Exam 1 - Hypertension Flashcards
1
Q
What is the definition of hypertension for systolic and diastolic?
A
Systolic greater than 140, Diastolic greater than 90
2
Q
What is the lifetime risk of HTN?
A
90%
3
Q
What is the ratio of adults who have HTN?
A
1 in 3
4
Q
What are some risk factors for developing HTN?
A
Cigarette smoking, Obesity (BMI above 30), physical inactivity, dyslipidemia, DM, renal dysfunction, men over 55 y/o, women over 65 y/o, family history of premature cardiovascular dz
5
Q
What are the two types of Hypertension?
A
Essential Hypertension (90% of cases), Secondary Hypertension (10%)
6
Q
What is the most common type of HTN?
A
Essential HTN
7
Q
What is a strong component of Essential HTN?
A
Hereditary component
8
Q
What are two common causes of Secondary HTN?
A
CKD, renovascular dz
9
Q
Secondary HTN makes up what percentage of cases?
A
10%
10
Q
Systolic BP represents what?
A
Cardiac contraction. Amount of blood pumped out by ventricles (cardiac output)
11
Q
What is Cardiac Output and what number represents it?
A
Amount of blood pumped out of the ventricles. Represented by Systolic BP.
12
Q
What does Diastolic BP represent?
A
Number that represents nadir (lowest point). Filling of heart with blood. Sum of peripheral resistance in peripheral vasculature.
13
Q
What is happening in the heart during Diastole?
A
Filling of heart with blood
14
Q
Sum of peripheral resistance in peripheral vasculature is represented by what measurment?
A
Diastolic BP
15
Q
What is Total Peripheral Resistance (TPR)?
A
Sum of peripheral resistance in peripheral vasculature. Measured by Diastolic BP.
16
Q
What guidelines are used in the treatment of HTN?
A
JNC 8
17
Q
In a PT over 60 y/o what is the target BP?
A
150/90 or less
18
Q
In a PT younger than 60 y/o what is the target BP?
A
140/90 or less
19
Q
What is the target BP for any patient who has with DM or CKD?
A
140/90 or less
20
Q
What are some non-pharmacological therapies in treating HTN?
A
Stop smoking, weight loss (biggest impact 5-10mmHg decrease per 10kg loss), increase physical activity, DASH diet, sodium restriction, limit EtOH to 2 a day or less
21
Q
A majority of PTs will need how many medications to reach their goal?
A
2
22
Q
What are the main four first-line options for treating HTN?
A
ACE-I, ARB, CCBs, Thiazide Diuretics
23
Q
What two first line treatments are not used in African-Americans?
A
ACE-I, ARB
24
Q
If PT has DM or CKD what are the two first line treatments even if they are African American?
A
ARB, ACE-I
25
Should you use ARBs and ACE-Is together?
No
26
What is first line treatment of HTN is PT has a cardiac history?
Beta Blocker
27
What is the most common treatment approach when adding a second agent and max dose?
Start with one agent. If not at goal add a second agent *before* maxing out first agent. If still not at goal then max out dose on both before adding a third agent.
28
If PT has a SBP above 160 and/or DBP above 100 how many agents do you start with?
Two. (But in practice you use one and then a second later, but two is the answer for exam purposes).
29
What are the three types of Diuretics?
Thiazide Diuretics, Loop Diuretics, and Potassium Sparing Diuretics
30
What are the three Thiazide Diuretics?
HCZT, chlorthalidone, metolzaone
31
What is the MOA for the three Thiadize Diuretics?
Inhibits sodium reabsorption in distal tubule
32
What is special about Metolazone?
Not used for BP management, only fluid management. Very potent, one-time use only.
33
What happens to the electrolytes in Thiazide Diuretics?
Down: K+ and Na+
Up: Ca++, Uric Acid, Glucose
34
What must the serum Creatine clearance be in order for HCZT to work?
Above 30 ml/min
35
What will a Thiazide Diuretic initially increase that is a side-effect?
Urination, so give it in the morning
36
Thiazide diuretics can cause what to the skin?
Sun burns more easily
37
Thiazide Diuretics are ineffective in PT's with what?
Severe renal disease
38
Thiazide Diuretics contain ____ which some Abx also contain so to ask the PT what their reaction is before giving
Sulfa
39
If a PT is taking ____ don't give a Thiazide Diuretic because of possibly toxic concentrations
Lithium
40
What do Loop Diuretics end in?
