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Pharmacology II > Antihypertensives B > Flashcards

Antihypertensives B Flashcards

1
Q

What are eight antihypertensive agents?

A
  1. Diuretics
  2. Central-acting Sympatholytics
  3. Peripheral-acting Sympatholytics
  4. Beta blockers
  5. ACE inhibitors
  6. Angiotensin II antagonists (ARBs)
  7. Calcium-channel blockers (CCBs)
  8. Direct vasoldilators
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2
Q

True or False:

Most diuretics are fairly inexpensive.

A

True

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3
Q

True or False:

Diuretics have a lower side effect profile than other antihypertensives.

A

False

(They have a higher side effect profile)

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4
Q

True or False:

Diuretics are often used in combination with other antihypertensives.

A

True

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5
Q

True or False:

When using diuretics, the higher the dose, the more it will lower blood pressure.

A

False

(BP lowering effects not necessarily dose related)

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6
Q

Which diuretic is most commonly used for blood pressure?

A

Thiazides

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7
Q

What is the MOA for thiazide diuretics?

A
  • Inhibit Na+ and Chloride reabsorption at distal tubule
  • Promotes Na+ and H2O loss
  • Decreases blood volume
  • Decreases preload
  • Lowers BP
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8
Q

What is the thiazide prototype?

A

Hydrochlorothiazide

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9
Q

What is the route for Hydrochlorothiazide?

A

PO

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10
Q

What is the usual dose for Hydrochlorothiazide?

A

12.5 - 50 mg qd

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11
Q

What are three common indications for Hydrochlorothiazide?

A
  1. Htn
  2. Peripheral edema
  3. HF
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12
Q

How is Hydrochlorothiazide metabolized?

A

There is no metabolization

(excreted unchanged)

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13
Q

How is Hydrochlorothiazide excreted?

A

Renal

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14
Q

What are the four side / adverse effects of Hydrochlorothiazide?

A
  • Hypokalemia
  • Hypomagnesemia
  • Hyperuricemia
  • Hyperglycemia
  • Hyper-pee-emia
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15
Q

What are six precautions for Hydrochlorothiazide?

A
  1. Volume depletion
  2. Electrolyte abnormalities
  3. Severe renal impairment
  4. Arrythmias
  5. History of gait
  6. Diabetes
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16
Q

True or False:

Hydrochlorothiazide is generally safe and well-tolerated.

A

True

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17
Q

What kind of drug is Dofetilide (Tikosyn)?

A

Dysrhythmic

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18
Q

When Hydrochlorothiazide interacts with Dofetilide (Tikosyn), what happens?

A

Prolonged QT / other arrythmias

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19
Q

What are the four central-acting sympatholytics?

A
  1. Guanfacine (Tenex)
  2. Clonidine (Catapres)
  3. Guanabenz (Wytensin)
  4. Methyldopa (Aldomet)
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20
Q

Which central-acting sympatholytic is the drug of choice for Htn in pregnancy?

A

Methyldopa (Aldomet)

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21
Q

What is the route for Guanfacine (Tenex)?

A

PO

(Central-Acting Sympatholytic)

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22
Q

What is the route for Clonidine (Catapres)?

A

PO

(Central-Acting Sympatholytic)

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23
Q

What is the route for Guanabenz (Wytensin)?

A

PO

(Central-Acting Sympatholytic)

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24
Q

What is the route for Methyldopa (Aldomet)?

A

PO

(Central-Acting Sympatholytic)

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25
Q

What is the MOA for central-acting sympatholytics?

A
  • Stimulate alpha-2 receptors in the brain (agonist)
  • Repeated stimulation of receptors shuts down release of NE to
    • Heart
    • Kidneys
    • Peripheral Vascular
  • Reduces total PVR ⇢ Lowered BP
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26
Q

What is the centrally-acting sympatholytic prototype?

A

Methyldopa (Aldomet)

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27
Q

What is the usual dosage for Methyldopa (Aldomet)?

A

250 - 500 mg bid

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28
Q

What are the two indications for Methyldopa (Aldomet)?

A
  • Moderate to severe HTN
  • Hypertensive states in PG
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29
Q

How is Methyldopa (Aldomet) metabolized?

A

Liver

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30
Q

How is Methyldopa (Aldomet) excreted?

A

Primarily renal (some feces)

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31
Q

What are the eight select adverse / side effects of Methyldopa (Aldomet)?

A
  1. Sedation
  2. Bradycardia
  3. HA
  4. GI upset
  5. Dry mouth
  6. Depression
  7. Orthostatic hypotension
  8. Rebound hypertension
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32
Q

True or False:

Rebound hypertension from sudden withdrawal from Methyldopa (Aldomet) may be higher than pre-treated blood pressure

A

True

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33
Q

What are the four significant drug interactions of Methyldopa (Aldomet)?

A
  1. MAOIs (Monoamine oxidase inhibitors)
  2. Oral Fe+
    • In pregnant ladies, separate doses by 2 hours
  3. Caution with levodopa
  4. General anesthetics
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34
Q

What is Methyldopa (Aldomet) contraindicated to?

A

Active hepatic disease

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35
Q

What are the four peripheral-acting sympatholytics?

A
  1. Doxazosin (Cardura)
  2. Prazosin (Minipress)
  3. Terazosin (Hytrin)
  4. Reserpine (Serpasil)
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36
Q

What is the route for Doxazosin (Cardura)?

A

PO

(Peripheral-Acting Sympatholytic)

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37
Q

What is the route for Prazosin (Minipress)?

A

PO

(Peripheral-Acting Sympatholytics)

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38
Q

What is the route for Terazosin (Hytrin)?

A

PO

(Peripheral-Acting Sympatholytic)

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39
Q

What is the route for Reserpine (Serpasil)?

A

PO

(Peripheral-Acting Sympatholytic)

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40
Q

Which peripheral-acting sympatholytic is currently unavailable in the US but will probably be back soon?

A

Reserpine (Serpasil)

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41
Q

What are peripheral-acting sympatholytics also known as?

A

Alpha-1 Blockers

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42
Q

What is a possible side effect for peripheral-acting sympatholytics, especially on the first dose?

A

Orthostatic hypotension

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43
Q

Besides Htn, some peripheral-acting sympatholytics are also used for what?

A

Benign Prostatic Hyperplasia (BPH)

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44
Q

What is the MOA for peripheral sympatholytics?

A
  • Block alpha-1 receptors in arterioles and veins
  • Prevents NE from binding to receptors
  • Decreases CO and / or PVR
  • Lowers BP
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45
Q

How do alpha-1 blockers treat benign prostatic hyperplasia (BPH)?

A
  • Blocks alpha-1 receptors found in smooth muscle lining of prostate gland bladder neck
  • Relaxation of smooth muscle in prostate gland and bladder neck
  • Improved urine flow and decreased BPH symptoms
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46
Q

What is the Alpha-1 blocker prototype?

A

Doxazosin (Cardura)

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47
Q

What is the route for Doxazosin (Cardura)?

A

PO

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48
Q

What is the usual dose for Doxazosin (Cardura)?

A
  • Htn:
    • Initially 1 mg qd - may titrate up over several weeks
    • Max 16 mg/day
  • BPH:
    • 4-8 mg/d
    • Max 8 mg/day
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49
Q

What are the two indications of Doxazosin (Cardura)?

A
  1. Htn
  2. BPH
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50
Q

How is Doxazosin (Cardura) metabolized?

A

Liver

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51
Q

How is Doxazosin (Cardura) excreted?

A

Primarily feces (some part renal)

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52
Q

What are the five adverse / side effects of Doxazosin (Cardura)?

A
  1. Syncope
  2. Orthostatic hypotension
  3. Arrythmias
  4. HA
  5. Priapism
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53
Q

What is / are the contraindication(s) for Doxazosin (Cardura)?

A

Prostate cancer

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54
Q

What is / are the precaution(s) for Doxazosin (Cardura)?

A

Impaired liver function

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55
Q

What are the four significant interactions of Doxazosin (Cardura)?

A
  1. Cimetadine (Tagamet)
  2. Verapamil (Calan)
  3. Sildenafil (Viagra)
  4. Tamsulosin (Flomax)
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56
Q

What are the four indications for calcium channel blockers (CCBs)?

A
  1. Htn
  2. Angina
  3. Dysrhythmias
  4. Headache prohlyaxis
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57
Q

Calcium channel bloackers have variable effects on what two things?

A
  1. HR
  2. AV node conduction
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58
Q

What are the eight dihydropyridine CCBs?

A
  1. Nifedipine (Procardia)
  2. Amlodipine (Norvasc)
  3. Felodipine (Plendil)
  4. Isradipine (DynaCirc)
  5. Nicardipine (Cardene)
  6. Nisoldipine (Sular)
  7. Clevidipine (Cleviprex)
  8. Nimodipine
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59
Q

What are the three dihydropyridine CCBs that have in angina indication?

A
  1. Nifedipine (Procardia)
  2. Amlodipine (Norvasc)
  3. Nicardipine (Cardene)
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60
Q

Which dihydropyridine CCB is not used for Htn but instead is used for subarachnoid hemorrhage?

A

Nimodipine

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61
Q

What is the route for Nifedipine (Procardia)?

A

PO

(Dihydropyridine CCB)

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62
Q

What is the route for Amlodipine (Norvasc)?

A

PO

(Dihydropyridine CCB)

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63
Q

What is the route for Felodipine (Plendil)?

A

PO

(Dihydropyridine CCB)

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64
Q

What is the route for Isradipine (DynaCirc)?

A

PO

(Dihydropyridine CCB)

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65
Q

What is the route for Nicardipine (Cardene)?

A

PO / IV

(Dihydropyridine CCB)

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66
Q

What is the route for Nisoldipine (Sular)?

A

PO

(Dihydropyridine CCB)

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67
Q

What is the route for Clevidipine (Cleviprex)?

A

IV

(Dihydropyridine CCB)

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68
Q

What is the route for Nimodipine?

A

PO

(Dihydropyridine CCB)

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69
Q

What are the two non-dihyrdropyridine CCBs?

A
  1. Verapamil (Calan)
  2. Diltiazem (Cardizem)
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70
Q

What are the two non-dihydrophyridine CCBs indicated for?

  • Verapamil (Calan)
  • Diltiazem (Cardizem)
A

Angina

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71
Q

What is the route for Verapamil (Calan)?

A

PO

(Non-Dihydropyridine CCB)

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72
Q

What is the route for Dilitiazem (Cardizem)?

A

PO / IV

(Non-Dihydropyridine CCB)

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73
Q

What is the MOA of CCBs?

A
  • Inhibit Ca++ influx into vascular smooth muscle and cardiac myocytes
    • Dilates peripheral arterioles (vasodilation)
    • Dilates coronary arteries (increase oxygen supply to heart)
    • Decreases cardiac contractility ( - Inotrope)
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74
Q

In addition to

  • vasodilation
  • increase oxygen supply to heart
  • negative inotrope

what are two more effects of CCBs’ MOA?

What is the net effect on BP?

A
  1. Decreases SA node automaticity
  2. Decreases AV node conduction

Decreases PVR which lowers BP

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75
Q

Which drug is the least selective of the CCBs? What does this mean in terms of adverse / side effects?

A

Verapamil (Calan)

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76
Q

Verapamil (Calan) has significant action on what two things?

A
  • Heart
  • Vessels
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77
Q

Which drug is the most potent negative inotropic of the CCBs?

A

Verapamil (Calan)

78
Q

What is the dihydropirdine prototype?

A

Amlodipine (Norvasc)

79
Q

What is the usual dose of Amlodipine (Norvasc)?

A

2.5 - 10 mg / day

80
Q

What are the two indications for Amlodipine (Norvasc)?

A
  1. Htn
  2. Angina
81
Q

How is Amlodipine (Norvasc) metabolized?

82
Q

How is Amlodipine (Norvasc) excreted?

A
  1. Renal
  2. Bile
  3. Feces
83
Q

What are the three precautions of Amlodipine (Norvasc)?

A
  1. Hepatic impairment
  2. Aortic stenosis (vasodilation may cause decrease in CO)
  3. CAD / Unstable angina (Norvasc may exacerbate)
84
Q

What are the eight adverse / side effects of Amlodipine (Norvasc)?

A
  1. Vertigo
  2. Palpitations
  3. Myalgias
  4. Headache
  5. Dyspepsia
  6. Peripheral edema
  7. Gynecomastia
  8. Flushing
85
Q

Beta blockers may be used for Htn when certain co-morbitidities are present. What are these?

A
  1. SVT
  2. Angina
  3. Post MI
  4. Migraine
86
Q

What kind of drugs may be used cautiously in patients with chronic lung disease and / or diabetes?

A

SELECTIVE beta-1 blockers

87
Q

What are ten indications for beta-blockers as a class?

A
  1. Hypertension (no longer 1st line)
  2. Hyperthyroidism
  3. Heart failure
  4. Angina
  5. Post-MI prophylaxis
  6. Panic attacks
  7. Performance anxiety
  8. Migraine prophylaxis
  9. Essential tremor
  10. Dysrhythmias
88
Q

What are the four effects of Beta-1 receptors?

A
  1. Positive chronotropic
  2. Positive inotropic
  3. Positive dromotropic
  4. Renin release from kidneys
89
Q

What are the three effects of Beta-2 receptors?

A
  1. Smooth muscle relaxation
  2. Smooth muscle tremor
  3. Glycongenolysis of liver / muscle
90
Q

What are the seven non-selevtive beta blockers?

A
  1. Carvedilol (Coreg)
  2. Labetalol (Trandate)
  3. Nadolol (Corgard)
  4. Propranolol (Inderal)
  5. Timolol (generic)
  6. Pindolol (generic)
  7. Penbutol (Levatol)
91
Q

What are the only beta blockers with indication for migrain prophylaxis?

A
  1. Nadolol (Corgard)
  2. Propranolol (Inderal)
  3. Timolol (generic)
92
Q

What is the route for Carvedilol (Coreg)?

A

PO

(Non-selevtive beta blockers)

93
Q

What is the route for Labetalol (Trandate)?

A

PO / IV

(Non-selevtive beta blockers)

94
Q

What is the route for Nadolol (Corgad)?

A

PO

(Non-selevtive beta blockers)

95
Q

What is the route for Propranolol (Inderal)?

96
Q

What is the route for Timolol (generic)?

A

PO

(Non-selevtive beta blockers)

97
Q

What is the route for Penbutolol (Levatol)?

A

PO

(Non-selevtive beta blockers)

98
Q

What is the route for Pindolol (generic)?

A

PO

(Non-selevtive beta blockers)

99
Q

What are the six selective beta-1 blockers?

A
  1. Acebutolol (Sectral)
  2. Betaxolol (Kerlone)
  3. Bisoprolol (Zebeta)
  4. Atenolol (Tenormin)
  5. Metoprolol (Lopressor)
  6. Nebivolol (Bystolic)
100
Q

What is the route for Acebutolol (Sectral)?

A

PO

(Selevtive beta-1 blocker)

101
Q

What is the route for Beaxolol (Kerlone)?

A

PO

(Selevtive beta-1 blocker)

102
Q

What is the route for Bisoprolol (Zebeta)?

A

PO

(Selevtive beta-1 blocker)

103
Q

What is the route for Atenolol (Tenormin)?

A

PO

(Selevtive beta-1 blocker)

104
Q

What is the route for Metoprolol (Lopressor)?

A

PO / IV

(Selevtive beta-1 blocker)

105
Q

What is the route for Nebivolol (Bystolic)?

A

PO

(Selevtive beta-1 blocker)

106
Q

What is the primary MOA for beta blockers?

A
  • Block beta receptors in heart
  • Inhibits epinephrine from SNS
  • Decreases cardiac contractility (negative inotropic)
  • Decreases HR (negative chronotropic)
  • Lowered BP
107
Q

Because selective beta-1 blockers have minimal effect on beta-2 receptor sites, what is there less of?

A
  • Less hypoglycemia (from inhibition of glycogenolysis)
  • Less likely to cause bronchospasm
108
Q

Which drugs are often used as first-line agents for HF and Htn?

A

ACE Inhibitors

109
Q

ACE inhibitors may be combined with either of these?

