Cardiovascular Flashcards
What are the JNC 8 Blood pressure goal for persons > 60 years?
What are the JNC 8 Blood pressure goal for persons > 60 years?
What are the JNC 8 Blood pressure goal for persons
The goal blood pressure for all others including African Americans or patients with diabetics or chronic kidney disease is
What should initial therapy for non-african american patients with HTN?
Initial therapy should be a thiazide-type diuretic, an ACEI, or a CCB
What should be the initial BP therapy for patients with CKD?
patients with chronic kidney disease, treatment should include an ACEI or angiotensin receptor blocker (ARB) to improve kidney outcomes regardless of race or diabetes status
What should be the initial BP therapy for patients with CKD?
patients with chronic kidney disease, treatment should include an ACEI or angiotensin receptor blocker (ARB) to improve kidney outcomes regardless of race or diabetes status
Hydrochlorothiazide
“Moderate Diuretic”
treatment of primary HTN
treatment of edema
HTN 12.5-25mg
diuresis 25-200mg
antihypertensive effect plateaus at 25mg
What effect does NSAIDS have on HTN medication?
increases BP in patients receiving BB, diuretics, and angiotensin blockers
Hydrochlorothiazide side effects
hypokalemia hyponatremia hyperuricemia increase calcium reabsorption hyperglycemia
What should be the initial BP therapy for patients with CKD?
patients with chronic kidney disease, treatment should include an ACEI or angiotensin receptor blocker (ARB) to improve kidney outcomes regardless of race or diabetes status
Furosemide
management of chronic edema
treatment of HTN
20-80mg
Hydrochlorothiazide
“Moderate Diuretic”
initial dosing 12.5-25 target 25-50
antihypertensive effect plateaus at 25
Furosemide interactions
Hypotensive drugs Anti-inflammatory drugs Anticoagulants Lithium Ototoxic & nephrotoxic drugs (Aminoglycosides) Administration of ACE inhibitors Digoxin
Hydrochlorothiazide side effects
potassium loss
hyperuricemia
increase calcium reabsorption
Hydrochlorothiazide interactions
hypotensive agents lithium uricosuric agents digoxin NSAIDs
Side effects of potassium sparing diuretics
Hyperkalemia
impotence, gynecomastia, and decreased libido in 50% of males and menstrual abnormalities in females
cause GI upset
Furosemide side effects
volume depletion hyponatremia hypochloremia dehydration hypotension shock ototoxic
Furosemide interactions
Hypotensive drugs Anti-inflammatory drugs Anticoagulants Lithium Ototoxic & nephrotoxic drugs (Aminoglycosides) Administration of ACE inhibitors Digoxin
Triamterene
directly inhibit basal Na+/K+ exchange mechanism in distal and collecting tubules, independent of aldosterone, to inhibit access of sodium to the transport site
used alone in treatment of hypertension or for relieving edema
treatment of hypokalemia or mineralocorticoid excess.
Spironolactone
competitively blocks the effect of aldosterone on kidney tubules
used alone in treatment of hypertension or for relieving edema
treatment of hypokalemia or mineralocorticoid excess.
treatment of hyperaldosteronism
Side effects of potassium sparing diuretics
Hyperkalemia
impotence, gynecomastia, and decreased libido in 50% of males and menstrual abnormalities in females
cause GI upset
How much potassium is needed to prevent hypokalemia?
20mEq
How much potassium is needed to restore normal potassium levels?
40-80mEq
What effects do ACE and ARBs have on potassium?
increase serum potassium levels
Methyldopa
lower arterial pressure by the stimulation of central inhibitory α2-adrenergic receptors
drug of choice in treating hypertension in pregnant wome
Clonidine
lower arterial pressure by the stimulation of central inhibitory α2-adrenergic receptors
Labetalol
nonselective beta-blockers that also block alpha-receptors
does not affect serum lipids
indicated for the treatment of hypertension and CHF
Carvedilol
nonselective beta-blockers that also block alpha-receptors
What happens if Methyldopa or Clonidine is discontinued abruptly?
is rebound hypertension that may occur if the drug is suddenly discontinued
propranolol
nonselective
metoprolol
cardioselective
Labetalol
nonselective beta-blockers that also block alpha-receptors
carvedilol
nonselective beta-blockers that also block alpha-receptors
What is the “first does effect” in alpha 1 blockers?
marked hypotension and syncope with first few doses or with rapid increase in dose
give at bedtime to reduce effect
What are side effects of beta blockers?
Nonselective agents may cause bronchoconstriction.
Other adverse effects include slow heart rate, fatigue, sleep disturbances, and male sexual dysfunction
Decreased cardiac output may lead to reduction in exercise tolerance.
Contraindicated in sinus bradycardia.
Prazosin
Alpha1 Adrenergic Blocker
Treatment of hypertension
Terazosin
Alpha1 Adrenergic Blocker
Treatment of hypertension and symptoms associated with benign prostatic hyperplasia
Doxazosin
Alpha1 Adrenergic Blocker
Treatment of hypertension and symptoms associated with benign prostatic hyperplasia
What is 5-alpha-reductase is an enzyme?
5-alpha-reductase is an enzyme that converts testosterone to dihydrotestosterone in the prostate gland. DHT increases growth of prostate epithelial tissue.
Do alpha 1 antagonists shrink the prostate?
no
Phentolamine [Regitine]
blocks both presynaptic (α2) and postsynaptic (α1) adrenergic receptors
Prevention or control of hypertensive episodes that occur in patients with pheochromocytoma (given IV by controlled infusion) and for prevention and treatment of dermal necrosis and sloughing following extravasation of intravenous norepinephrine or dopamine
Do 5-alpha-reductatase inhibitors shrink the prostate?
yes
Finasteride
is a specific inhibitor of 5-alpha-reductase
treatment of benign prostatic hypertrophy and male pattern hair loss
Pregnancy Category X
(tablets should not be handled by a woman who is pregnant or may become pregnant and men should not donate blood for 6 months after stopping the drug to avoid transmission to a pregnant woman.)
What is 5-alpha-reductase is an enzyme?
5-alpha-reductase is an enzyme that converts testosterone to dihydrotestosterone in the prostate gland. DHT increases growth of prostate epithelial tissue.
Dutasteride [Avodart]
2nd generation 5α-reductase (both type 1 and type 2) inhibitor for treatment of BPH
extensively metabolized by CYP3A4 but has a terminal half-life of 5 weeks
Phentolamine [Regitine]
blocks both presynaptic (α2) and postsynaptic (α1) adrenergic receptors
Prevention or control of hypertensive episodes that occur in patients with pheochromocytoma (given IV by controlled infusion) and for prevention and treatment of dermal necrosis and sloughing following extravasation of intravenous norepinephrine or dopamine
Hydralazine [Apresoline]
Vasodilator
mechanism is not clear
homeostatic mechanism including an increase in renin secretion, increased cardiac rate and output, and salt and water retention
What are Hydralazine [Apresoline] indications?
Indications: Hydralazine is indicated for the treatment of primary hypertension (usually considered a 3rd step drug because of reflex tachycardia & salt & water retention.)
indicated to produce afterload reduction in patients with CHF