"-ide"
41
What is the MOA for Loop Diuretics?
Inhibits active transport of Na, Cl, and K in thick ascending limb of Loop of Henle causing them to be excreted with water into collecting ducts
42
Does a Loop Diuretic work before or after a Thiazide Diuretic?
Before
43
Loop Diuretics are the preferred diuretic for what condition?
CHF
44
Loop Diuretics used in what main three conditions?
CHF (preferred diuretic), Edema (peripheral and pulmonary), HTN (not as potent as Thiazide)
45
What happens to electrolyes in Loop Diuretics?
Down: Na, K, Ca, Mg
Up:Uric Acid
46
Diuretics can complicate gout because they increase what?
Uric Acid
47
Loop Diuretics can easily cause dehydration because?
Na is excreted out, taking with it water
48
How frequent does Ototoxicity occur with Loop Diuretics?
Very rare. Usually only when combined with another ototoxic drug
49
What does a Loop Diuretic do to serum Cr? What must the SrCr be for a Loop Diuretic to work?
Increase SrCr. Above 10 ml/min to work.
50
What two things must you be take precaution in when using Loop Diuretics?
Sulfa allergies, nephrotoxicity
51
What are the two types of Potassium Sparing Diuretics?
Aldosterone Receptor Blockers, Potassium Sparing Drugs
52
What is the MOA of Aldosterone Receptor Blockers (a type of K-Sparing Diuretic)?
Competes with Aldosterone, prevents Na reabsorption and K excretion
53
What are the two Aldosterone Receptor Blocker drugs?
Spironolactone, Eplerenone
54
What is the MOA of Potassium Sparing Drugs (a type of Potassium Sparing Diuretic)?
Blocks Na reabsorption and K excretion. Effect is independent of aldosterone blocker.
55
What are the two Potassium Sparing Drugs (a type of Potassium Sparing Diuretic)?
Triamterene, Amiloride
56
Are Potassium Sparing Drugs ever used on their own to treat HTN?
No. Very poorly effective on their own but they are used in conjunction with others.
57
What is the MOA of Potassium Sparing Diuretics?
Blocks Na reabsorption and K excretion in distal tubule
58
Potassium Sparing Diuretics are often used in combination with what else? Why?
Thiazide Diuretic, to help balance K
59
Spironolactone is most often used for what condition
Class IV Heart Failure
60
What are some adverse effects of Potassium Sparing Diuretics?
Both Spirinolactone and Eplerenone: Hyperkalemia
Spironolactone: Gynecomastia, menstural irregularities
Eplerenone: Fewer side effects as more selective
61
What converts Angiotensin I to Angiotensin II?
ACE (Angiotensin Converting Enzyme)
62
What converts Angiotensinogen to Angiotensin I?
Renin
63
What converts Bradykinins to inactive kinins?
ACE
64
What is the cause of the ACE-I cough?
Build up of Bradykinins. Inhibition of ACE prevents the conversion of Bradykinins to inactive kinins causing the kinins to stay around longer and cause cough
65
What do ACE-Inhibitors end in?
"-pril"
66
What is the MOA of an ACE Inhibitor
Inhibits ACE to prevent conversion of Angiotensin I to Angiotensin II
67
What does ACE-I do to the kidneys?
Dialates the efferent arteriole. "Protects kidneys".
68
Which HTN drug is "kidney protective"? How?
ACE-I. Dialates efferent arteriole and preventing microproteinuria from becoming macroproteinuria.
69
What conditions is an ACE-I possible first line therapy for?
HTN, CKD
70
How often is an ACE-I dosed?
Most often once a day, sometimes twice.
71
What two things must be monitored in within 4 weeks of starting an ACE-I?
Serum K and Serum Cr.
72
What can happen to Serum Cr soon after starting an ACE-I?
Benign increase in Serum Cr less than 30% within 4 weeks of starting ACE-I. Will go back down to base and be normal.
73
What can an ACE-I do to serum K levels?
Dangerously raise them
74
What is a serious, life-threatening side-effect of an ACE-I?
Angioedema (swelling of face, tongue, throat). Due to allergy.
75
What causes the ACE-I cough? What percentage of PTs get it?
Increased bradykinins from ACE-I. Up to 20% of PTs get it.
76
Hyperkalemia when an ACE-I is used happens most commonly in what two conditions?