A
  1. Diuretic
  2. CCB
110
Q

What category of drugs are first choice for patients with both Htn and HF?

A

ACE Inhibitors

111
Q

Post MI, ACE inhibitors slows the progression of what?

A

LVH (left ventricular hypertrophy)

112
Q

What is the MOA for ACE Inhibitors?

What is the net result?

A
  • Block angiotensin-converting enzyme (ACE)
  • Prevents conversion of Angio-1 to Angio-2
  • Angiotensin-2 is a POTENT vasoconstrictor
  • Angio-2 also inhibits degradation of bradykinin (vasodilator)
  • Bradykinin causes cough and angiodema
  • Vasodilation AND reduced PVR
  • Lowered BP + cough and / or angiodema
113
Q

What are the eleven ACE inhibitors?

A
  1. Benazepril (Lotensin)
  2. Captopril (Capoten)
  3. Enalapril (Vasotec)
  4. Enalaprilat
  5. Forsinopril (Monopril)
  6. Lisinopril (Zestril)
  7. Moexipril (Univasc)
  8. Perinodpril (Aceon)
  9. Quinapril (Accupril)
  10. Ramipril (Altace)
  11. Trandolapril (Mavik)
114
Q

What is the route for Benazepril (Lotensin)?

A

PO

(ACE Inhibitor)

115
Q

What is the route for Captopril (Capoten)?

A

PO

(ACE Inhibitor)

116
Q

What is the route for Enalapril (Vasotec)?

A

PO

(ACE Inhibitor)

117
Q

What is the route for Enalaprilat?

A

IV

(ACE Inhibitor)

118
Q

What is the route for Fosinopril (Monopril)?

A

PO

(ACE Inhibitor)

119
Q

What is the route for Lisinopril (Zestril)?

A

PO

(ACE Inhibitor)

120
Q

What is the route for Moexipril (Univasc)?

A

PO

(ACE Inhibitor)

121
Q

What is the route for Perindopril (Aceon)?

A

PO

(ACE Inhibitor)

122
Q

What is the route for Quinapril (Accupril)?

A

PO

(ACE Inhibitor)

123
Q

What is the route for Ramipril (Altace)?

A

PO

(ACE Inhibitor)

124
Q

What is the route for Trandolapril (Mavik)?

A

PO

(ACE Inhibitor)

125
Q

What is the ACE Inhibitor prototype?

A

Enalapril (Vasotec)

126
Q

What is the usual dose of Enalapril (Vasotec) for Htn?

A

2.5 - 40 mg / d

May take qd or bid (40/d max)

127
Q

What are the five indications for Enalapril (Vasotec)?

A
  1. Htn
  2. HF
  3. LV Dysfunction
  4. Post MI
  5. Nephropathy prevention in DM
128
Q

Where is Enalapril (Vasotec) metabolized?

129
Q

How is Enalapril (Vasotec) excreted?

A

Primarily renal (~ 30% renal)

130
Q

What are three significant interactions of Enalapril (Vasotec)?

A
  1. Potassium-sparing diuretics
  2. Lithium
  3. Azothiaprine (anti-rejection drug)
131
Q

What are the five adverse / side effects of Enalapril (Vasotec)?

A
  1. Hyperkalemia
  2. Hypotension
  3. Dry cough
  4. Fatigue
  5. Dizziness
132
Q

What is the precaution for Enalapril (Vasotec)?

A

May induce ARF (acute renal failure)

133
Q

What is the contraindication for Enalapril (Vasotec)?

A

Angioedema

134
Q

What is the BLACK BOX WARNING for Enalapril (Vasotec)?

135
Q

What drugs are similar to ACEIs but do not cause cough / angiodema?

A

Angiotensin II Receptor Blockers (ARBs)

136
Q

True or False:

ARBs prohibit conversion of Angiotensin-1 to Angiotensin-2.

A

False

(They do NOT prohibit the conversion)

137
Q

What does unopposed ACE cause?

What does this then cause?

A
  • Degradation of Bradykinin (vasodilator)
  • Bradykinin causes cough and / or angiodem

No bradykinin = No cough / angiodema

138
Q

What is the MOA for ARBs?

What is the net result?

