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Pharm 2 Exam > ch 41 > Flashcards

ch 41 Flashcards

1
Q

stage 1 HTN

A

when diagnosis is made

130-139 or 80-89

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2
Q

Stage 2 HTN

A

> 140 or >90

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3
Q

lifestyle mods for HTN

A 
sodium restriction
DASH diet
Restricting alcohol
aerobic exercise
Healthy body weight
smoking/tobacco cessation
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4
Q

What determines BP

A

cardiac output and peripheral resistance - increase in either with increase BP

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5
Q

What influences Cardiac output

A

Heart rate
myocardial contractility
blood volume
venous return of blood to heart

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6
Q

what antihypertensive meds work in the brain stem

A

Clonidine
methyldopa
(indirect alpha 2 agonists ch.17)

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7
Q

what antihypertensive meds work on the heart (B1 receptors)

A

B Blockers (-lol)

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8
Q

what antihypertensive meds work renal tubules

A

Thiazide diuretics
furosemide
Potassium sparing diuretics

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9
Q

what antihypertensive meds work on vascular A1 receptors

A

Prazosin
Terazosin
both BPH drugs that work on HTN

Labetalol

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10
Q

what antihypertensive meds work on vascular smooth muscle

A 
Hydralazine
minoxidil
Nitroprusside
CCBs 
Thiazides
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11
Q

what antihypertensive meds work on the B1 receptors on juxaglomerular cells (component of RAAS)

A

B Blockers

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12
Q

what antihypertensive meds work on Renin (component of RAAS)

A

Aliskiren

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13
Q

what antihypertensive meds work on ACE in RAAS

A

Captopril
Enalapril
Ace inhibitors

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14
Q

what antihypertensive meds work on Angiotensin II receptors in RAAS

A

Losartan
Valsartan
other ARBs

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15
Q

what antihypertensive meds work on Aldosterone receptors on RAAS

A

Eplerenone

Spironolactone

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16
Q

what are your classes of antihypertensive drugs

A 
Diuretics
Sympatholytics (antiadrenergic drugs)
     -B Blockers (-lol), A1 blockers, centrally acting Alpha 2 
     agonists
CCBs
    -dihydropyridines (-pine)
    -nondihyropyridines (verapamil and diltiazem)
Drugs that suppress RAAS
    -ACE (-pril)
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17
Q

HTN with no comorbidities - first line

A

Thiazide Diuretic

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18
Q

nephrosclerosis secondary to HTN - what meds

A

ACE then ARB if cant tolerate ACE
Most cases a diuretic is also used
Loop diuretic

NOOOOO potassium sparing diuretics here

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19
Q

HTN in a diabetic

A

Choices
ACEs
ARBs
(these can help slow progression of renal damage and reduce albuminuria in diabetic nephropathy pt)
CCBs (not high on the choice list - linked to increase risk of MI in this population)
diuretics in low doses (Thiazide and loop - promotes hyperglycemia)

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20
Q

what diuretics promote hyperglycemia

A

Thiazide and loop

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21
Q

what antihypertensive can mask the signs of hypoglycemia

A

B Blockers

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22
Q

what race is at higher risk for HTN

A

African Americans

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23
Q

Lifestyle mods and African Americans for HTN

A

high incidence of salt sensitivity and cigarette use. Lifestyle mods are important

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24
Q

HTN treatment in African Americans

A

Diuretics
CCBs

(for more comorbidities consider - Alpha/B blockers and ACEs )

25
Q

antihypertensive drugs to avoid in Heart failure

A

Verapamil
Diltiazem

act on heart to decrease myocardial contractility and can thereby further reduce Cardiac Output

26
Q

antihypertensive drugs to avoid in AV heart block (3)

A

B blockers (-lol)
Verapamil
Diltiazem

Act on heart to suppress AV conduction and can intensify AV block

27
Q

Drug classes to consider for heart failure

A 
Diuretic
B Blocker
Ace inhibitor
ARB
Aldosterone Antagonist
28
Q

antihypertensive drugs to avoid in coronary artery disease (1)

A

Hydralazine

Reflex tachycardia can precipitate a anginal attack

29
Q

antihypertensive drugs to avoid in post MI

A

Hydralazine

Reflex tachycardia can increase cardiac work and oxygen demand

30
Q

antihypertensive drugs to avoid in dyslipidemia

A

B Blockers
Diuretics

may exacerbate dyslipidemia

31
Q

antihypertensive drugs to avoid in renal insufficiency

A

Potassium sparing diuretics
Potassium supplements

can lead to dangerous accumulations of K+

32
Q

antihypertensive drugs to avoid in asthma

A

B Blockers

B2 blockade promotes Bronchoconstriction

33
Q

antihypertensive drugs to avoid in Diabetes

A

Thiazides
furosemide
Both promote hyperglycemia

B Blockers suppress glycogenolysis and can mask signs of Hypoglycemia

34
Q

antihypertensive drugs to avoid in Gout

A

Thiazides
Furosemide

promote hyperuricemia

35
Q

antihypertensive drugs to avoid in hyperkalemia

A

K+ sparing diuretics
ACE inhibitors
DRIs
Aldosterone antagonists

can cause potassium accumulation

36
Q

antihypertensive drugs to avoid in hypokalemia

A

Thiazides

can cause potassium loss

37
Q

antihypertensive drugs to avoid in collagen diseases

A

Hydralazine

can precipitate a lupus erythematosus - like syndrome

38
Q

antihypertensive drugs to avoid in liver disease

A

Methyldopa

hapatotoxic

39
Q

antihypertensive drugs to avoid in preeclampsia

A

ACE
ARBs
DRIs

can injure the fetus

40
Q

Diuretic for Heart failure

A

Loops

41
Q

drug choice for preeclampsia pregnancy

A

labetalol and methyldopa

mag sulfate to prevent/treat seizures

42
Q

older adults hypertension presents as

A

isolated systolic hypertension (diastolic is usually normal or low)

43
Q

treat HTN in children

A

ACE
diuretics
B Blockers
CCBS

44
Q

HTN in breastfeeding

A

B blockers

diuretics appear safe but may suppress lactation

45
Q

treating HTN in older adults

A

ACE
diuretics
B Blockers

Be carful with over diuresis in older adults.

Central acting alpha agonists and peripheral alpha 1 antagonists should be avoided

46
Q

left untreated HTN can cause

A

heart disease, kidney disease and stroke

47
Q

adverse effects of chronic HTN in pregnancy

A 
placental abruption
maternal cardiac decompensation
premature birth
fetal growth delay
CNS hemorrhage
renal failure
48
Q

If pt is already on a antihypertensive when they get pregnant, what should be done

A

They can remain on their med as long as its not an ACE, ARB or DRI

49
Q

when do you treat hypertension in a pregnant pt

A

severe defined at SBP >160 or DBP >110
reducing BP does not lower the risk of preeclampsia
someone who has chronic HTN is already at risk

50
Q

What is determinants to designate preeclampsia

A

Combination of elevated BP>140/90 and proteinuria >or equal to 300mg in 24 hrs that develops after the 20th week of gestation

51
Q

what is chronic HTN

A

HTN that was present before pregnancy or develops before the 20th week gestation

52
Q

At what point does pre-eclampsia change to eclampsia

A

when they begin having seizures

53
Q

Risk factors for preeclampsia

A

black race
chronic HTN
Collagen vascular disorders
previous preeclampsia

54
Q

Risks of preeclampsia to the fetus

A

intrauterine growth restriction
premature birth
death

55
Q

The mother is at risk in preeclampsia for

A 
seizures (eclampsia)
renal failure
pulmonary edema
stroke 
death
hemorrhage 
encephalopathy
56
Q

suggested measures with preeclampsia

A

bed rest
prolonged hospitalization
treatment with antihypertensive drugs
prophylaxis with an anticonvulsant

57
Q

The definitive intervention for preeclampsia is

A

delivery

58
Q

CAD such as MI and HTN

A

B Blocker - helps with cardiovascular remodeling

59
Q

diabetic who is HTN

A

ACE - treating HTN and gives renal protection

Pharm 2 Exam (18 decks)

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