DM and CKD
77
Can an ACE-I be used in pregnancy?
NO
78
If a PT has had angioedema with another ACE-I can you use a different one?
No. Having had angioedema from an ACE-I is a contraindication to further ACE-I use.
79
Can you use an ACE-I in a PT with renal artery stenosis?
No
80
What three drugs classes can an ACE-I interact with?
Potassium supplements, Potassium Sparing Diuretic, NSAID
81
What is the only ACE-I that is available in IV?
Enalaprilat
82
What is the most common ACE-I and its dose?
Lisinipril, 10-40mg daily
83
Catopril absorption is decreased by 30-40% when taken with what?
Food
84
Angiotensin II Receptor Blockers end in what?
"-sartan"
85
What is the MOA for ARBs?
Inhibits angiotensin II at its receptor sites.
86
What is the effect of an ARB on bradykinin?
Nothing. Does not prevent the breakdown of bradykinin to its inactive forms.
87
What are two first line conditions ARBs can treat?
HTN, CKD
88
Is CHF treatable with ARBs and ACE-Is?
Yes
89
How often is an ARB dosed?
Usually once daily
90
Can ARBs cause potassium?
Yes. So can ACE-Is
91
What is a "Salt Substitute" and what medication classes can interact with it?
KCl for food instead of NaCl. Can raise K levels dangerously high if PT on ACE-I or ARB. (Also potassium sparing diuretic?)
92
Can an ARB be used in pregnancy?
NO
93
Can an ARB be used in PTs with renal artery stenosis?
Yes but with caution
94
Can an ARB be used in a PT who has had angioedema while taking an ACE-I?
Yes, but use caution?
95
What three categories of drugs can an ARB interact with?
Potassium supplements, Potassium Sparing Diuretics, NSAIDs
96
What is the MAO of Aliskiren?
Prevents conversion of Angiotensinogen to Angiotensin I. Directly inhibits renin.
97
Which new agent directly inhibits renin?
Aliskiren?
98
What converts Angiotensinogen to Angiotensin I?
Renin
99
Can Aliskiren be used in pregnancy?
No
100
Is the role of Aliskiren figured out and where it fits in treatment of HTN clear?
No. Still a new agent and role in HTN therapy is unclear.
101
Is Aliskiren a monotherapy, combo therapy, or both?
Both
102
What are the two categories of Calcium Channel Blockers (CCBs)?
Non-dihydropyridines and dihydropyridines
103
What are the two non-dihydropyridines?
Verapamil, Diltiazem
104
What do the dihydropyridines CCBs end in?
"-ipine"
105
What do the non-dihydropyridines CCBs end in?
Nothing. Just two of them and need to memorize them (Verapamil, Diltiazem)
106
What is the role of a calcium channel?
When open allows for influx of calcium into smooth muscle (cardiac smooth muscle and vascular smooth muscle) leading activation of intracellular calcium leading to muscle contraction
107
What is the MOA of CCBs in general?
Inhibit influx of calcium into cells to prevent muscle contraction
108
What is the action of Non-Dihydropyridine CCBs on cardiac smooth muscle?
Decreases inotropy (force of contractions) and decreases chronotropy (rate of contractions) by inhibiting the smooth muscle
109
What is the action of Dihydropyridine CCBs on vascular smooth muscle?
Vasodilation by inhibiting the vascular smooth muscle. Dihydropyridine.
110
Do Dihydropyridine CCBs work on vascular or cardiac smooth muscle?
Vascular Smooth Muscle
111
Do Non-Dihydropyridine CCBs work on vascular or cardiac smooth muscle?
Cardiac Smooth Muscle
112
What do Dihydropyridine CCBs inhibit and what is the result?
Inhibits the flow of calcium into vascular smooth muscle, results in peripheral vasodilation
113
What are four Dihydropyridine CCBs?
Amlodipine, felodipine, isradipine, nifedipine (AFIN)
114
What do Non-Dihydropyridine CCBs inhibit and what is the effect?
Inhibit calcium influx into cardiac smooth muscle, resulting is decreased rate and force of contractions
115
What are the two Non-Dihydropyridine CCBs?
Verapamil, Diltiazem (VD...venereal disease)
116
Where do Non-Dihydropyridine CCBs manly work?
In the heart. Reduce force and speed of cardiac contractions.
