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Cardiovascular Disorders Flashcards

1
Q

Which stage of hypertension is a SBP of 120-139 mmHg / DBP of 80-89 mmHg?

A

Pre-hypertension

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2
Q

Which stage of hypertension is SBP 140-159mmHg / DBP 90-99?

A

Stage 1 Hypertension

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3
Q

What stage of hypertension is SBP >160 mmHg / >100 mmHg?

A

Stage 2 Hypertension

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4
Q

What are the JNC8 blood pressure goals for uncomplicated Hypertension in >60 years and <60 years?

A

<140/90 for <60 years

<150/90 for >60 years

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5
Q

What are the JNC8 blood pressure goals for a patient with diabetes or CKD?

A

<140/90

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6
Q

What treatment does JNC8 recommend for a patient with hypertension and the compelling indication of Left Ventricular Dysfunction?

A

Diuretic with ACEi or ARB, then add a Beta Blocker

Can add on an Aldosterone Antagonist as second line

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7
Q

What treatment does JNC8 recommend for a patient with hypertension and the compelling indication of prior MI?

A

Beta blocker, then add ACEi or ARB

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8
Q

What treatment does JNC8 recommend for a patient with hypertension and the compelling indication of Coronary Artery Disease?

A

Beta blocker, then ACEi or ARB

CCB as second line

Thiazide as 3rd line

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9
Q

What treatment does JNC8 recommend for a patient with hypertension and the compelling indication of Diabetes Mellitus?

A

ACEi or ARB if Caucasian

CCB or Thiazide if African American

ACEi or ARB, CCB, Thiazide as second line

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10
Q

What treatment does JNC8 recommend for a patient with hypertension and the compelling indication of CKD?

A

ACEi or ARB

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11
Q

What treatment does JNC8 recommend for a patient with hypertension and the compelling indication of Recurrent Stroke Prevention?

A

Thiazide or Thiazide + ACEi

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12
Q

What therapy approach does JNC8 recommend for stage 1 hypertension?

A

Mono therapy using ACEi, ARB, CCB, or Thiazide

For African Americans: CCB or Thiazide

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13
Q

What therapy approach does JNC8 recommend for stage 2 hypertension?

A

Initiate a two drug combination, preferably using:

Thiazide or CCB
PLUS
ACEi or ARB

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14
Q

What class of diuretic is chlorthalidone?

A

Thiazide diuretic

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15
Q

What class of drug is Lozol?

A

Thiazide diuretics

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16
Q

What class of drug is Metolazone?

A

Thiazide diuretics

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17
Q

What is the MOA of thiazide diuretics?

A

Inhibit Na+ reabsorption in the distal convoluted tubule

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18
Q

What is the brand name of chlorthalidone?

A

Thalitone

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19
Q

What is the brand name of hydrochlorothiazide?

A

Microzide

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20
Q

What is the brand name of Metolazone?

A

Zaroxolyn

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21
Q

What is a contraindication for thiazide diuretics?

A

Sulfa allergy

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22
Q

What are the six primary side effects of thiazide diuretics?

A

Hypokalemia, hypomagnesemia, hyponatremia, hypercalcemia, hyperglycemia, hyperuricemia.

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23
Q

What are the five main monitoring parameters for Thiazide diuretics?

A

Blood pressure, electrolytes, BUN/SCr, blood glucose, uric acid

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24
Q

What is the drug interaction between thiazide diuretics and lithium?

A

Thiazides may increase the risk of lithium toxicity

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25
Q

What is the drug interaction between thiazide diuretics and antidiabetic agents?

A

Thiazides may decrease the effects of antidiabetic agents

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26
Q

What is the drug interaction between thiazide diuretics and NSAIDs?

A

NSAIDs May decrease the antihypertensive effects of thiazides

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27
Q

What is the correlation between thiazide diuretics and creatinine clearance?

A

Thiazide diuretics are not effective when CrCl is less than 30 mL/min. The exception to this is Metolazone. In the case of CrCL less than 30 mL/min a loop diuretic should be used.

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28
Q

True or False

Thiazide diuretics have a ceiling dose and loop diuretics do not?

A

True

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29
Q

What is the MOA of Loop diuretics?

A

Inhibit Na+ reabsorption in the ascending loop of Henle

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30
Q

What are the only three cases that loop diuretics should be used for hypertension?

A

CrCl <30 mL/min
Severe edema
Heart failure

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31
Q

What is the MOA of potassium sparing diuretics?

A

Inhibits Na+ reabsorption in the collecting ducts

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32
Q

What are the two potassium sparing diuretics?

