Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NAPLEX > Chapter 28: Hypertension > Flashcards

Chapter 28: Hypertension Flashcards

1
Q

Stage 1 hypertension

A

SBP 130-139 or DBP <80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Stage 2 hypertension `

A

SBP >= 140 or DBP >=90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When to start treatment

A
  • Stage 2 HTN (SBP>=140 or DBP >= 90)
  • Stage 1 HTN (SBP 130-139 or DBP <80)
    • Clinical CVD (stroke, HF, or coronary heart disease)
    • 10 yr ASCVD risk >=20
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

BP goal

A

<130/80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Initial drug selection

A
  • non-black: thiazide, CCB, ACE or ARB
  • black: thiazide or CCB
  • CKD: ACE or ARB (all races)
  • Diabetes with albuminuria: ACE or ARB (all races)
  • Diabetes with CAD: ACE or ARB (all races)
  • Start 2 first-line drugs in stage 2 htn when average SBP and DBP >20/10 above goal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pregnant patients with chronic hypertension

A
  • Should receive treatment if SBP>160 or DBP >105
  • Recommended 1st line drugs are labetalol and nifedipine er, methyldopa (but less effective)
  • Maintain BP between SBP 120-160 and DBP 80-110
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Thiazide type-diuretics MOA

A

Inhibit sodium reabsorption in the distal convoluted tubules causing increased excretion of sodium, chloride, water and potassium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Nephron diagram

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Thiazide type-diuretics

A
  • Chlorthalidone
  • Hydrochlorothiazide
  • Chlorothiazide (IV)
  • Indapamide
  • Metolazone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Thiazide type-diuretics side effects and CI

A

CI: hypersensitivity to sulfonamide-derived drugs
SE: decreased K, Mg, and Na; increased Ca, UA, LDL, TG, and BG; photosensitivity, impotence, dizziness and rash
-Can decrease lithium renal clearance and increase risk of lithium toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Dihydropyridine CCBs MOA

A

Inhibit Ca ions from entering vascular smooth muscle and myocardial cells; this causes peripheral arterial vasodilation (decreases SVR and BP) and coronary artery vasodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Dihydropyridine CCBs CI and SE

A

CI: Nicardipine should not be used in advanced aortic stenosis
SE: peripheral edema, headache, flushing, palpitations, reflex tachycardia, gingival hyperplasia
Clevidipine CI: allergy to soybeans, soy products or eggs
Clevidipine SE: hypertriglyceridemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Dihydropyridine CCBs CI and SE

A

CI: Nicardipine should not be used in advanced aortic stenosis
SE: peripheral edema, headache, flushing, palpitations, reflex tachycardia, gingival hyperplasia
Clevidipine CI: allergy to soybeans, soy products or eggs
Clevidipine SE: hypertriglyceridemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Clevidipine kcal/ml

A

2kcal/ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Non-Dihydropyridine CCBs MOA

A
  • Primarily used to control HR
  • Inhibit Ca ions rom entering vascular smooth muscle and myocardial cells but they are more selective for the myocardium that the DHP CCBs.
  • Decrease in BP is due to negative inotropic (decreased force of ventricular contractions) and negative chronotropic (decrease HR) effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Non-Dihydropyridine CCBs warnings and SE

A

Warnings: HF (may worsen symptoms, bradycardia
SE: edema, constipation (verapamil), gingival hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

CCBs drug interations

A
  • ALL CCBs are major substrates of cyp450 3A4 must use caution with inducers and inhibitors. Do not use with grapefruit juice
  • Dilt and verapamil are substrates and inhibitors or P-gp and inhibitors of CYP3A4. Patients who take statins should use lower doses or simvastatin or lovastatin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CCBs drug interations

A
  • ALL CCBs are major substrates of cyp450 3A4 must use caution with inducers and inhibitors. Do not use with grapefruit juice
  • Dilt and verapamil are substrates and inhibitors or P-gp and inhibitors of CYP3A4. Patients who take statins should use lower doses or simvastatin or lovastatin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Angiotensin-Converting Enzyme Inhibitors (ACEi) MOA

A

Block the conversion angiotensin I (Ang I) to Ang II, resulting in decreased vasoconstriction and decreased aldosterone secretion. They also block the degradation of bradykinin, which is though to contribute to vasodilatory effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Angiotensin-Converting Enzyme Inhibitors (ACEi)

A
  • Benazepril
  • Enalapril and Enalaprilat (IV)
  • Lisinopril
  • Quinapril
  • Ramipril
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Angiotensin-Converting Enzyme Inhibitors (ACEi) Boxed warning

A

Can cause injury and death to developing fetus when used in 2nd and 3rd trimester. Stop use as soon as pregnancy is detected.

22
Q

Angiotensin-Converting Enzyme Inhibitors (ACEi) CI and SE

A

CI: Do not use with history of angioedema. Do not use w/i 36hrs of sacubitril/valsartan (entresto).
SE: Cough, hyperkalemia, increased SCr, hypotension

23
Q

Angiotensin Receptor Blockers (ARBs)

A
  • Irbesartan
  • Losartan
  • Olmesartan
  • Valsartan
24
Q

Angiotensin Receptor Blockers (ARBs)

A
  • Irbesartan
  • Losartan
  • Olmesartan
  • Valsartan
25
Q

Angiotensin Receptor Blockers (ARBs) CI and SE

A

Same as ACEi except:

  • less cough
  • less angioedema
  • no washout period required for entresto
26
Q

Direct Renin inhibitor

A

Directly inhibits renin, which is responsible for the conversion of angiotensinogen to Ang I. A decrease in the formation of Ang I results in a decrease in the formation of Ang II

27
Q

ACEi/ARB and lithium

A

Can decrease lithium renal clearance and can increase lithium toxicity

28
Q

ACEi/ARB and lithium

A

Can decrease lithium renal clearance and can increase lithium toxicity

29
Q

Potassium Sparing diuretics MOA

A

Compete with aldosterone at receptor sites in the distal convoluted tubule and collecting ducts of the nephron, increasing Na and H2O excretion and conserving K

30
Q

Potassium Sparing diuretics boxed warning, CI, and SE

A

Boxed warning: amiloride and triamterene hyperkalemia (k>5.5)
CI: Do not use if hyperkalemia, severe renal impairment, Addison’s disease
SE: hyperkalemia, increased SCr, dizziness; Spironolactone: gynecomastia, breast tenderness, impotence

31
Q

K sparing diuretics and lithium

A

Can decrease lithium renal clearance and can increase lithium toxicity

32
Q

K sparing diuretics and lithium

A

Can decrease lithium renal clearance and can increase lithium toxicity

33
Q

Beta-Blockers MOA

A

Decrease BP by competitively blocking beta-1 and/or beta-2 adrenergic receptors, resulting in decreases in HR and myocardial contractility

34
Q

BBs role

A
  • No longer recommened 1st line therapy for HTN unless the patient has a comorbid condition (post-MI, stable ischemic heart disease, HF)
  • Bisoprolol, carvedilol, and metoprolol succinate should be used for HF
35
Q

BBs with beta-1 selectivity

A
  • Atenolol
  • Esmolol (IV)
  • Metoprolol tartrate
  • Metoprolol succinate
36
Q

BBs with beta-1 selectivity boxed warning, warnings and SE

A

Boxed warning: do not d/c abruptly, taper dose over 1-2 weeks
Warnings: can worsen hyperglycemia or hypoglycemia and can mask hypoglycemic symptoms
SE: bradycardia, fatigue, hypotension, dizziness, depression, impotence

37
Q

BBs with beta-1 and beta-2 activity (non selective)

A
  • Propranolol (has high lipid solubility and crosses blood brain barrier and associated with more CNS SEs [migraine prophylaxis]
  • Nadolol
38
Q

BBs with beta-1 and beta-2 activity (non selective)

A
  • Propranolol (has high lipid solubility and crosses blood brain barrier and associated with more CNS SEs [migraine prophylaxis]
  • Nadolol
39
Q

BBs with non-selective BB and alpha-1 blockers

A
  • Carvedilol (take w/food, CR versions have less bioavailability [coreg 3.125 bid= coreg CR 10mg qd]
  • Labetalol (drug of choice in pregnancy) (SE: dizziness)
40
Q

Centrally-Acting Alpha-2 adrenergic agonists MOA

A

Decrease BP by stimulating alpha-2 adrenergic receptors in the brain and reducing sympathetic outflow of NE which decreases SVR and HR

41
Q

Centrally-Acting Alpha-2 adrenergic agonists CI, warnings, SE

A

CI: Do not use methyldopa with MAOi
Warnings: Do not d/c abruptly (rebound HTN) taper over 2-4 days. Methyldopa; hemolytic anemia
SE: dry mouth, somnolence, fatigue, dizziness, constipation, decreased HR, hypotension, impotence. methyldopa; drug-induced lupus erythematosus (DILE)

42
Q

Centrally-Acting Alpha-2 adrenergic agonists CI, warnings, SE

A

CI: Do not use methyldopa with MAOi
Warnings: Do not d/c abruptly (rebound HTN) taper over 2-4 days. Methyldopa; hemolytic anemia
SE: dry mouth, somnolence, fatigue, dizziness, constipation, decreased HR, hypotension, impotence. methyldopa; drug-induced lupus erythematosus

43
Q

Direct Vasodilators MOA

A

Cause direct vasodilation of arterioles, with little effect on veins. Results in decreases in SVR and reduction in BP

44
Q

Direct Vasodilators Warnings and SE

A

Hydralazine: DILE, peripheral edema, headache, flushing, palpitations, reflex tachycardia
Minoxidil: potent antihypertensive, fluid retention, tachycardia, hair growth

45
Q

Direct Vasodilators Warnings and SE

A

Hydralazine: DILE, peripheral edema, headache, flushing, palpitations, reflex tachycardia
Minoxidil: potent antihypertensive, fluid retention, tachycardia, hair growth

46
Q

Alpha-blockers

A
  • Doxazosin, prazosin, terazosin
  • Bind to alpha-1 adrenergic receptors, which results in peripheral vasodilation of arterioles and veins
  • NOT recommended for HTN, may be used in the who have HTN and BPH
47
Q

Hypertensive Crisis BP

A

BP >= 180/120

48
Q

Hypertensive emergency

A

emergency: pt has acute target organ damage (encephalopathy, stroke, AKI, ACS), treat with IV meds, decrease BP by no more than 25% within the 1st hr, then, if stable, decrease to about 160/100 in the next 2-6 hours

49
Q

Hypertensive urgency

A
  • no evidence of acute target organ damage
  • treat with any oral medication that has a short onset of actions (15-30 mins)
  • decrease BP gradually over 24-48hr
50
Q

IV hypertension meds

A
  • Chlorothiazide
  • Clevidipine
  • Diltiazem
  • Enalaprilat
  • Esmolol
  • Hydralazine
  • Labetolol
  • Metoprolol tart
  • Nicardipine
  • Nitroglycerin
  • Nitroprusside
  • Propranolol
  • Verapamil
51
Q

Drugs that can increase BP

A
  • amphetamines and ADHD drugs
  • cocaine
  • decongestants (sudafed)
  • erythropoiesis-stimulating agents
  • immunosuppressants (cyclosporine)
  • NSAIDs
  • Systemic steroids

NAPLEX (45 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions