Chapter 28: Hypertension Flashcards
1
Q
What is the cause of primary, or essential, HTN
A
Cause is unknown, but risk factors are usually present (like obesity, smoking, excessive salt intake, etc)
2
Q
What is the cause of secondary HTN
A
Renal disease
3
Q
What is normal BP considered
A
SBP < 120 mmHg and DBP < 80 mmHg
4
Q
What is stage 1 HTN considered
A
SBP 130-139 mmHg or DBP 80-89
5
Q
What is stage 2 HTN considered
A
SBP >/= 140 mmHg or DBP >/= 90 mmHg
6
Q
Lifestyle management of HTN includes reducing Na intake to < _____ mg daily
A
1500
7
Q
Key drugs that can increase BP
A
o Amphetamines and ADHD drugs o Cocaine o Decongestants (e.g. pseudoephedrine, phenylephrine) o Erythropoietin-stimulating agents o Immunosuppressants (e.g. cyclosporine) o NSAIDs o Systemic steroids
8
Q
What are natural products that can be used for HTN
A
Fish oil, Coenzyme Q10, L-arginine, garlic
9
Q
What are the 4 preferred drug classes for initial treatment or titration of treatment
A
ACEi, ARB, CCBs, or thiazide diuretics
10
Q
When to start treatment in Stage 2 HTN
A
When SBP is >/= 140 mmHg or DBP >/= 90 mmHg
11
Q
When to start treatment in Stage 1 HTN
A
SBP 130-139 mmHg or DBP 80-89 and
- Clinical CVD (stroke, HF, or CAD)
- 10-yr ASCVD risk >/= 10%
12
Q
BP goal for all pts
A
< 130/80 mmHg
13
Q
Initial drug selection for Non-black pts
A
thiazide, CCB, ACEi, or ARB
14
Q
Initial drug selection for black pts
A
thiazide or CCB
15
Q
Initial drug selection for pts with CKD (all races)
A
ACEi or ARB
16
Q
Initial drug selection for pts with diabetes with albuminuria (all races)
A
ACEi or ARB
17
Q
How many drugs should a pt be started on in stage 2 HTN when Average SBP and DBP >20/10 mmHg above goal (e.g., 150/90 mmHg)
A
2
18
Q
Which antihypertensives have a boxed warning for fetal toxicity
A
ACEi, ARBs and aliskiren
19
Q
Pregnant patients with chronic HTN should receive drug treatment if SBP is >/= ___ or DBP is >/= ___
A
SBP >/= 160
DBP >/= 105
20
Q
First line treatments for HTN in pregnant pts
A
labetalol and nifedipine ER (methyldopa can be recommended but is less effective)
21
Q
Lisinopril/HCTZ brand name
A
Zestoretic
22
Q
Losartan/HCTZ brand name
A
Hyzaar
23
Q
Olmesartan/HCTZ brand name
A
Benicar HCT
24
Q
Valsartan/HCTZ brand name
A
Diovan HCT
25
Benazepril/amlodipine brand name
Lotrel
26
Valsartan/amlodipine brand name
Exforge
27
Atenolol/chlorthalidone brand name
Tenoretic
28
Bisoprolol/HXTZ brand name
Ziac
29
Triamterene/HCTZ brand name
Maxzide, Dyazide
30
Thiazide diuretics MOA
inhibit Na reabsorption in the DCTs, causing increased excretion of Na, Cl, water and K
31
Chlorthalidone doses
12.5-25 mg daily
32
HCTZ doses
12.5-50 mg daily
33
Thiazide diuretic CI
Hypersensitivity to sulfonamide-derived drugs
34
Thiazide diuretic SE
- ↓ electrolytes: K, Mg, Na
- ↑ electrolytes/labs: Ca, UA, LDL, TG, BG
- Photosensitivity
35
Thiazides are not effective when CrCl < ___
30 mL/min
36
Which thiazide diuretic is the only one available IV
chlorthalidone
37
Which drug class should be avoided with thiazide diuretics
NSAIDs (can cause Na & water retention)
38
Thiazide diuretics can decrease ___ renal clearance and increase risk of toxicity
Lithium
39
DHP CCBs are used in what conditions
HTN, chronic stable angina and Prinzmetal’s angina
40
DHP CCB MOA
Inhibit Ca ions from entering vascular smooth muscle and myocardial cells; this causes peripheral arterial vasodilation
41
Amlodipine brand name
Norvasc
42
Nicardipine IV brand name
Cardene IV
43
Nifedipine ER brand name
Adalat CC, Procardia XL
44
Which CCB should not be used for chronic hypertension or acute BP reduction in non-pregnant adults (profound hypotension, MI, and/or death has occurred)
Nifedipine IR
45
CCB SE
Can cause peripheral edema/HA/flushing/palpitations/reflex tachycardia/fatigue (worse with Nifedipine IR, can occur with others), gingival hyperplasia
46
____ & ____ are considered the safest if a CCB must be used to lower BP in HFrEF
Amlodipine and felodipine
47
____ are used to prevent peripheral vasoconstriction in Raynaud’s
DHP CCBs (e.g. nifedipine ER)
48
Clevidipine (Cleviprex) CI
Allergy to soybeans, soy products or eggs
49
Clevidipine (Cleviprex) warnings
Hypotension, reflex tachycardia, infections
50
Clevidipine (Cleviprex) SE
Hypertriglyceridemia
51
A lipid emulsion of Clevidipine (provides __ kcal/mL): it is ____ in color
2
| milky-white
52
Clevidipine max time of use after vial puncture is ___ hours
12
53
___ are primarily used to control HR in certain arrhythmias (e.g. atrial fibrillation), and sometimes used for HTN and angina
Non-DHP CCBs
54
Which class of CCBs are more selective for the myocardium
non-DHP CCBs
55
The decrease in BP produced by non-DHP CCBs is d/t ____ (↓ force of ventricular contraction) and ____ (↓ HR) effects
negative inotropic
| negative chronotropic
56
Diltiazem brand name
Cardiem, Tiazac
57
Verapamil brand name
Calan SR
58
non-DHP CCB warnings
HF (may worsen symptoms), bradycardia
59
non-DHP CCB SE
Edema, constipation (more with verapamil), gingival hyperplasia
60
Use caution with CCBs & ____
other drugs that ↓ HR, including BB, digoxin, clonidine, & amiodarone
61
All CCBs are major substrates of CYP450 ___. Check for drug interactions and do not use with ____
3A4
| grapefruit juice
62
Diltiazem and verapamil are substrates and inhibitors of ___ and moderate inhibitors of ___
Pgp
| CYP3A4
63
Patients on diltiazem or verapamil and a statin should use lower doses of which 2 statins
simvastatin and lovastatin
64
Which 2 classes of HTN meds have been shown to slow the progression of kidney disease in patients with albuminuria
ACEi and ARB
65
How are ACEi and ARBs beneficial in HF
protect the myocardium from the remodeling effects of Ang II
66
ACEi MOA
block the conversion of angiotensin I to Ang II, resulting in ↓ vasoconstriction and ↓ aldosterone secretion
67
ACEi block the degradation of
bradykinin, which is thought to contribute to vasodilatory effects (& SE of dry and hacking cough)
68
Benazepril brand name
Lotensin
69
Enalapril brand name
Vasotec
70
Enalaprilat brand name
Vasotec IV
71
Lisinopril brand name
Prinivil, Zestril
72
Quinapril brand name
Accupril
73
Ramipril brand name
Altace
74
ACEi BW
Can cause injury and death to developing fetus when used in 2nd and 3rd trimesters; d/c as soon as pregnancy is detected
75
ACEi should not be used within __ hrs of sacubitril/valsartan (Entresto)
36
76
ACEi warnings
Angioedema, hyperkalemia, hypotension, renal impairment, bilateral renal artery stenosis (avoid use)
77
ACEi SE
cough, hyperkalemia, ↑ SCr, hypotension
78
Irbesartan brand name
Avapro
79
Losartan brand name
Cozaar
80
Olmesartan brand name
Benicar
81
Valsartan brand name
Diovan
82
ARB MOA
Block Ang II from binding to the angiotensin II type-1 (AT1) receptor on vascular smooth muscle, preventing vasoconstriction
83
Which class of HTN meds does not require a washout period
ARBs
84
Which class of HTN meds has less cough and angioedema
ARBs
85
Olmesartan warning
sprue-like enteropathy
86
Aliskiren CI
Do not use with ACEi or ARBs in patients with diabetes
87
All RAAS inhibitors ↑ risk for ____
hyperkalemia
88
ACEi and ARBs can ↓ ____ renal clearance and ↑ the risk of toxicity
lithium
89
____ is a non-selective aldosterone receptor antagonists that also blocks ___
Spironolactone
| androgen
90
____ is a selective aldosterone antagonist that does NOT exhibit endocrine side effects
Eplerenone
91
Spironolactone brand name
Aldactone
92
Amiloride and triamterene BW
hyperkalemia (K > 5.5 mEq/L) – more likely in patients with diabetes, renal impairment, or elderly patients
93
K-sparing diuretics CI
Do not use if hyperkalemia, severe renal impairment, Addison’s disease (spironolactone)
94
K-sparing diuretics SE (all meds)
Hyperkalemia, ↑ SCr, dizziness
95
Spironolactone SE
gynecomastia, breast tenderness, impotence
96
Which BB should be used if treating chronic HF
Bisoprolol, carvedilol, or metoprolol succinate
97
BB with intrinsic sympathomimetic activity (ISA) like ____ do not ↓ HR to the same degree as BB without ISA and are not recommended in post-MI pts
acebutolol
98
Atenolol brand name
Tenormin
99
Esmolol brand name
Brevibloc
100
Esmolol formulation
injection
101
Metoprolol tartrate brand name
Lopressor
102
Metoprolol succinate ER brand name
Toprol XL
103
Beta-blockers BW
Do not d/c abruptly; gradually taper dose over 1-2 weeks to avoid acute tachycardia, HTN, and/or ischemia
104
BB warnings
- Use caution in pts with diabetes: can worsen hyperglycemia or hypoglycemia and mask hypoglycemic symptoms
- Caution with bronchospastic diseases (e.g. asthma, COPD), Beta-1 selective preferred
- Caution in Raynaud’s/other peripheral vascular diseases, and HF
105
Beta-blockers side effects
Bradycardia, fatigue, hypotension, dizziness, depression, impotence, cold extremities (can exacerbate Raynaud’s)
106
Which 2 BB should be taken with or immediately following food, while the others can be taken without regard to food
```
Lopressor (metoprolol tartrate)
Toprol XL (metoprolol succinate)
```
107
IV:PO ratio for metoprolol tartrate
1:2.5
108
What are the beta-1 selective drugs
Remember: AMEBBA
- Atenolol
- Metoprolol
- Esmolol
- Bisprolol
- Betaxolol
- Acebutolol
109
Nebivolol brand name
Bystolic
110
Which BB is a B1 selective blocker with Nitric oxide-dependent vasodilation
Nebivolol
111
Which BB are B1 and B2 non-selective
Propranolol and Nadolol
112
Non-selective BB are used in
portal HTN
113
Propranolol brand name
Inderal LA, Inderal XL
114
Nadolol brand name
Corgard
115
Propranolol has high __ solubility & therefore causes more ____ SE, but this makes it more useful in conditions like ____
lipid
CNS
migraine ppx
116
Which BB are non-selective BB and Alpha-1 blockers
Carvedilol, labetalol
117
Carvedilol brand name
Coreg, Coreg CR
118
How should all forms of carvedilol be taken
with food
119
T/F: carvedilol dosing conversions are 1:1
false
120
Labetalol SE
dizziness
121
BB can decrease ___ secretion
insulin
122
____ is commonly used for resistant HTN and in pts who cannot swallow since it’s available as a patch
Clonidine
123
Clonidine brand name for HTN
Catapres, Catapres-TTS patch
124
Clonidine brand name for ADHD
Kapvay
125
Guanfacine ER brand name for ADHD
Intuniv
126
Methyldopa (Centrally-acting alpha-2 adrenergic agonist) CI
concurrent use with MAOi
127
Methyldopa warning
risk for hemolytic anemia
128
Centrally-acting alpha-2 adrenergic agonists warning
Do not d/c abruptly (can cause rebound HTN); must taper over 2-4 days
129
Centrally-acting alpha-2 adrenergic agonists SE
- Dry mouth, somnolence, fatigue, dizziness, constipation, ↓ HR, hypotension
130
Methyldopa SE
hypersensitivity rxn [e.g. drug-induced lupus erythematosus (DILE)]
131
Clonidine patch is applied how many times per week
once
132
Hydralazine warning
DILE
133
Hydralazine SE
Peripheral edema/HA/flushing/palpitations/reflex tachycardia
134
Minoxidil SE
Fluid retention, tachycardia, hair growth
135
Hypertensive crises is BP >/=
180/120 mmHg
136
patient has acute target organ damage (e.g. encephalopathy, stroke, acute kidney injury, acute coronary syndrome, aortic dissection, acute pulmonary edema)
Hypertensive emergency
137
How is hypertensive emergency treated
IV meds (chlorothizaide, clevidipine, diltiazem, enalaprilat, esmolol, hydralazine, labetalol, metoprolol tartrate, nicardipine, nitroglycerin, nitroprusside, propranolol, verapamil)
138
In hypertensie crisis, Decrease BP by no more than __% (within first __), then if stable, decrease to ~160/100 mmHg in the next 2-6 hrs
25
| hour
139
How is hypertensive urgency treated
any oral med that has a short onset of action
140
Hypertensive urgency- decrease BP gradually over ___-___ hrs
24-48