A

Midamor (Amiloride)

Triamterene (Dyrenium)

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33
Q

What are the two contraindications for potassium sparing diuretics?

A

Hyperkalemia and CKD

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34
Q

What are the three main monitoring parameters for potassium sparing diuretics?

A

Blood pressure, K+, BUN/SCr

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35
Q

What is the risk involved with using potassium sparing diuretics K+ supplements, ACEis, ARBs, ARAs, Or NSAIDs?

A

Increased risk of hyperkalemia

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36
Q

True or False

Potassium sparing diuretics are often used as monotherapy?

A

False

Potassium sparing diuretics are weak antihypertensives. Therefore they are usually used with HCTZ to decrease K+ loss

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37
Q

What is the brand name for triamterene and hydrochlorothiazide?

A

Dyazide or Maxzide

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38
Q

What is the brand name for amiloride and HCTZ

A

Moduretic

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39
Q

What is the MOA of aldosterone receptor antagonists and how often are they used for hypertension?

A

Similar to potassium sparing diuretics but they also block the effects of aldosterone.

They are not often used for hypertension

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40
Q

What is the name brand for Spironolactone and hydrochlorothiazide?

A

aldactazide

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41
Q

What is the MOA of beta blockers?

A

Decreased cardiac output it by negative inotropic (decreased contractility) and negative chronotropic (decreased HR) effects.

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42
Q

What makes a beta blocker cardioselective and why would you need one?

A

Finding more to B1 than B2 receptors (at low doses) making it less likely to cause bronchoconstriction. It is safer to use in patients with Asthma, COPD, PAD or DM.

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43
Q

Which beta blockers are cardioselective?

A

BAMBA

Bisoprolol, Atenolol, Metoprolol, Betaxolol, Acebutolol

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44
Q

Which beta blockers have intrinsic sympathomimetic activity/partial B receptor agonist activity?

A

CAPP

Carteolol, Acebutolol, Pindolol, Penbutolol

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45
Q

Which beta blockers are lipophilic and thus more likely to cause CNS side effects such as depression and fatigue?

A

Propranolol, metoprolol, carvedilol, labetolol, pindolol

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46
Q

What is the brand name of acebutolol?

A

Sectral

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47
Q

What is the brand name of betaxolol?

A

Kerlone

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48
Q

What is the brand name of bisoprolol?

A

Zebeta

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49
Q

What are the two contra indications for beta blockers?

A

Greater than or equal to 2nd° heart block and heart failure (with the exception of metoprolol, bisoprolol or carvedilol)

50
Q

What is the concern with beta blockers and diabetic patients?

A

Beta blockers can mask hypoglycemia in patients with diabetes

51
Q

What drug interaction exist between beta blockers and negative chronotropes (digoxin, verapamil, diltiazem, clonodine)?

A

Increased risk of Bradycardia

52
Q

What is the proper way to discontinue beta blockers?

A

Abrupt discontinuation may cause angina, MI, or hypertensive emergency. You must taper the dose over two weeks

53
Q

What is the brand name for carvedilol?

54
Q

What is the brand name for labetalol?

55
Q

What is the brand name for Nadolol?

56
Q

What is the brand name for timolol?

57
Q

Which beta blockers have alpha-1 blocking properties?

A

Labetalol and carvedilol

58
Q

What is the brand name for atenolol and chlorthalidone?

59
Q

What is the brand name for bisoprolol and hydrochlorthiazide?

60
Q

What is the brand name for a propanolol and hydrochlorthiazide?

61
Q

What is the brand name for metoprolol and hydrochlorthiazide?

A

LopressorHCT

62
Q

What is the mechanism of action of the angiotensin converting enzyme inhibitors?

A

Prevent the conversion of angiotensin one to angiotensin II leading to vasodilation, decreased aldosterone production and inhibited degradation of bradykinin

63
Q

What is the brand name of benazepril?

64
Q

What is the brand name of captopril?

65
Q

What is the brand name of enalapril?

66
Q

What is the brand name of fosinopril?

67
Q

What is the brand name of quinapril?

68
Q

What is the brand name of moexipril?

69
Q

What is the brand name of perindopril?

70
Q

What is the brand name of Ramipril?

71
Q

What is the brand name of trandolapril?

72
Q

What are the five contraindications for ACE inhibitors?

A

Pregnancy, history of angioedema or renal failure with previous use, hyperkalemia, and bilateral renal artery stenosis

73
Q

What are the four primary side effects of ACE inhibitors?

A

Hyperkalemia, renal insufficiency, dry cough, and angioedema

74
Q

What are the three monitoring parameters for ACE inhibitors?

A

BP
BUN/ SCr
K+

75
Q

What is the drug interaction with ACEis or ARBs and lithium?

A

ACEis or ARBs may increase lithium toxicity

76
Q

Which ACEi has the shortest duration of action?

77
Q

What is the brand name for benazepril and amlodipine?

78
Q

What is the name brand for benazepril and hydrochlorthiazide?

A

Lotensin HCT

79
Q

What is the brand name for captopril and hydrochlorthiazide?

80
Q

What is the brand name for enalapril and hydrochlorthiazide?

81
Q

What is the brand name for fosinopril and hydrochlorthiazide?

A

Monopril HCT

82
Q

What is the brand name for lisinopril and HCTZ?

A

Zestoretic

83
Q

What is the brand name for trandolapril and verapamil?

84
Q

What is the MOA of the angiotensin II receptor blockers?

A

Inhibit the binding of angiotensin II to the angiotensin type one receptor leading to vasodilation, decreased aldosterone production, with no effect on bradykinin

85
Q

What is the brand name of eprosartan??

86
Q

What is the brand name of Irbesartan?

87
Q

What is the brand name of losartan?

88
Q

What is the brand name of olmesartan?

89
Q

What is the brand name of telmisartan?

90
Q

What is the brand name of valsartan?

91
Q

What is the brand name of candesartan and hctz?

A

Atacand HCT

92
Q

What is the brand name of irbesartan and hctz?

93
Q

What is the brand name of losartan and hctz?

94
Q

What is the brand name of olmesartan and amlodipine?

95
Q

What is the brand name of telmisartan and amlodipine?

96
Q

What is the brand name of valsartan and amlodipine?

97
Q

What is the name brand for Aliskiren?

98
Q

What is the MOA of renin inhibitors?

A

Inhibits renin and prevents the conversion of angiotensinogen to angiotensin one, which then decreases production of angiotensin II

99
Q

What are the four contra indications for renin inhibitors?

A

Pregnancy, history of drug induced angioedema, hyperkalemia, and bilateral renal artery stenosis

100
Q

What are the five primary side effects for renin inhibitors?

A

Headache, dizziness, diarrhea, hyperkalemia, and renal insufficiency

101
Q

Which three drugs may increase the effects of renin inhibitors?

A

Atorvastatin, ketoconazole, and cyclosporine

102
Q

What type of meals should be avoided when taking aliskiren?

A

High fat meals

103
Q

What is the brand name of aliskiren and hydrochlorothiazide?

104
Q

What is the MOA of calcium channel blockers?

A

Bind to L type channels and the heart to block in word movement of calcium waiting to vascular smooth muscle relaxation (vasodilation)

105
Q

Which calcium channel blockers have negative inotropic effects (decreased contractility)?

A

All of them except amlodipine and felodipine

106
Q

How are the dihydropyridine calcium Channel blockers different?

A

They are more selective to vasculature and are more potent vasodilators. They also have no effect on cardiac conduction

107
Q

Which calcium channel blocker’s are non-dihydropyridines and what makes them different?

A

Diltiazem and verapamil. They cause less peripheral vasodilation and have negative chronotropic properties. (Decreased heart rate)

108
Q

What is the brand name for felodipine?

109
Q

What is the brand name of israpidine?

A

DynaCirc CR

110
Q

What is the brand name for nicardipine?

111
Q

What is the brand name for nifedipine?

A

adalat or procardia XL

112
Q

What is the brand name for nisoldipine?

113
Q

What are the six primary side effects of DHP calcium channel blockers?

A

Reflex tachycardia, headache, Flushing, peripheral edema, gingival hyperplasia, heart failure exacerbation (except for amlodipine and felodipine which do not cause negative inotropy/decreased contractility)

114
Q

What are the three key monitoring parameters for calcium channel blocker’s

A

Blood pressure, heart rate, signs of heart failure

115
Q

What is the effect of CYP3A4 inducers and inhibitors on DHP calcium channel blockers?

A

CYP3A4 inducers may decrease CCB effects

Inhibitors my increase effects

116
Q

True or false you should not use grapefruit juice when taking any calcium channel blocker?

117
Q

What is the brand name for diltiazem?

A

cardizem or Taztia

118
Q

What is the brand name for verapamil?

119
Q

What are the two contra indications for non-DHP calcium channel blocker’s?

A

Greater than or equal to 2nd° heart block and systolic heart failure

120
Q

What are the five primary side effects of non-DHP calcium channel blockers?

A

Bradycardia or heart block, constipation, peripheral edema, gingival hyperplasia, and Heart failure exacerbation

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