A
  • Block Angiotensin-2 receptors
  • Prevent Agnio-2-induced vasoconstriction
  • Inhibit release of aldosterone from adrenal cortex which promotes H2O and Na+ loss
  • Reduced fluid volume + vasodilation
  • Lowered BP without cough / angiodema
139
Q

What are the eight ARBs?

A
  1. Candesartan (Atacand)
  2. Eprosartan (Teveten)
  3. Irbesartan (Avapro)
  4. Losartan (Cozaar)
  5. Olmesartan (Benicar)
  6. Telmesartan (Micardis)
  7. Valsartan (Diovan)
  8. Azilsartan (Edarbi)
140
Q

What is the route for Candesartan (Atacand)?

141
Q

What is the route for Eprosartan (Teveten)?

142
Q

What is the route for Irbesartan (Avapro)?

143
Q

What is the route for Losartan (Cozaar)?

144
Q

What is the route for Olmesartan (Benicar)?

145
Q

What is the route for Telmesartan (Micardis)?

146
Q

What is the route for Valsartan (Diovan)?

147
Q

What is the route for Azilsartan (Edarbi)?

148
Q

What is the ARB prototype?

A

Valsartan (Diovan)

149
Q

What is the usual Htn dose for Valsartan (Diovan)?

A

80 - 160 mg / d to start

Max 320 mg / day

150
Q

What are the indications for Valsartan (Diovan)?

A
  1. Htn
  2. HF
  3. LV Dysfunction
  4. Post MI
  5. Nephropathy prevention in DM
151
Q

Where is Valsartan (Diovan) metabolized?

152
Q

How is Valsartan (Diovan) excreted?

153
Q

What are the four adverse / side effects of Valsartan (Diovan)?

A
  1. Neutropenia
  2. Fatigue
  3. Abdominal pain
  4. Viral infection
154
Q

What are the significant interactions of Valsartan (Diovan)?

A

Potassium-sparing diuretics

155
Q

What is the BLACK BOX WARNING for Valsartan (Diovan)?

156
Q

Which drug is a selective renin inhibitor? It directly inhibits renin which acts earlier in the RAAS system.

A

Aliskiren (Tekturna)

157
Q

True or False:

Aliskiren (Tekturna) may cause diarrhea.

158
Q

True or False:

Aliskiren (Tekturna) may cause cough / angiodema - more so than ACEs.

A

False

(It is true that they may cause cough / angiodema but to a lesser extent than ACEs)

159
Q

True or False:

Aliskiren (Tekturna) is the only antihypertensive drug you can give to pregnant women.

A

False

(It is contraindicated in pregnancy)

160
Q

What kind of drugs are reserved for URGENT to EMERGENT Htn or SEVERE Htn with failure on other therapies?

A

Direct vasodilators

161
Q

Direct vasodilators are a potential for significant to life-threatening adverse effects due to what?

A

Reflex cardiac stimulation

162
Q

Direct vasodilators are often combined with what kinds of drug to balance cardiac stimulation effects?

A

Beta blockers

163
Q

What is the MOA for direct vasodilators?

A
  • Directly relax smooth muscle in arterioles and veins
  • Vasodilation
  • Reduces PVR
  • Lowers BP
  • Reflex cardiac stimulation
164
Q

Vasodilator mechanisms triggers reflex cardiac stimulation (competeing reflexes). What are these three competing reflexes?

A
  1. Increased cardiac contractility
  2. Increased HR
  3. Increased O2 consumption
165
Q

A patient has a potential for cyanide posioning when taking which drug?

A

Nitroprusside

166
Q

What are the three direct vasodilators?

A
  1. Hydralazine (Apresoline)
  2. Minoxidil (generic)
  3. Nitroprusside (Nitropress)
167
Q

Minoxidil is what well known OTC topical formulation? What is it used for?

A

Rogaine - baldness

168
Q

Which direct vasodilator is reserved for hypertensive emergency only?

A

Nitroprusside (Nitropress)

169
Q

What constitutes a hypertensive urgency?

A
  • Markedly increased BP
    • > 180 systolic / and or 120 diastolic
  • No ACUTE target organ damage
170
Q

What kind of therapy is given in a hypertensive urgency?

A

Immediate PO therapy (usually) appropriate

⇣ ⇣

Reduce BP over several hours to few days

171
Q

True or False:

A Hytertensive urgency requires hospitalization.

A

False

(It does NOT require hospitalization)

172
Q

What constitutes a hyertensive emergency / crisis?

A
  • Markedly increased BP
    • > 180 systolic and / or 120 diastolic
  • ACUTE target organ damage
173
Q

What kind of therapy is given in a hypertensive emergency?

A

Parenteral therapy required

⇣ ⇣

Reduce BP rapidly (over 2-3 hours)

174
Q

True or False:

A hypertensive emergency / crisis requires hospitalization.

175
Q

What are five examples of acute target-organ damage?

A
  1. Renal failure
  2. Cardiac failure
  3. Papilledema and / or Retinopathy
  4. Encephalopathy
  5. Stroke (CVA)
176
Q

What are seven acute symptoms of a hypertensive emergency?

A
  1. Blurred vision
  2. Headache
  3. Change in mental status
  4. Restlessness
  5. Anxiety
  6. Shortness of breath
  7. Chest pain
177
Q

What is the direct vasodilator prototype?

A

Hydralazine (generic)

178
Q

What is the usual Htn dose for Hydralazine (generic)?

A
  • PO
    • Start mg qid x 2 - 4 days then increase 25 mg qid x 1 wk
    • Max: 300 mg/day
  • Alt:
    • 10 - 40 mg IM / IV q 4-6 h
    • Switch to PO ASAP
    • Switch to a safer drug
179
Q

What are the three indications for Hydralazine (generic)?

A
  1. Severe Htn unresponsive to safer drugs
  2. Hypertensive crisis
  3. HF
180
Q

Where is Hydralazine (generic) metabolized?

181
Q

How is Hydralazine (generic) excreted?

A

Urine / Feces

(90/10)

182
Q

What are the seven adverse / side effects of Hydralazine (generic)?

A
  1. Headache
  2. Tachycardia
  3. Nausea
  4. Sweating
  5. Arrythmias
  6. Precipitation of angina
  7. Drug-induced Lupus
183
Q

According to the JNC-8 Guidelines, what is the goal for the general population of 60 and over?

How are they treated if they are not at this goal?

A

GOAL: SBP < 150 and DBP < 90

  • Pharm therapy indicated if
    • SBP 150 or >
    • OR
    • DBP 90 or >
184
Q

According to the JNC-8 Guidelines, what is the goal for the general population under 60?

How are they treated if they are not at this goal?

A

GOAL: DBP < 90

GOAL: SBP < 140

  • Pharm therapy indicated if
    • DBP 90 or >
    • OR
    • SBP 140 or >
185
Q

According to the JNC-8 Guidelines, what is the goal for the patients 18 or older with CKD?

How are they treated if they are not at this goal?

A

GOAL: SBP < 140 and DBP < 90

  • Pharm therapy indicated if
    • SBP 140 or >
    • OR
    • DBP 90 or >
186
Q

According to the JNC-8 Guidelines, what is the goal patients 18 or older with DM and Htn?

How are they treated if they are not at this goal?

A

GOAL: SBP < 140 and DBP < 90

  • Pharm therapy indicated when
    • SBP 140 or >
    • OR
    • DBP 90 or >
187
Q

According to the JNC-8 Guidelines, how would you initiate therapy for the general Non-Black population with / without DM?

A

Initiate therapy with any of the below:

  • Thiazide
  • ACEI
  • ARB
  • CCB
188
Q

According to the JNC-8 Guidelines, how would you initiate therapy for the general Black population with / without DM?

A

Initiate therapy with either:

  • Thiazide
  • CCB
189
Q

According to the JNC-8 Guidelines, how would you initiate therapy for the patients 18 or older with CKD and Htn?

A

Initiate therapy or add-on therapy with ACEI or ARB, regardless of race or DM status

190
Q

According to the JNC-8 Guidelines, what would you do for all patients if BP goal is not reached by one month?

A
  • Increse dose of initial drug

OR

  • Add on any of the following:
    • Thiazide
    • CCB
    • ACEI
    • ARB

Pharmacology II (3 decks)

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