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Renal II Exam Three > Antihypertensives DSA > Flashcards

Antihypertensives DSA Flashcards

1
Q

What are the general classes employed in monotherapy for Essential HTN?

A
  1. ACE Inhibitors
  2. ARBs
  3. Calcium channel blockers (long-acting)
  4. Thiazide diuretics
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2
Q

What drugs are expressely NOT used for primary HTN unless specifically indicated?

A

Beta Blockers

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3
Q

What drugs are recommended in mild to moderate CKD for patients with or without diabetes?

A

ACE inhibitors and ARBs

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4
Q

What are some advantages of monotherapy for HTN?

A
  1. Compliance
  2. decreased cost
  3. fewer adverse effects
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5
Q

Describe the rationale for polypharmacy tx of HTN

A
  1. The rationale behind polypharmacy is that each of the drugs acts on one of a set of interacting, mutually compensatory regulatory mechanisms for maintaining blood pressure
  2. Additional rationale is minimal toxicity: Two or three drugs at half standard doses might have greater efficacy and less toxicity than one drug at standard or twice standard dose
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6
Q

Name six common two drug combos for HTN tx

A
  1. ACEIs and calcium channel blockers (trandolapril/verapamil)
  2. ACEIs and diuretics (benazepril/hydrochlorothiazide)
  3. ARBs and diuretics (valsartan/hydrochlorothiazide)
  4. β-blockers and diuretics (propranolol/hydrochlorothiazide)
  5. Centrally acting agent and diuretic (reserpine/chlorothiazide)
  6. Diuretic and diuretic (spironolactone/hydrochlorothiazide, see below)
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7
Q

What is an example of a triple drug regimen for HTN?

A

a thiazide diuretic, a dihydropyridine CCB, and either an ACE inhibitor, an angiotensin receptor blocker, or a renin inhibitor

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8
Q

What are some general classes that are combined in two drug diuretic therapy?

A
  1. Loop agents and thiazide diuretics
  2. Potassium-sparing diuretics and loop agents or thiazides
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9
Q

What are some antiHTN drugs that may be indicated for systolic heart failure? (5)

A
  1. ACE inhibitor
  2. ARB
  3. Beta Blocker
  4. diuretic
  5. aldosterone antagonist
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10
Q

What are four drug classes that are indicated post MI?

A
  1. ACEi
  2. B-Blocker
  3. ARB
  4. Aldosterone antagonist
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11
Q

What are two classes of drugs indicated for proteinuric chronic kidney disease?

A

ACEi

ARB

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12
Q

What are two drugs indicated for Angina pectoris?

A

B-blocker

calcium channel blocker

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13
Q

What are two drug classes recommended for A Fib rate control?

A

Beta blocker

Nondihydropiridine calcium channel blocker

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14
Q

What are two drug classes recommended for atrial flutter rate control?

A

B-blocker

nondihydropiridine calcium channel blocker

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15
Q

What is likely to have a favorable effect in BPH?

A

Alpha blockers

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16
Q

What is likely to have a favorable effect on essential tremor?

A

beta-blocker (non-cardio selective)

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17
Q

What is likely to have a positive impact on hyperthyroidism?

A

beta-blocker

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18
Q

what are two drug classes likely to have a positive effect on migraine headaches?

A

beta blocker

calcium channel blocker

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19
Q

What is one drug class that could have a positive influence on a patient with osteoporosis?

A

Thiazide diuretics

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20
Q

What is a drug class that is likely to have a positive effect on Raynaud’s syndrome?

A

Dihydropyridine calcium channel blocker

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21
Q

What class of drugs is contraindicated in angioedema?

A

ACEi

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22
Q

What class of drugs is contraindicated in bronchospastic disease?

A

Beta blocker

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23
Q

What class of drug is contraindicated in depression (HTN control)?

A

Reserpine

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24
Q

What HTN drug is contraindicated in liver disease?

A

Methyldopa

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25
Q

Name three classes of drugs contraindicated in pregnancy (or in those “at risk for”)

A

ACEi

ARB

Renin inhibitor

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26
Q

What are two drug classes contraindicated for patients with second or third degree heart block?

A

Beta blocker

Nondihydropiridine calcium channel blocker

27
Q

What are two HTN drugs that may have an adverse effect on depression?

A

Beta blocker

Central alpha-2 agonists

28
Q

What is one general drug category that may have an adverse effect on patients with THE GOUT?

A

Diuretic

If you do not understand, just memorize.

29
Q

What are four drug classes that would make a hyperkalemic patient worse?

A

Aldosterone antagonist

ACEi

ARB

Renin inhibitor

I would think that sodium channel blockers would be here also, but they were not listed in up to date.

30
Q

What is a HTN drug class that may aggravate a patient with hyponatremia?

A

Thiazide diuretics

31
Q

What are three HTN drug classes that may have adverse effects on renovascular disease?

A

ACEi

ARB

Renin inhibitor

32
Q

What is a common choice of drug (specific) for combination with loop agents?

A

Metolazone

33
Q

Combination of Thiazides and loop diuretics is not recommended for outpatient use because?

A

Cause profuse diuresis, and extreme potassium wasting

34
Q

Combining K+ sparing diuretics with loop agents or thiazides can be highly efficacious, but this combination should be avoided in what two categories of patients?

