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Advanced Pharmacology > 5080 - HTN & Hyperlipidemia > Flashcards

5080 - HTN & Hyperlipidemia Flashcards

Exam 1 study guide review

1
Q

CMA

A

Cost minimization analysis - compares cost of 2 different interventions where outcomes are not necessarily equal or even measured. Should only be used when outcomes are identical.

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2
Q

Cost minimization analysis

A

How hospital formularies are developed

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3
Q

CBA

A

Cost benefit analysis - dollar signs assigned to treatments as well as outcomes. As ratio or an actual dollar amount.

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4
Q

CEA

A

Cost effectiveness analysis - commonly used. Compares multiple treatments that have different costs.

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5
Q

CUA

A

Cost utility analysis - takes patient preference into analysis. Often reported as quality adjusted life years.

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6
Q

quality adjusted life years

A

CUA - cost utility analysis

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7
Q

Medicare PART A

A

hospital insurance

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8
Q

Medicare PART B

A

outpatient medical insurance

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9
Q

Medicare PART D

A

prescription drug plan

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10
Q

Dosage form versus delivery system

A

Delivery system talks about how the dose form is delivered

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11
Q

Routes of administration

A

Oral: PO
Parenteral: IV, SC, IM
Sublingual; Inhalation; Rectal; Vaginal; Ocular; Nasal; Transdermal

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12
Q

How many Americans have HTN?

A

75 million

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13
Q

90% of people over 55 have:

A

HTN

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14
Q

Primary hypertension:

A

90% of cases - multifactorial response

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15
Q

Secondar hypertension:

A

10% of cases - with specific and known direct cause. Most common in renal dysfunction. Also sleep apnea, Cushing’s and other.

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16
Q

Meds can cause HTN specifically:

A

Stimulants, immunosuppressants, decongestants, high-dose NSAIDs

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17
Q

Uncontrolled HTN can lead to:

A

MI, stroke, renal failure and death

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18
Q

Measure what doubles cardiovascular risk in HTN:

A

Every 20/10 reading

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19
Q

MAP is:

A

1/3 SBP + 2/3 DBP

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20
Q

BP patho is:

A

Cardiac output + total peripheral resistance

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21
Q

RAAS stands for:

A

Renin angiotensin aldosterone system

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22
Q

RAAS does what:

A

effects blood pressure by manipulating sodium., potassium and blood volume

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23
Q

BP 140/90 is:

A

prehypertension

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24
Q

BP 160/100 is:

A

stage 1 hypertension

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25
Q

BP >160/100 is:

A

stage 2 hypertension

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26
Q

Clinical presentation of BP:

A

Asymptomatic

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27
Q

Risk factors for HTN:

A

Age, DM, hyperlipidemia, family hx, obesity, inactivity, tobacco use

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28
Q

Lab tests for HTN:

A

BUN, serum creatinine, fasting lipids, blood glucose, electrolytes, Hb/Hct. Values may be normal, but will help identify other cardiac risk factors or end organ damage

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29
Q

HTN complications:

A

kidney disease, stroke, CVD, retinopathy, PAD

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30
Q

ACE inhibitors:

A

Inhibits conversion from angiotensin 1 to angiotensin 2. Also blocks bradykinin which causes cough from ACE inhibitors.

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31
Q

ACE inhibitors are proven to:

A

Reduce cardiovascular risk as well as chronic kidney disease.

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32
Q

ACE inhibitors are first-line therapy for:

A

DM, stroke, and post MI

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33
Q

ACE inhibitors can increase which electrolyte:

A

Potassium

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34
Q

Do not use ACE inhibitors during:

A

Pregnancy

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35
Q

ARB (angiotensin receptor blockers) are:

A

Similar to ACE inhibitors by blocking angiotensin 2 regardless of pathway. No cough with ARBs. Generally equivalent to ACE however fewer side effects.

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36
Q

Thiazide diuretics are:

A

First-line medications for HTN or as a combination. They are preferred.

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37
Q

What is the classifications of: Benezepril, Catopril, Enalapril, Fosinopril, Lisinopril, Moxepril, Periindopril, Quinapril, Ramipril, and Trandolapril?

A

ACE inhibitors for treating HTN

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38
Q

What are the classifications of: Azilsartan, Candesartan, Eprosartan, Irbesartan, Losartan, Olmesartan, Telmisartan, and Valsartan?

A

ARBs (angiotensin receptor blockers) for treating HTN

39
Q

Thiazide diuretics are dosed in:

A

The morning

40
Q

Thiazide diuretics adverse events are:

A

Electrolyte abnormalities and hyperuricemia (high uric acid in the blood)

41
Q

What is the classification of: Chlorthalidone, Hydrochlorothiazide, Indapamide, Metolazone?

A

Thiazide diuretics

42
Q

Calcium channel blockers two classes are:

A

Dihydropyridines (potent vasodilators) and Non-dihydropyrides (decrease heart-rate and AV node conduction)

43
Q

Calcium channel blockers work by:

A

Inhibiting the influx of calcium across the membrane

44
Q

What is the classification of: Amlodipine, Felodipine, Isradipine, Nicardipine, Nifedipine, and Nisoldipine?

A

Dihydropyridine calcium channel blockers

45
Q

What is the classification of: Diltiazem (SR, CD, XT, XR, LA), and Verapamil (SR):

A

Non-dihydropyridine calcium channel blockers

46
Q

Adverse effects of non-dihydropyridine calcium channel blockers:

A

Hypotension, AV block, bradycardia

47
Q

Drug interactions of non-dihydropyridine calcium channel blockers:

A

CYP 3A4 inhibitors and grapefruit juice

48
Q

Loop diuretics are:

A

Treatment of HTN but NOT first-line tx

49
Q

What is the classification of: Bumetanide, Furosemide and Torsemide:

A

Loop diuretics

50
Q

Adverse events of loop diuretics

A

Hypokalemia and hypocalcemia

51
Q

What is the classification of: Amiloride, and Triamterene:

A

Potassium sparing diuretics (for HTN)

52
Q

What is the classification of: Eplerenone, Spironolactone:

A

Aldosterone antagonists (for HTN)

53
Q

What is the classification of: Atenolol, Meteprolol tartrate/succinate?

A

Cardioselective beta blockers (for HTN)

54
Q

What is the classification of: Nadolol, Propranolol

A

Nonselective beta blockers (for HTN)

55
Q

What is the classification of: Carvedilol, Nebivolol:

A

Mixed alpha and beta blockers (for HTN)

56
Q

What is the classification of: Doxazosin, Prazosin, Terazosin:

A

Alpha blockers (for HTN)

57
Q

What is the classification of: Aliskiren:

A

Direct renin inhibitors (for HTN)

58
Q

What is the classification of: Clonidine, Methyldopa:

A

Central alpha2-agonists (for HTN)

59
Q

What is the classification of: Reserpine:

A

Peripheral Adrenergic Antagonists (for HTN)

60
Q

What is the classification of: Minoxidil, Hydralazine:

A

Direct arterial vasodilators (for HTN)

61
Q

Monitor __ for ACE & ARBs:

A

BP, BUN, Serum Creatinine, Potassium

62
Q

Monitor __ for Calcium Channel Blockers and Beta Blockers:

A

BP, HR

63
Q

Monitor __ for diuretics:

A

BP, BUN, Serum Creatinine, Potassium, Magnesium, Sodium - and uric acid for thiazides

64
Q

Nonpharmacological therapy for HTN:

A

Weight loses, sodium restriction, limit alcohol, increase physical activity, smoking cessation

65
Q

Compelling indications for HTN therapy are:

A

Heart failure with reduced ejection fraction; post MI; Coronary artery disease; DM; Chronic kidney disease; stroke

66
Q

Chylomicrons, VLDL, LDL, HDL are:

A

Lipoproteins

67
Q

Atherogenic development causes/is evidenced by:

A

Angina, MI, arrhythmias, stroke and PAD

68
Q

Cytokine recruitment and plaque formation is cause by:

A

Inflammatory cascade promoted by LDL on the artery wall

69
Q

Laboratory tests for hyperlipidemia:

A

TC, LDL, Triglycerides, HDL, CRP, ApoB

70
Q

Assess these risk factors: ___ every ___ years in patients __ to __ years old.

A

1: Medical history, physical exam, fasting lipid panel, ASCVD risk. 2: 4- years. 3: 20-79 years old

71
Q 
Target lab values for cholesterol:
Total:
HDL:
LDL:
Triglycerides:
A

Total: <200 mg/dL
HDL: >= 60 mg/dL
LDL: <100 mg/dL
Triglycerides: <150 mg/dL

72
Q

HMG-CoA Reductase Inhibitors are:

A

Statins

73
Q

What statin intensity of:
Atorvastatin 80mg
Rosuvastatin 40mg

A

High intensity LDL >=50%

74
Q 
What statin intensity of: 
Atorvastatin 20mg
Rosuvastatin 10mg
Simvastatin 20-40mg
Pravastatin 80mg
Lovastatin 80mg
Pitavastatin 4mg
A

Moderate intensity LDL 30-50%

75
Q 
What statin intensity of:
Fluvastatin 10-20mg
Lovastatin 20mg
Pitavastatin 10-20mg
Simvastatin 10mg
A

Low intensity LDL <30%

76
Q

Statin metabolism for Lovastatin, Simvastatin and

Atorvastatin:

A

CYP 3A4

77
Q

Statin metabolism for Fluvastatin and Rosuvastatin:

A

CYP 2C9

78
Q

Statin metabolism for Pitavastatin:

A

UGT1A3

79
Q

Statin metabolism for Pravastatin:

A

Not oxidized

80
Q

Adverse events of statin medications for hyperlipidemia:

A

Rhabdomyolysis (death of muscle fibers = muscle injury), elevated serum transaminase, PREGNANCY CATEGORY X

81
Q

Clinical controversies with statin medications:

A

Cancer, diabetes and cognition

82
Q

Statin myopathy is __ and how to reverse:

A

Myopathy, myalgia (muscle pain), myositis (muscle inflammation), rhabdomyopathy - so alway measure baseline CK before initiating - to reverse adverse effects, DC offending agent.

83
Q

Ezetimibe (Zetia) is:

A

Cholesterol absorption inhibitor by blocking NPC1L1. Used as second line agent. It lacks the morbidity or mortality benefit in cardiovascular disease. Reduces LDL by 19% as single agent.

84
Q

What classification is: Fenofibrate, Gemfibrozil:

A

Fibrate medication that reduces triglycerides by 50%, reduces CVD mortality, provides small increase in HDL.

85
Q

When is Fenofibrate or Gemfibrozil used:

A

When triglycerides are >500 mg/dL to treat cholesterol

86
Q

Adverse events of Fibrates:

A

Myalgias, renal insufficiency

87
Q

Drug interactions of Fibrates:

A

Warfarin (INR concerns) and with Gemfibrozil, statins.

88
Q

What classification is: Cholestyramine, Colestipol, Colesevela,:

A

Bile acid sequestrates. Usually have high adverse drug reactions in GI and high drug interaction profiles.

89
Q

What is a second line agent that can increase HDL and decrease TGs:

A

Niacin, by reducing hepatic synthesis of VLDL and decreases hepatic removal of HDL.

90
Q

Adverse effects of Niacin:

A

flushing, itching, hepatotoxicity, concern for pre-existing gout and DM

91
Q

What OTC with primary use to treat hypertriglyceridemia and reduce CAD risk:

A

Omega-3 fatty acids

92
Q

What adverse event concern with Omega-3 fatty acids:

A

Alter INR

93
Q

Nonpharmacological interventions for hyperlipidemia:

A

Dietary counseling, reduce saturated fats, increase fiber, weight control, physical activity

94
Q

Treatment goal of hyperlipidemia therapy:

A

Prevention of ASCVD using fixed dose statin therapy (in moderate to high)

Advanced Pharmacology (2 decks)

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