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Pharm (Cholley) > CV HTN > Flashcards

CV HTN Flashcards

1
Q

What fraction of time is spent in diastole?

A

2/3

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2
Q

What fraction of time is spent in systole?

A

1/3

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3
Q

What is the major determinant of SBP?

A

CO

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4
Q

What largely determines DBP?

A

Total peripheral resistance (TPR)

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5
Q

Define CO

A

Fxn of SV, HR, & venous capacitance

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6
Q

Define PCT (What is it responsible for?)

A
  • Major site for NaCl & NaHCO3 reabsorption

- Responsible for 60-70% of total reabsorption of Na

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7
Q

What permits rapid reabsorption of CO2?

A

Conversion of HCO3 to CO2 via carbonic acid

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8
Q

What is the most common loop diuretic?

A

Furosemide (Lasix)

- Others: Bumetanide, Torsemide

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9
Q

What are the most common thiazides?

A
  • Chlorthalidone

- Hydrocholorothiazide (HCTZ)

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10
Q

What are the most common potassium sparing?

A
  • Amiloride

- Triamterene

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11
Q

What is the most common aldosterone antagonist?

A

Spironolactone

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12
Q

What does diuresis result in?

A

Decreased plasma & SV

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13
Q

Diuretics MOA

A

Blocks reabsorption of Na & Cl

- H2O follows due to the osmotic pressure within the nephron created by the ions

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14
Q

Define TAL (What is it responsible for?)

A
  • Pumps Na, K, & Cl out of lumen into kidney
  • Major site of Ca & Mg reabsorption
  • Responsible for 20-30% of Na reabsorption
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15
Q

Loop diuretics MOA

A
  • Blocks Na+K+Cl- symporter at TAL

* More potent diuresis, smaller decrease in PVR, & less vasodilation

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16
Q

Loop diuretics: Efficacy

A
  • Diuresis exceeds BP lowering
  • Preferred in HF or severe edema
  • Less likely to cause hyperglycemia, hyperlipidemia
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17
Q

What are some characteristics of Furosemide?

A
  • Short duration of action
  • Poor anti-hypertensive
  • Use in pts w/ kidney disease or fluid retention
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18
Q

What is Torsemide?

A

Effective BP med at low dosage

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19
Q

What 2 meds are used in tx of hypercalcemia?

A
  • Furosemide

- Torsemide

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20
Q

Describe the DCT (What is it responsible for?_

A
  • Pumps Na & Cl out of lumen via Na/Cl carrier (NCC)
  • Target of thiazide diuretics
  • Responsible for 5-8% Na reabsorption
  • Ca also reabsorbed via PTH
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21
Q

Thiazide diuretics MOA

A
  • Blocks reabsorption of Na & Cl in DCT, H2O follows
  • Initial diuresis - decreased plasma & SV
  • Provides chronic anti-hypertensive action via decrease in PVR & SM relaxation
22
Q

What does ADH do?

A

Facilitates H2O reabsorption from collecting tubule by activation of V2 receptors

23
Q

What do V2 receptors do?

A

Stimulate adenyl cyclase via Gs

24
Q

What does increased cAMP cause?

A

Insertion of additional aquaporin (AQP2) channels into mem

25
Q

What is the action of ADH & desmopressin?

A

Reduce urine volume & increase [ ]

26
Q

What are ADH & desmopressin useful for?

A

Pituitary diabetes insipidus

- But they are of no value in the nephrogenic form of diabetes insipidus

27
Q

What can cause significant H2O retention & dangerous hyponatremia?

A

Tumors producing peptides

28
Q

What syndrome can be tx w/ demeclocycline & conivaptan?

A

Syndrome of inappropriate ADH secretion (SIADH)

29
Q

What is the goal of HTN tx?

A

Reduce morbidity & mortality from CV events

30
Q

What is the equation for BP?

A

BP = CO x TPR

31
Q

What is the fxn of angiotensin blockers?

A

Reduce PVR & blood volume

32
Q

What is the fxn of sympatholytic agents?

A
  • Reduce PVR by inhibiting cardiac fxn –> increased venous pooling
  • Reduces SV
33
Q

What do CCBs do?

A

Inhibit Ca influx –> coronary & peripheral vasodilation

34
Q

What is the fxn of diuretics?

A

Deplete the body of Na & reduce blood volume

35
Q

What is the fxn of aldosterone antagonists?

A

Inhibits aldosterone –> inhibits Na/H2O retention & vasoconstriction

36
Q

What is the fxn of direct vasodilators?

A

Relaxes SM –> Reduced pressure –> dilated resistance vessels & increased capacitance

37
Q

What are some examples of drug families that can be used together?

A
  • Diuretics & BBs
  • ACE-Is & BBs
  • Renin inhibitors & diuretics
  • Renin inhibitors & ACE-Is/ARBs
38
Q

What is NOT recommended (& potentially harmful) for those w/ elevated BP or HTN?

A

Simultaneous use of ACE-I, ARB, & renin inhibitor

39
Q

What is a “strong” recommendation regarding BP goal?

A

Adults w/ HTN & known CVD or 10yr ASCVD risk of 10% or higher = 130/80

40
Q

What is a “weak” recommendation regarding BP goal?

A

Adults w/ HTN w/out increased CVD risk = 130/80 (may be REASONABLE)

41
Q

What is recommended for initial therapy?

A

First line agents = thiazides, CCBs, & ACE-Is or ARBs

42
Q

What is recommended tx for HTN w/ SIHD?

A

Meds for compelling indications as first line therapy, w/ addition of other drugs as needed

43
Q

What GDMT beta blockers should be used for BP control or relief of angina? Which should not?

A

Carvedilol, metoprolol tartrate, metoprolol succinate, nadolol, bisoprolol, propranolol, & timolol

  • Avoid those w/ intrinsic sympathomimetic activity
  • Atenolol should not be used bc it is less successful than placebo at reducing CV events
44
Q

In pts w/ HFrEF, what tx for HTN is considered to have no benefit?

A

Non-DHP CCBs

45
Q

In pts w/ acute ICH, what is considered harmful tx?

A

Lowering SBP less than 140 in those who present within 6 hrs & have a SBP btwn 150 & 220

46
Q

In pts w/ PAD, what is the recommended tx?

A

Treat similarly to those w/out PAD

47
Q

What is a “weak” recommendation for tx of AF?

A

ARB can be useful for prevention of reoccurrence

48
Q

In pts w/ asx aortic stenosis, what is a strong recommendation for tx of HTN?

A

Start at low dose & gradually titrate upward as needed

49
Q

In pts w/ chronic aortic stenosis, what is a weak recommendation for tx of systolic HTN?

A

It is reasonable to treat w/ agents that do not slow HR (avoid beta blockers)

50
Q

In aortic dz, what is a strong recommendation for tx of HTN?

A

Beta blockers

51
Q

What is considered a “weak” recommendation for pts w/ cognitive decline or dementia & HTN?

A

BP lowering is reasonable

Pharm (Cholley) (9 decks)

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