A
  1. Those with renal insufficiency
  2. Those who are recieving angiotensin antagonists
35
Q

Name three combinations involving anthypertensives that are to be avoided!

A
  1. ACE inhibitors, ARBs, and renin inhibitors (only one at a time)
  2. Beta-blockers and non-dihydropyridine CCBs
  3. Potassium-sparing diuretics and ACE inhibitors/ARBs/renin inhibitors
36
Q

What defines a hypertensive urgency?

A

>180/120 without acute end organ damage

37
Q

What definces hypertensive emergency?

A

>180/120 with acute end organ damage

38
Q

In general, what are the reduction goals for the first hour and the next 23 hours for hypertensive emergencies?

A
  • 10-20% in the first hour
  • Further 5-15 percent over next 23 hours
39
Q

How are the drugs used in hypertensive emergencies administered?

A

IV

40
Q

What are the seven vasodilators used for tx of hypertensive emergencies?

A
  1. Sodium nitroprusside
  2. Nitroglycerine
  3. Nicardipine
  4. Clevidipine
  5. Enalaprilat
  6. Fenoldopam
  7. Hydralazine
41
Q

What is considered the most effective parenteral drug for HTN emergencies? What limits prolonged use?

A

Sodium nitroprusside

Potential for cyanide toxicity

42
Q

Nitroglycerine has less antiHTN efficacy than any other agent for HTN emergencies. Who is it useful for?

A

Adjuct therapy in patients with cardiac ischemia or after coronary bypass surgery

43
Q

Nicardipine has a long onset of action and longer elimination half life. What is it’s safety profile like?

A

Good.

44
Q

What is clevidipine used for?

A

As an ultrashort acting DHP-CCB it is approced only for HTN emergencies

45
Q

Enaliprilat is rarely used for HTN emergencies, due to slow onset and long duration of action. Characterize the hypotensive response.

A

Unpredictable, and dependent on plasma volume and renin activity

46
Q

In what patients should fenoldopam be avoided?

A

Those with glaucoma

47
Q

What limits the parental use of hydralazine? In what patients is this particularly useful?

A

Limited by prolonged and unpredicatable hypotensive effect.

Very useful for pregnant patients

48
Q

What are three adrenergic antagonists used in tx of hypertensive emergency?

A

phentolamine

esmolol

labetolol

49
Q

In what patients with htn emergency would you use phentolamine?

A

Those who have htn due to elevated catecholamines (cocaine intoxication or pheochromocytoma)

50
Q

In what classic scenarios would esmolol be used to treat htn emergencies?

A

Aortic dissection or postoperative HTN

51
Q

What is a combined alpha and beta blocker that may be safe to use in patients with active coronary disease?

A

Labetolol

52
Q

What anti-hypertensives cross the placenta?

A

All

53
Q

What are four drugs useful in acute management of sever HTN in a pregnant patient?

A
  1. labetelol
  2. hydralazine
  3. calcium channel blockers
  4. nitroglycerine
54
Q

What are five drugs useful in the long term oral therapy for pregnant patients?

A
  1. Methyldopa
  2. labetalol
  3. nifedipine
  4. hydralazine
  5. thiazide diuretics
55
Q

Can hydralazine be used as monotherapy for the pregnant patient?

A

No, due to reflex tachycardia it should not. It may be combined with methyldopa or labetalol if needed as add-on therapy

56
Q

As we discussed earlier some anti-htn’s are expressely forbidden in pregnancy. Name all those that are verboten.

A
  1. ACE inhibitors
  2. ARBs
  3. Direct Renin inhibitors
  4. Nitroprusside
57
Q

What do ace inhibitors, arbs and renin inhibitors do in pregnancy?

A

Associated with significant fetal renal and cardiac abnormalities

58
Q

What does nitroprusside do in pregnancy?

A

Possible fetal cyanide poisoning if used for more than a few hours. Last resort for ugent control of severe refractory HTN

59
Q

A common use for diuretics is for the reduction of peripheral or pulmonary edema that has accumulated as a result of cardiac, renal, or vascular diseases that reduce blood delivery to the kidney
Physiologically, this reduction is sensed as a lack of effective arterial blood volume and leads to salt and water retention, followed by edema formation. What are examples of edemetous states that are treated with loop diuretics?

A
  1. Heart failure
  2. Kidney Disease
  3. Hepatic Cirrhosis
60
Q

What drugs are beneficial for individuals that develop hyperkalemia associated with early stage renal failure?

A

Thiazides and Loop diuretics

61
Q

List four nonedematous states that are treated with diuretics.

A
  1. HTN
  2. Nephrolithiasis
  3. Hypercalcemia
  4. Diabetes insipidus
62
Q

What diuretics are useful in treatment of nephrolithiasis?

A

Thiazides d/t calcium reuptake

Loop diuretics to flush stones out

63
Q

What diuretics are useful in treating patients with hypercalcemia?

A

Loop diuretics, but should administer with saline to maintain effective Ca++ diuresis and prevent marked volume contration.

64
Q

What would you use to treat diabetes insipidus?

A

Supplementary ADH or an analog would be effective in central diabetes insipidus.

Thiazide diuretics can be used to reduce polyuria and polydipsia in both types of diabetes insipidus.

Renal II Exam Three (13 decks)

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