Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Block 9 Week 2 > Antihypertensive Therapy- Earley > Flashcards

Antihypertensive Therapy- Earley Flashcards

1
Q

What is normal BP?
Prehypertensive?
Hypertensive stage 1?
Hypertensive stage 2?

A 
less than 120, less than 80
120-139 or 80-89
greater than 140 or 90
140-159 o 90-99
greater than 160 or greater 100
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the therapeutic goal for someone less than 60 years old?
For someone greater than 60?
For someone with diabetes and/or Chronic Kidney Disease?

A

less than 140 and less than 90
less than 150 and less than 90
less than 140 and less than 90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

(blank) hypertension is when the cause isn’t known. What percent of cases have this?

A

essential HTN

85-90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What causes secondary HTN?

A 
Sleep apnea
Drug-induced or related causes
Chronic kidney disease
Primary aldosteronism
Renovascular disease
Chronic steroid therapy and Cushing’s syndrome
Pheochromocytoma
Coarctation of the aorta
Thyroid or parathyroid disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are contributing factors to essential HTN?

A 
Obesity
Stress
Lack of exercise
Diet (excess dietary salt)
Alcohol intake
Smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the prevalence of HTN?

A

30% of all adults in US
(similar rates for men and women)
Highest prevalence in elderly (60-80% by age 80)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Among adults with hypertension:

83% were (blank)
76% were taking (blank) to lower their blood pressure
52% were (blank)

A

aware
medication
controlled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are complication of HTN?

A
  • CV diseases (stroke, atherosclerosis, heart failure)
  • Renal damage
  • Retinal damage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Starting at 115/75, risk (blank) each increase of 20/10 mmHg of having HTN complications

A

doubles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the overview of HTN?

A
  • lifestyle modification
  • antihypertensive drugs
  • follow-up and monitoring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

These are the lifestyle modifications necessary for HTN control:
Reduce weight to normal BMI (

A

5-20 mmHg/10kg loss
8-14 mmHg
2-8 mmHg
4-9 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does DASH stand for in the DASH diet?

A

Dietary Approach to Stop HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do you calculate MAP (mean arterial pressure)?

How do you calculate CO?

A

MAP=CO X PVR

CO=HR X SV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What affects HR and contractility?

A

ANS
BV
venous tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What affect PVR?

A 
Circulating factors (NE, Ang II)
SNS activation
local mechanisms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the four antihypertensive drug classifications?

A
  • Diuretics
  • Agents affecting adrenergic function (Sympathoplegics)
  • Vasodilators
  • Agents affecting the Renin Angiotensin Aldosterone System (RAS)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the most commony used diuretics?

A

thiazides (chlorothiazide, hydrochorothiazide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the three major types of diuretics?

A
  • Thiazides
  • Loop diuretics
  • Potassium sparing diuretics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What diuretic will you use for a case of severe HTN or heart failure? What are some of these?

A

Loop diuretics

Furosemide, bumetanide, ethacrynic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What diuretic will you use for reduction in heart failure mortality and what are some examples of these?

A

Potassium sparing diuretics

-spironolactone, triamterene, amiloride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the initial effects of diuretics?

A

-increase Na+ and water excretion. Decrease CO due to decreased BV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the effects of diuretics after 6-8 weeks?

A

CO returns to normal but PVR declines (poorly understood)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How much do diuretics lower BP?

A

10-15 mmHg in most patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the toxic effects of diuretics?

A
  • K+ depletion (except K+ sparing diuretics)
  • **can be minimized by limiting Na+ intake
  • Mg2+ depletion, impaired glucose tolerance, and increase serum lipid concentration
  • Gout (increased uric acid)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are these affected by:

  • Heart cardiomyocytes, SA and AV node
  • Vascular smooth muscle
A

Adrenergic function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is this:

agent that prevents adrenergic transmission

A

reserpine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is this:

selective alpha-1 agrenergic receptor blockers

A

Prazosin, terazosin, Doxazosin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

If you see a zosin word what does this mean?

A

alpha 1 antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are some agents that act directly on the CNS?

A

Methyldopa

Clonidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How does reserprine work?

A

depletes neurotransmitters (e.g NE) in the nerve endings in the BRAIN AND PERIPHERY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the main effect of reserpine?

A

depress sympathetic nervous system function centrally and peripherally-> decreased HR, decreased contractility and PVR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How does reserpine affect HR? Contractility? PVR?