117
What are other conditions of Non-Dihydropyridine CCBs can treat?
SVT, AFib
118
Verapamil is used as prophylaxis for what?
Migraines
119
What is a common adverse effect of all CCBs?
Hypotension
120
What are 5 possible adverse reactions in Non-Dihydropyridine?
Constipation (Verapamil), Exacerbation of CHF, bradycardia, heart block, gingival hyperplasia
121
Which Non-Dihydropyridine can cause constipation?
Verapamil
122
Can Non-Dihydropyridines be used to treat CHF/heart failure?
NO! Will exacerbate and make much worse.
123
What are four possible adverse effects of Dihydropyridines?
Peripheral Edema (worse w/Nifedipine), reflex tachycardia, flushing, headache
124
Can Dihydropyridine CCBs be used for CHF?
Yes; especially Amlodipine, Felodipine, and Isradipine
125
Peripheral edema occurs with which type of CCBs?
Dihydropyridine CCBs. Worst with Nifedipine.
126
Which CCB causes the worst peripheral edema?
Nifedipine
127
Peripheral edema from Dihydropyridine CCBs is dependent on what?
Dose dependent.
128
Reflex tachycardia can happen with which CCBs?
Dihydropyridine CCBs
129
Should you ever use sublingual Nifedipine?
NO! Causes severe hypotension and increased risk of MI.
130
Dihydropyridine CCBs are useful for patients with what? What age group?
Isolated systolic hypertension, especially elderly.
131
What is is the most common and second most common Dihydropyridine CCBs?
Amlodipine (Norvasc), Felodipine (Plendil)
132
What allergy contraindicates Clevidipine via IV?
Soy or egg allergy
133
Which cytochrome system metabolizes Verapamil?
P450 3A4
134
Which cytochrome system can Verapamil inhibit?
P450 3A4 (same system that metabolizes it)
135
What is BP goal for 45 y/o caucasian male who has a BP of 160/84? What classes are used first to treat?
Less than 140/90 due to age under 60. ACE-I, ARB, CCB, or Thiazide Diuretic.
136
Furosemide is what type of diuretic?
Loop Diuretic
137
Hypercalemia occurs with which type of diuretic?
Occurs with Thiazide Diuretics, not Loop Diuretics
138
Aliskerin directly inhibits what?
Renin
139
If a PT is taking Lisinipril (ACE-I) what dietary substitute should they avoid?
Avoid "salt substitute"
140
Where do Thiazide Diuretics work?
In Distal Tubule (not in Loop of Henle) by inhibiting Na+ reabsorption leading to Na+ and H2O excretion
141
Where do Loop Diuretics work?
in Thick Ascending Limb of Loop of Henle by inhibiting Na+, K+, and Cl- reabsorption leading to Na+ and H2O excretion
142
Where do Potassium Sparing Diuretics work?
In Distal Tubule before Collecting Ducts (not in Loop of Henle) by either competing with Aldosterone or another non-Aldosterone mechanism leading to inhibiting of Na+ reabsorption and Na+ and H2O excretion
143
Where do CCBs work?
In vascular and cardiac smooth muscle by inhibiting influx of serum Ca++ into smooth muscle preventing muscular contraction and leading to vasodilation
144
Where do diuretics work?
In Nephron of kidney
145
What is the preferred diuretic class for CHF?
Loop Diuretics
146
Which class of diuretics is most potent?
Thiazides
147
What are two gender side effects of Spirinolactone?
Gynecomastia, menstural irregularities
148
What are the three most common ß-blockers?
Atenolol, Metoprolol Succinate, Metoprolol Tartrate
149
How often are the three most ß-blockers dosed?
Atenolol: 1/day
Metoprolol Succinate: 1/day
Metoprolol Tartrate: 2/day
150
What is the place in line of ß-blockers in HTN treatment?
Not first in line. Used only in PTs with heart or kidney disease.
151
What is a ß-blocker used first in line for?
Heart failure, post-MI, high CAD, CKD
152
ß-blockers are reserved for PTs who have significant histories of what two conditions?
Significant heart disease or kidney disease
153
What is the MOA for ß-blockers?
Block Beta-1 receptors which decreases BP and HR by decreasing effects of epinepherine and norepineperhine.
154
Beta 1 receptors are specific to which organ?
Heart. (We have 1 heart.)
155
Beta 2 receptors are specific to which organ?
Lungs. (We have 2 lungs.)
156
Beta 1 receptors are located in the ____, Beta 2 receptors are located in the ____
Beta 1=heart
Beta 2=lungs
(1 heart, 2 lungs)
157
What do ß-blockers end in?
"-lol"
158
ß-blockers that effect only Beta-1 receptors are known as what?
Cardioselective
159
Which are the cardioselective ß-blockers?
Atenolol, Metopolol, Esmolol, Bioprolol, Betaxalol, Acebutol. (AMEBBA)
160
Cardioselective ß-blockers are dependent on what?
Dose
161
What are the two mixed alpha and beta blockers?
Carvedilol and Labetolol (CL)
162
What are the four ISA ß-blockers?
Carteolol, Acebutolol, Pentbutolol, Pindolol (CAPP)
163
How often are the ISA ß-blockers used?
Rarely, if at all
164
Which receptors do the Non-Specific ß-blockers hit?
Beta 1 and Beta 2
165
What are the three non-specific ß-blockers?
Nadolol, Propanolol, Timolol (NPT)
166
Other than HTN what two other conditions is Propanolol used for?
Migraines and Hyperthyroidism (dose up to 4x/day to help with hyperthyroid symptoms)
167
What is the major initial ß-blocker side effect?
"Beta Blocker Blues": tired, fatigued, depressed, and a "funny" feeling in chest from heart beating slower. Will eventually go away within 1 month.
168
What is a ß-blocker side effect that won't go away after a month?
Sexual dysfunction
169
What can happen if a ß-blocker is suddenly discontinued?
Rebound HTN
170
Can a PT with asthma or COPD take a ß-blocker?
Yes, but cannot be a non-selective ß-blocker. Must be a cardioselective ß-blocker!
171
What type of ß-blocker must an asthma or CPOD patient take and which to definitely avoid?
Take Cardioselective only. Definitely not "mixed" due to Beta-2 blocking.
172
What condition can ß-blockers mask?
Hypoglycemia. PT may only be sweating but not other symptoms. Tell them to check BGL if sweating.
173
If a PT is on a ß-blocker and is sweating what condition might they have?
Hypoglycemia
174
ß-blockers are first line treatment for what heart condition? What do they prevent? Which three ß-blockers?
Heart failure, but only early stages by preventing heart remodeling. Metoprolol Succinate, Carvedilol, and Bisoprolol.
175
What pregnancy category are ß-blockers in?
C
176
Sotalol is a ß-blocker used for what condition?
Class III anti-arrhythmic. Most often used as anti-arrhythmic agent.
177
Class III heart failure is treated by which medication?
Sotolol
178
What class of heart failure does Solotol treat?
Class III
179
What are the two types of Alpha blockers/agonists? Where in the body and which receptors do they work on?
(eg what receptors?)
Alpha 1 blockers cause vasodilation in periphery
| Alpha 2 agonists cause vasodilation in brain "central"
180
Where do Alpha 1 blockers work?
In periphery, cause vasodilation
181
Where do Alpha 2 Agonists work?
In brain, cause vasodilation
182
What do Alpha blockers end in?
"-zosin"
183
What will Alpha 1 receptors normally do to vessels? Where are Alpha 1 receptors?
Alpha 1 causes constriction, found in periphery.
184
What will Alpha 2 receptors normally do to vessels? Where are they found?
Alpha 2 normally causes dilation, found in brain
185
Are Alpha blockers used as monotherapy or add-on?
Add-on
186
What condition is an Alpha blocker used for as monotherapy?
Benign Prostatic Hypertrophy (BPH)
187
What is the MOA for Alpha Blockers? Which receptor does it work on?
Completely inhibits Alpha-1 receptors in the periphery which causes vasodilation
188
Who are Alpha blockers especially used in?
Males
189
What two conditions are Alpha blockers used in?
HTN, BPH
190
Which two Alpha blockers are used for BPH?
Tamsulosin (Flomax), Alfuzosin (Uroxatral)
191
What is the Alpha blocker "first dose effect"?
Significant hypotension with first dose and subsequent dose titrations
192
What type of "reflex" might happen in Alpha Blockers, especially in early therapy? When does it not happen?
Reflex Tachycardia. Doesn't happen if also taking Beta-blocker.
193
When does Reflex Tachycardia not happen with an Alpha blocker?
When PT is also on Beta-blocker
194
What needs to happen to dose of an Alpha blocker in order to minimize side effects?
Slowly titrate up
195
What are the daily frequency of Doxazosin, Terazosin, and Prazosin?
Doxazosin=1/day
Terazosin=1-2/day
Prazosin=2-3/day
196
What is the MOA of an Alpha 2 Agonist?
Stimulates Alpha-2 receptors in brain which reduces sympathetic outflow from brain, which produces decrease in BP and peripheral vascular resistance
197
What are the two Alpha 2 Agonists?
Methyldopa, Clonidine
198
What class is Methyldopa?
Alpha 2 Agonist
199
What is Methyldopa used for?
Limited use, but good in preggers (Category B)
200
What is the pregnancy category for Methyldopa?
Category B.
201
What drug class in Clonidine?
Alpha 2 Agonist
202
What is Clonidine majorly used for?
Resistant HTN
| Also for opiate substance withdrawal, adjunct in pain management, ADHD in kids
203
What are some adverse effects of Alpha 2 Agonists?
Orthostatic hypotension, dizziness, fatigue, depression, sedation, Na+ and H2O retention, rebound tachycardia and HTN is abruptly stopped. Methyldope (liver toxicity, hemolytic anemia), Clonidine (rash with patch, anticholinergic effects like dry mouth, sedation, constipation, urinary retention)
204
What are specific adverse effects of Methyldope and Clonidine?
Methyldope=liver toxicity, hemolytic anemia
| Clonidine=rash with patch, anticholinergic effects like dry mouth, sedation, constipation, urinary retention
205
How does Clonidine come and how long is it used?
Comes as a patch which stays on for 7 days
206
How long does the Clonidine patch take to work and how long does it work after patch is removed?
Onset is 12-24 hours, continues to work up to 3 days after patch removed. (Alpha 2 Agonist)
207
What is the MOA of Vasodilators?
Causes peripheral vasodilation. Direct vasodilators, especially in arteries and arterioles, leading to decreased systemic vascular resistance.
208
Do Direct Vasodilators work centrally or peripherally?
Peripherally
209
What are the two Vasodilator drugs?
Hydralazine, Minoxodil
210
What are three common side-effects of Vasodilators?
Reflex Tachycardia, increased renin due to increased vasodilation causing fluid retention, headache
211
How do you treat the side general side effects of Vasodilators? (Reflex tachycardia, fluid retention, headache)
Reflex tachycardia=Beta-blocker co-administration
Fluid Retention=Diuretic
Headache=NSAIDs
212
What class is Hydralazine in?
Vasodilator
213
What are 5 specific adverse effects of Hydralazine?
Lupus-like syndrome (uncommon), dermatitis, drug fever, peripheral neuropathy, hepatitis
214
What class of drug is Minoxidil?
Vasodilator
215
What is the adverse effect of Minoxidol?
Hirsutism (hair growth)
216
Is Monoxidil used any longer for HTN?
No, but is used in Rogaine for hair growth
217
What are the two preferred combos of HTN meds?
ACE-I/ARB + Thiazide
| ACE-I/ARB + DihydroyrIdine CCB
218
What are three acceptable combos of HTN meds?
CCT + Thiazide
Thiazide + Potassium Sparing Diuretic
Beta-blocker + Diuretic or Dihydropyridine CCB
219
What sort of agents can induce HTN? (Lots!)
Corticosteroids, NSAIDs, Appetite Suppressants, Caffine, Cyclosporine, Estrogen, Pseudoephedrine, Thyroid hormone, Duloxetine, Venlafaxine, Erythropoietin?
220
Why do patients stop taking their meds?
Think they don't need it any longer, side-effects, cost, out of refills, confusion about what to take and when, pill burden
221
44 y/o white male goes to PCP with a CC that his BP was high during health screening last month. BP last year was 158/84, advised to lose weight and exercise more.
FH: father HTN, died of MI at 54, mother DM and HTN and died from stroke at age 68.
SH: smoke 1 ppd, has job related stress
Now: 155/88, HR80, WNL labs, Scr 1.2. What is BP goal? Meds?
BP goal is 140/90 or less.
222
Mildly overweight 55 y/o woman with a w/4-yr hx HTN and a 20 pack-year smoking. Admitted for community-acquired pneumonia. PMH: hyperlipidemia, angina, CKD (CrCl 40ml/min), and type 2 DM. FH: Father MI @ 63 years old. Meds: HCZT 25 mg/day, metoprolol tartrate 75 mg BID, Glipizide 5mg daily. Recent BP 163-167/88-108, HR 58-65. What meds? What BP goal?
Add ACE or ARB Losartan 50mg/day. Maintain both HCZT and Metoprolol.
BP goal: 140/90 or less
223
JK 32 y/o female pregnant just diagnosed with HTN with BP 145/95. Which medication would you recommend for her?
Carvedilol (cat c in first trimester, d in 2nd and 3rd) or Methyldopa (cat b)
224
75 y/o with BPH, hyperlipidemia, HTN. Meds: Metoprolol XL 100mg daily, Crestor 10mg daily. Due to his recent diagnosis of BPH which class and medication would you like to add?
Terazosen (Alpha 1 blocker)
225
Does Acetaminophen increase BP?
No.
226
Which lifestyle modification has greatest effect on BP?
Weight loss
227
What is the required creatinine clearance for Metalozone and Furosemide?
Less than 30 mL/min
228
Which of these can cause hyperkalemia? Lisinopril, Valsartan, Bisoprolol (Can be more than one.)
Lisinopril and Valsartan. ACE-Is and ARBs can cause hyperkalemia.
229
What do you do for a patient who has developed a dry cough from taking an ACE-I?
Discontinue the ACE-I and start ARB.
230
Which of the following is Beta-1 selective?
| Bisoprolol, Carvedilol, Pindolol, Labetolol, Nadolol
Bisoprolol
231
Can Aliskiren be combined with an ARB or ACE-I? Why?
No, due to K+ and kidneys issues.
232
Which three drug classes are always dosed in the morning?
Thazides, Loop, K sparing diuretics.
233
What type of ß-blocker is Propanolol?
Propanolol is nonselective ß blocker.
234
Can you use ACE-Is and/or ARBs with renal artery stenosis?
Do not use ACE-I in rental art stenosis, caution with ARBs
235
What classes can cause rebound HTN if suddenly discontinued?
Beta blocker and Alpha 2 Agonist clonidine
236
What effect do ARBs have on Bradykinin?
ARBs do not inhibit bradykinin breakdown
237
What are two good agents to use in a pregnant HTN woman?
Methyldopa and Levatolol
238
If a PT is hyperkalemic what classes of antihypertensives should you avoid using?
ACE-I, ARB, K sparing diuretics
239
What does an ACE-Inhibitor prevent the conversion of?
Conversion of Angiotensin I to Angiotensin II
240
How often is metoprolol succsincate dosed?
Once a day
241
What is Captopril's most common side effect?
cough (ACE-I)
242
What type of edema can happen with dihydropyridines?
Peripheral edema
243
ARBs compete with what and cause excretion of what?
ARBs compete with Aldosterone which causes excretion of Na
244
What HTN medications require caution is a PT has a Sulfa allergy?
Thazides and Loop Diuretics use caution
245
How often is an ACE-I dosed?
1/day
246
What is the #1 side-effect from Verapimil?
Constipation
247
What is a major side-effect of ACE-Is that can possibly be fatal?
Angioedema-swelling of face/lips/necks in ACE-I (less commonly in ARBs)
248
Which ß-blocker can prevent migraines?
Propranolol can prevent migraines
249
HCZT causes electrolytes to go in which direction?
Down:Na and K
Up:Ca, Uric acid, Glucose
250
How often is the Clonidine patch changed?
Changed every 7 days
251
Which class of CCBs are avoided in CHF?
Non-dihydropyradine CCBs (Verapimil, Diltiazem)
252
Where do Loop Diuretics work in the nephron?
Loop of Henle thick ascending segment
253
Where do Thiazide diuretics work?
Distal tubule
254
What are the two first-line treatments in African Americans without DM or CKD?
CCBs and Thiazides
255
Which classes must a PT avoid "salt substitute"?
ACE, ARB, K sparring diuretic, Aldostone blocker
256
When are Alpha 1 blockers dosed?
Night
257
Can a pregnant PT take an ACE/ARB?
NO
258
Can you use Propanolol in someone who has asthma?
NO
259
Can you use a Beta Blocker in a PT who has a heart block?
NO
260
Can you use a Beta Blocker in a PT who has a severe peripheral vascular disease?
No
