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CP Test 2 > B4-102 CBCL: Hypertension and Treatment > Flashcards

B4-102 CBCL: Hypertension and Treatment Flashcards

1
Q

inhibit NaCl reabsorption in distal convoluted tubule

A

thiazides

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2
Q

preferred antihypertensive drugs in elderly

A
  • thiazides
  • Ca+ channel blockers
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3
Q

preferred thiazide due to long half life and proven reduction of CVD

A

chlorthalidone

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4
Q

uses for thiazides

A

* hypertension
* congestive heart failure
* nephrolithiasis
* nephrogenic diabetes insipidus

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5
Q

adverse effects: thiazides

A
  • hypokalemic metabolic acidosis
    hyponatremia
  • hypergluc
    glycemia
    lipidemia
    uricemia
    calcemia
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6
Q

potassium sparing diurectics

A

Keep your SEAT

Spironolactone
Eplerenone
Amiloride
Triamterene

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7
Q

used to counteract hypokalemia caused by loop or thiazide diuretics

A

potassium sparing diuretics

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8
Q

end in -pril

A

ACE inhibitors

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9
Q

how do ACE inhibitors lower bp?

A

reduced angiotensin and increased bradykinin cause vasodilation

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10
Q

adverse effects: ACE inhibitors

A

Captopril’s CATCHH

cough
angioedema
teratogen
creatinine (increased)
hyperkalemia
hypotension

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11
Q

first choice of treatment for hypertensive patients with
* diabetes
* chronic renal disease
* left ventricular hypertrophy

A

ACE inhibitors

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12
Q

lower BP without compromising blood supply to heart, brain, or kidneys

A

ACE inhibitors

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13
Q

do not use in combination with ARBs or direct renin inhibitor

A

ACE inhibitor

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14
Q

end in -sartan

A

angiotensin receptor antagonists

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15
Q

how do angiotensin receptor antagonists differ from ACE inhibitors?

A
  1. more specific- no bradykinin increase
  2. more complete inhibition
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16
Q

adverse effects: ARBs

A
  • hyperkalemia
  • decreased GFR
  • hypotension
  • teratogen

similar to ACE, without coughing/bradykinin induced effects

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17
Q

reduced intracellular Ca+ causing arteriolar smooth muscle relaxation

A

Ca+ channel blockers

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18
Q

do not cause reflex tachycardia

A

verapamil and diltiazem

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19
Q

verapamil
diltiazem
-dipines

A

Ca+ Channel blockers

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20
Q
  • strongest vasodilators
  • most likely to produce reflex tachycardia
A

dihyropyridines
-dipines

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21
Q

adverse effects: dihydropyridines

A

peripheral edema
flushing
dizziness

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22
Q

adverse effects: nondihydropyridines

verapamil and dilitiazem

A
  • cardiac depression
  • bradycardia
  • AV block
  • constipation
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23
Q
  • orally active
  • dose-dependent reduction of plasma renin
  • dose dependent reduction of blood pressure
A

aliskiren

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24
Q

contraindications: aliskiren

A
  • pregnancy
  • do no combine with ACE inhibitors or ARB
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25
Q
  • reduction in renal sympathetic nerve activity
  • may also exert direct renal activity
A

clonidine

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26
Q

direct renin inhibitor

A

aliskiren

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27
Q

drugs that block renin secretion

A

clonidine
beta blockers

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28
Q

block intra and extra renal receptors involved in neural control of renin secretion

A

beta blockers

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29
Q

block adrenergic receptors at nerve endings

A

peripheral antagonists

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30
Q

stimulates medullary adrenergic receptors

A

central agonists

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31
Q

beta-1 selective blockers

4

A
  • atenolol
  • betaxolol
  • bisoprolol
  • metoprolol
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32
Q

beta-1 selective blockers

4

A
  • atenolol
  • betaxolol
  • bisoprolol
  • metoprolol
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33
Q

b1 selective and vasodilatory beta blockers

1

A

nebivolol

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34
Q

non selective beta blockers

2

A
  • nadolol
  • propranolol
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35
Q

beta blockers- intrinsic sympathomimetic activity

4

A
  • acebutolol (b1 selective)
  • penbutolol (non selective)
  • pindolol (non selective)
  • carteolol (non selective)
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36
Q

beta blockers- combined a and b receptors

2

A
  • carvedilol (a1 antagonist, nonselective)
  • labetalol (a1 antagonist, nonselective)
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37
Q

beta blockers lower BP by 3 mechanisms:

A
  1. reduce CO
  2. reduce renin secretion
  3. reduce sympathetic vasomotor tone
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38
Q

more effective in caucasian and young hypertensives

A

beta blockers

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39
Q

long term benefits on mortality and CVD when used in people with heart failure or acute MI

A

beta blockers

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40
Q

pose a significant risk of new-onset diabetes

A

beta blockers

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41
Q

can worsen symptoms of
* reduced myocardial reserve
* asthma
* peripheral vascular neuropathy
* diabetes

A

beta blockers

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42
Q

a1 antagonists

A

-zosins

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43
Q

mechanism of action: a1 antagonists

A

BP falls due to decreased TPR

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44
Q

centrally acting sympatholytic drugs

3

A
  • clonidine
  • methyldopa
  • guanfacine
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45
Q

sudden withdrawal causes hypertensive crisis, headache, tremor, abdominal pain

A

clonidine

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46
Q

limited to pregnancy

A

methyldopa

47
Q

orally active direct vasodilators

2

A

hydralazine
minoxidil

48
Q

IV direct vasodilators

5

A
  • sodium nitroprusside
  • diazoxide
  • fenoldopam
  • enalprilat
  • nicardipine
49
Q

IV direct vasodilator used for eclampsia

A

hydralazine

50
Q

when would you use IV vasodilators?

A

hypertensive emergencies

51
Q

dilate arteries selectively without affecting venous smooth muscle

3

A
  • hydralazine
  • minoxidil
  • diazoxide
52
Q

dilates arteries by acting as a D1 agonist

A

fenoldopam

53
Q

dilates both arteries and veins

A

sodium nitroprusside

54
Q

adverse effects: vasodilators

A
  • relex tachycardia
  • increased renin secretion
55
Q

may cause lupus like syndrome

A

hydralazine

56
Q

causes hypertrichosis

A

minoxidil

57
Q

still hypertensive with two drugs

A

resistant hypertension

58
Q

recommendations for treatment in pregnancy

4

A

New Moms Love Hugs

nifedipine
methyldopa
labetalol
hydralazine

59
Q

classes for treatment of primary hypertension

A
  • thiazide diuretics
  • ACE inhibitors
  • ARBs
  • dihydropyridine
  • Ca+ channel blockers
60
Q

classes of treatment of hypertension with heart failure

A
  • diuretics
  • ACE inhibitors
  • ARBs
  • beta blockers
  • aldosterone antagonists
61
Q

classes for treatment of hypertension in diabetes mellitus

A
  • ACE/ARBs
  • Ca channel blockers
  • thiazide diuretics
  • beta blockers
62
Q

classes for treatment of hypertensions with asthma

A
  • ARBs
  • Ca channel blockers
  • thiazides
  • cardioselective beta blockers
63
Q

should be avoided in patients with hypertension and asthma

A
  • nonselective beta blockers
  • ACE inhibitors
64
Q

can mask hypoglycemia symptoms

A

beta blockers

65
Q

protective against diabetic neuropathy

A

ACE/ARBs

66
Q

definition of hypertension

A

persistent systolic BP > 130 and/or
diastolic >80

67
Q

risk factors for hypertension

A
  • age
  • obesity
  • diabetes
  • sedentary
  • high sodium diet
  • excess alcohol intake
  • smoking
  • family hx
68
Q

primary hypertension is related to

A
  • increased CO or
  • increased TPR
69
Q

secondary hypertension is related to

A

renal/renovascular diseases

70
Q

severe hypertension without acute end-organ damage

A

hypertensive urgency

71
Q

severe hypertension with evidence of end organ damage

A

hypertensive emergency

72
Q

hypertension predisposes risk to

A
  • CAD
  • LVH
  • HF
  • a fib
  • aortic dissection/aneurysm
  • stroke
  • retinopathy
73
Q

life course points of intervention: genes and early life

A
  • genetic susceptibility
  • prenatal exposures
74
Q

life course points of intervention: life course contributors

A
  • diet, exercise, sleep, stress
  • housing policy
  • environmental exposures
75
Q

life course points of intervention: treatment

A
  • diagnosis of hypertensions
  • access to treatment, follow up, adequate control
  • sustained control or end organ damage
76
Q

common environmental exposures

A
  • lead
  • combustion products
77
Q

fetal and early life exposures are heavily associated with

A

heavy metals and organics

78
Q

first line treatment for hypertension

A
  • thiazides
  • ACE
  • ARB
  • calcium channel blockers
79
Q

second line treatment for hypertension

A
  • beta blockers
  • direct renin inhibitors
  • alpha blockers
  • centrally acting agents
  • vasodilators
80
Q

examples of end organ damage by hypertension

A
  • brain anuerysm
  • dementia
  • MI
  • heart failure
  • kidney disease
  • stroke
  • vision loss
81
Q

should be avoided in patients with sulfa allergies

A

thiazides

82
Q

social stress causes hypertension through:

A
  • increased sympathetic tone
  • vasoconstriction
  • oxidative stress
83
Q

can lead to significant loss of potassium and may have to be paired with a potassium sparing agent

A

chlorthalidone

84
Q

could lead to hyperkalemia through decreased aldosterone levels

A

ACEs/ARBs

85
Q
  • beta 1 selective
  • used for patients with asthma
A

acebutolol

86
Q

can worse diabetes and increase plasma lipids

A

beta blockers

87
Q

contraindicated in pregnancy

A

ACEs
ARBs

88
Q

can cause reflex tachycardia

A

nifedipine

89
Q

can result in bradycardia

A

verapamil, dilitiazem

90
Q

first line treatment for patients with hypertension and diabetes

A

ACE inhibitors

91
Q

do ACE inhibitors affect the lipid profile?

A

no

92
Q

can lead to hyperglycemia and hyperlipidemia

A

thiazides

93
Q

can precipitate diabetes

A

beta blockers

94
Q

should not be used with ARBs or direct renin inhibitors

A

ACEs

95
Q

potassium sparing agent for hypokalemia

A

spironolactone

96
Q

can lead to hyperkalemia

A

ACEs

**cannot combine with spironolactone

97
Q

should not be used in patients with suldonamide allergies

A

thiazides

98
Q

definition of hypertension in screening and treatment guidelines

A

.>130 systolic OR >80 diastolic

99
Q

hypertension is more common in

A

african american individuals

100
Q

how is race defined in health surveys and reasearch

A

patient self identifies

101
Q

DOC in elderly

A

thiazides or CCB

102
Q

may worsen CVD outcomes in elderly

A

beta blockers

103
Q

not as effective in elderly

A

ACEs
ARBs

104
Q

prevent degradation of bradykinin

A

ACEs

105
Q

can lead to angioedema

A

ACE inhibitors

106
Q

inhibit renin secretion

A

beta blockers

107
Q

can result in dry hacking cough

A

ACE inhibitors

108
Q

direct renin inhibitor

A

aliskiren

109
Q

work downstream of renin secretion but do not affect its activity directly

A

ACEs
ARBs

110
Q

do ACEs affect blood glucose concentrations?

A

no

111
Q

most common side effect is constipation

A

verapamil

112
Q

may cause hypokalemia

A

thiazides

113
Q

may cause hyperkalemia

A

ACEs
ARBs

CP Test 2 (16 decks)

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