A

It is going to reduce sympathetics to the heart
decrease HR
decrease contractility
decrease PVR

33
Q

What are the adverse effects of Reserpine?

A 
DEPRESSION
insomnia
NIGHTMARES
ulcers
diarrhea
abdominal cramping
nasal stuffiness
ORTHOSTATIC HYPOTENSION
dry mouth
IMPOTENCE
34
Q

What is the pharmacokinetics behind Reserpine?

How often do you use this?

A
  • onset is slow and full effect is seen in weeks

- Infrequently

35
Q

What is the mechanisms behind selective alpha-1 adrenergic receptor blockers (prazosin, terazosin, doxazosin)?
What are the main effects of these?
What are the adverse effects of these?

A
  • block alpha1 receptors in vasculature
  • decreased PVR-> decreased BP

-1st DOSE PHENOMENON (severe drop in BP when going from laying down to standing)
fluid retention, DIZZINESS, headache

36
Q

When do you use alpha 1 adrenergic receptor blockers?

A

used in stage 1 and stage 2 HT in combination with a diuretic and a beta-blocker

37
Q

What are the 2 ways to classify beta blockers?

A

nonselctive (1st gen and 3rd gen)

Cardiselective (2nd gen, Beta 1 selective)

38
Q

What is the mechanism behind beta blockers?

A

block cardiac B1 receptors-> lower CO

Block renal B1 receptos-> lower renin, lower PVR

39
Q

What kind of beta blocker is propranolol?
What is the main effect?
What are the adverse effects?

A

Non-selective Beta blocker

-bradycardia, depression, AGGRAVATES ASTHMA (B2 blockade in airways)

40
Q

When do you use propranolol?

A

-Stage 1 and 2 HT alone or in combo with a diuretic and/or vasodilator

41
Q

What are the drug interactions with propranolol?

A

-Verapamil (CCB), dilitiazem (CCB), digitalis (possible AV block)

42
Q

What are the most widely used beta-blockers for HTN?

What are these more selective for?

A
  • Metoprolol and Atenolol

- selective for B1 (less bronco constriction)

43
Q

(blank) is a combined nonselective beta and alpha 1 blocker. BUT beta blocking action is more prominent

A

Labetalol

44
Q

When do you use labetalol?

A

used IV for hypertensive emergencies

45
Q

What are agents that act on the CNS? What class of drugs are these?

A
  • alpha-methyldopa and clonidine

- alpha 2 agonists

46
Q

What is the mechanism of alpha-methyldopa?

A

a-methyldopa metabolized to a-methyl norepinephrine which is an a2 AGONIST which will suppress SNS output from the SNS

47
Q

What are the main effects of a-methyldopa, clonidine?

What are the adverse effects of these?

A
  • decreases PVR and HR

- SEDATION, drowsiness, DRY MOUTH, IMPOTENCE, bradycardia, withdrawal syndrome (rebound HT)

48
Q

What is the use of clonidine?

What is the use of methyldopa?

A

Stage 1 and 2 HT

Methyldopa, HT during pregnancy

49
Q

What are the three types of vasodilator drugs?

A

CCB (nifedipine)
Direct acting vasodilators (sodium nitroprusside)
Potassium Channel openers (minoxidil)

50
Q

How do CCBs work?

A

Inhibit calcium entry through L-type voltage gated calcium channels

51
Q

What are the three major types CCBs?

A

Phenylalkylamines

Benzothiazepines

Dihydropyridines

52
Q

What is an example of a phenylalkyamine?
What is an example of a benzothiazepine?
What is an example of a dihydropyridine?

A

verapamil
diltiazem
amlodipine

53
Q

What does this:
Selective blockade of vascular calcium channels
What is the main effect of this?

A

Amlodipine

Vasodilation-> lower PVR-> lower BP

54
Q

What are the adverse effects of amlodipine?

What is the use of amlodipine?

A
  • headache, FLUSHING, nausea, dizziness, ANKLE EDEMA, REFLEX TACHYCARDIA
  • HTN (more effective in AAs) and angina
55
Q

How does Verapamil and Diltiazem work?

A

Blockade of calcium channels in the vasculature, heart muscle and AV node

56
Q

What are the main effects of Verapamil and Dilitiazem?

A

Vasodilation-> lower PVR-> lower BP

i.e calcium channel blockers cause vasodilation and lower BP

57
Q

What are the adverse effects of verapamil and diltiazem?

A

Similiar to amlodipine but DO NOT CAUSE REFLEX TACHYCARIA

58
Q

What are the drug interaxns for verapamil and diltiazem?

A

Caution for AV block when used with beta blockers, and digitalis (amlodipine does not have this effect)

59
Q

What kind of drug is sodium nitroprusside and how does it work?

A

direct acting vasodilator

-increase cGMP -> increase NO-> vasodilation (of veins and arteries)

60
Q

What is the main effect of nitroprusside (IV)?

What are the adverse effects?

A

Vasodilation-> lower PVR-> lower BP

-REFLEX tachycardia, severe hypotension, POSSIBLE CYANIDE POISONING

61
Q

What are the pharmacokinetics of na-nitroprusside?

What is the use for it?

A
  • rapid acting, IV drip, short plasma half-life

- HTN Emergencies!

62
Q

What kind of drug is minoxidil?

How does it work?

A

Potassium channel openers
-> opens K+ channel-> SM hyperpolarization-> smooth muscle relaxation-> arterial dilation->decreased PVR-> decreased BP
(causes excessive hair growth, active ingredient in Rogaine)

63
Q

What are the three types of agents that affect RAS?

A

ACE inhibitors
Angiotensin II receptor blockers (ARB)
Renin inhibitors

64
Q

What are the commonly used Angiotensin II receptor blockers?

A

Losartan, valsartan, irbesartan

ARTAN=Angiotensin II blockers

65
Q

What are the commonly used ACE inhibitors?

A

Captopril, Enalapril, Lisinopril

PRIL= ACE inhibitors

66
Q

What is the MOA of ace inhibitors (captopril, enalapril, lisinopril, rampiril)?
What are the adverse effects?
What is the use?

A

inhibit ACE-> lower Ang II level
-> decreased PVR-> decreased BP (not as effective in AAs)

Skin rash, weird taste, COUGH, HYPERKALEMIA

Stage 1 and 2 HT, also for CHF

67
Q

What is the drug of choice in HT paitent with diabetes and why?

A

ACE inhibitors because they do not effect plasma lipids and glucose

68
Q

What drugs are contraindicated in pregnancy?

A

ACE inhibitors

69
Q

What is the mechanism of angiotensin II receptor blockers (ARB)-> losartan, valsartan, irbesartan)?
What are the adverse effects of ARB?

A

selectively blocks ang II receptor-> decrease PVR-> decrease BP

NO COUGH, otherwise same as ACE inihibitors (skin rash, weird taste, hyperkalemia)

***causes fetal toxicity)

70
Q

What type of drug is Aliskiren?

What does it do?

A

a renin inhibitor

-inhibits the conversation of angiotensinogen to angiotensin I, the rate limiting step of the RAS

71
Q

Is Aliskiren (renin inhibitor) more or less effective than ACE inhibitors and ARBs at lowering BP?

A

equally effective (or better) at lowering BP

72
Q

What are the side effects of Aliskiren (renin inhibitor)?

A

Diarrhea, stomach pain, heartburn, cough, rash, dizziness, headache, back pain. FETAL TOXICITY!

73
Q

Who shouldn’t you give Aliskiren to?

A

pregnant women

w/ ARBs or ACE inhibitors in pnts with diabetes and/or chronic kidney disease

74
Q

How do you treat HTN in a non diabetic or non CKD patient who is older than 18?

A

lifestyle interventions
If non black-> give thiazide type diuretic, ACEI, or ARB, or CCB in combo or alone
if Black-> Thiazide diuretic or CCB in combo or alone

75
Q

How do you treat HTN in a diabetic or CKD patient who is older than 18?

A

Initate ACEI or ARB, alone or in combo

76
Q

What are the three ways to give antihypertensive drugs?

A
  1. start on drug, titrate to max dose, then add second drug
  2. start one drug, add second drug before max dose of first drug has been reached
  3. begin with 2 drugs at same time
77
Q

What is resistant HTN?

How common is this?

A

BP > 140/90 mmHg (130/80 with diabetes and CKD) for patients prescribed 3 or more antihypertensive meds at optimal doses
OR
BP controlled with 4 or more antihypertensive drugs

-Up to 40% of all HTN patients (range 10-40%)

78
Q

How do you increase pnt adherence?

A
  • monopharmacy and simple dosing
  • RAS drugs and CCBs have greater adherence than diuretics and beta blockers
  • diet change adherence is bad

Block 9 Week 2 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions