blockers?
dihydropyridines-vasodilators
| non-dihydropyridines-rate controllers
38
What may cause reflex tachycardia due to potent vasodilation?
dihydropyridines-vasodilators
39
What is significant about dihydropyridines-vasodilators and reflex tachycardia?
more pronounced with first generation DHP (Procardia)
| much less with newer agents (amlodipine)
40
IR nifedipine is associated with what?
increased adverse CV events (AMI in angina patients), so NOT approved for HTN
41
What are the common dihydropyridines-vasodilators?
```
Amlodipine (norvasc)
felodipine (prendil)
isradipine (dynacirc)
nicardipine SR
Nifedipine LA
Nisoldipine
```
42
What are the non dihydropyridines available agents?
SR or CD preferred
Verapamil
Diltiazem
43
What CCB causes constipation?
verapamil
44
When is combination therapy preferred?
for pts with stage 2 HTN
| usually provides better BP control with fewer SEs
45
What are examples of loop diuretics?
furosemide BID
Bumetanide BID
Ethacrinic acid BID, TID
Torsemide QD
46
What loop diuretic is safe for sulfa allergies?
Ethacrinic acid
47
When are loop diuretics reserved?
fir pts with CrCl <30
48
What are weak anti-htn agents that have additive effect in combo with thiazide or loop?
potassium sparing diuretics
49
When are potassium sparing diuretics useful?
in pts with low serum K+
50
What can potassium sparing diuretics cause in pts with CKD and DM?
hyperkalemia
51
What are examples of potassium sparing diuretics ?
Triamtereine
| Amiloride
52
What is it called with triamterine is in combo with HCTZ?
Dyazide
| Maxzide
53
What is considered an independent class of JNC7?
aldosterone antagonist diuretics
54
What is an example of an aldosterone antagonist diuretic?
spironolactone (aldactone)
55
What is common in 10% of pts on spironolactone?
gynecomastia
56
What is the combo with spironolactone/HCTZ?
aldactozide
57
What is the newest aldosterone antagonist diuretic that rarely causes gynecomastia?
Epelrenone
58
What are the secondary beta blockers?
```
"All American Ear Better Meat"
Acebutol
Atenolol
Esmolol
Bisoprolol
Metoprolol
```
59
What is a secondary beta blockers that is alpha and beta blocker?
carvedilol phosphate (coreg CR)
60
What beta blocker has intrinsic sympathomimetic activity (ISA)?
acebutolol (secretal)
61
When is acebutolol (secretal) useful?
if beta blockers cause bradycardia
| cardioselective beta 1>beta2
62
What is a direct renin inhibitor that cannot to used with ACEIs or ARBS and is pregnancy cat X
Aliskiren (Tekturna)
63
What medications are mainly used in pts with BPH?
alpha -1 blockers
64
What are examples of alpha 1 blockers?
Doxazosin
Prazosin
Terazosin
65
When should first alpha 1 blocker be taken?
before bedtime to minimize dizziness and postural hypotension
66
What are the secondary agents that are centrally acting?
clonidine (catapress)
67
What forms is clonidine available?
tabs and transdermal patch replaced weekly
68
What is significant about clonidine?
short acting and fast onset (20-60minutes)
69
When is clonidine often used?
in resistant htn
70
What are the common side effects of clonidine?
anticholinergic side effects
71
What can happen with abrupt cessation of clonidine?
may cause rebound htn therefore taper dose gradually to DC
72
What is the centrally acting agent that is first line for pregnancy induced htn?
Methyldopa (aldomet)
73
What are the forms of methyldopa (aldomet)?
methyldopate injection and tablets
74
What are the 2 mediations that are direct vasodilators?
hydralazine (apresoline) and minoxidil (loniten)
75
Why is hydralazine taken with a diuretic and a beta blocker?
to minimize water mention and reflex tachycardia
76
What can happen at higher doses of hydralazine?
may cause lupus like syndrome & rash
77
What should be taken with Minoxidil?
a loop diuretic and beta blocker
78
What are the vasodilators for HTN emergencies?
```
sodium nitroprusside (CIV)
nitroglycerine (CIV)
```
79
What is the mainstay of treatment for most htn emergencies?
nitroprusside (NTP , Nitropress)
80
What is nitroprusside metabolized to?
cyanide
81
Why is there precauation when giving nitroprusside with renal insufficiency?
nitroprusside is metabolized to cyanide then to thiocyanate which can accumulate with renal insufficiency
82
When should you monitor levels of nitroprusside?
if used > 4 days or @ 4mcg/kg/min
83
What should be added IVPB to nitroprusside starting 2nd bag?
sodium thiosulfate
84
Why is sodium thiosulfate added to nitroprusside IVPB?
accelerate enzyme degradation of cyanide to thiocyanate (much less toxic)
85
What are the uses of nitroglycerin?
acute myocardial infarction (AMI)
| stroke
86
What are precautions of NTG?
development of tolerance
| increase IV administration rate
87
What are the contraindications of NTG?
concurrent use phosphodiesterase 5 inhibitors (ED meds)
88
What is the press of "last resort"?
epinephrine (adrenalin)
89
Why is epinephrine the pressor of last resort?
severe vasoconstriction may cause digital necrosis
90
What naturally occurring neurotransmitter is used for severe hypotension and may cause digital necrosis?
norepinephrine (Levophed)
91
What is the low dose or "renal dose" of dopamine? (Intropin)
1-3 mcg/kg/min
92
What is the effect of low dose dopamine?
dopaminergic agonist effects
93
What is the intermediate dose of dopamine?
3-10mcg/kg/min
94
Why shouldn't low dose dopamine be called "renal-dose dopamine"?
supported by little clinical data at best
| at worst its a myth
95
What is the effect of the intermediate dose of dopamine?
dopaminergic agonist and beta 1 effects
96
What is the high dose of dopamine?
>10mcg/kg/min
97
What are the effects of high dose dopamine
mainly alpha 1 effects
98
What is the pressor of choice that should be considered first?
norepinephrine (Levophed)
99
Dobutamine (Dobutrex) is mainly _____ activity with little ____ or ____ activity.
beta 1 activity
little beta 2 or alpha activity
100
What are the effects of dobutamine (Dobutrex)?
increases cardiac out with little vasoconstriction
| an inotrope with vasodilatory properties
101
What medication is a potent alpha agonist with weak beta agonist activity?
phenylepherine (Neo-Synephrine)
102
What is the effect of phenylepherine (Neo-Synephrine)?
vasocontrictive in arterioles and nasal mucosa
103
When is phenylepherine (Neo-Synephrine) useful?
alternative in those unable to tolerate tachycardia from dopamine and norepinephrine
104
What is the MOA of vasopressin (Pitressin)?
increases water permeability of renal tube
increases water resorption from the tubular lumen
105
What is the result of vasopressin (Pitressin)?
decreased urine volume & increased osmolarity
106
What is the fixed rate of vasopressin?
administer at 0.04 units/min
107
Why does vasopressin have a fixed rate dose?
greater dose may cause cardiac arrest!
108
When is vasopressin used?
in patients in refractory shock "added on" in addition to the use of other pressors
