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NAPLEX > Chapter 28: Hypertension > Flashcards

Chapter 28: Hypertension Flashcards

1
Q

Stage 1 hypertension

A

SBP 130-139 or DBP <80

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2
Q

Stage 2 hypertension `

A

SBP >= 140 or DBP >=90

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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
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4
Q

BP goal

A

<130/80

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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
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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
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7
Q

Thiazide type-diuretics MOA

A

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

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8
Q

Nephron diagram

A
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9
Q

Thiazide type-diuretics

A
  • Chlorthalidone
  • Hydrochlorothiazide
  • Chlorothiazide (IV)
  • Indapamide
  • Metolazone
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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

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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

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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

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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

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14
Q

Clevidipine kcal/ml

A

2kcal/ml

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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
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16
Q

Non-Dihydropyridine CCBs warnings and SE

A

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

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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
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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
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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

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20
Q

Angiotensin-Converting Enzyme Inhibitors (ACEi)

A
  • Benazepril
  • Enalapril and Enalaprilat (IV)
  • Lisinopril
  • Quinapril
  • Ramipril
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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)

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