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Clinical Medicine 2 > Exam 1: Hypertension > Flashcards

Exam 1: Hypertension Flashcards

1
Q

What classifies as elevated blood pressure?

A

120-129 systolic AND <80 diastolic

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2
Q

What classifies stage 1 hypertension?

A

130-139 systolic OR 80-89 diastolic

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3
Q

What classifies as stage 2 HTN?

A

> 140 systolic OR >90 diastolic

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4
Q

What is secondary hypertension?

A

Increased BP resulting from an identifiable medication or medical condition

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5
Q

What are the major conditions that can cause secondary Hypertension?

A

Renal disease, renovascular disease, OSA, thyroid disease, coarctation of the aorta, primary hyperaldosteronism, Cushing, pheocromocytoma, or medication induced

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6
Q

What is the gold standard for diagnosing HTN?

A

Ambulatory blood pressure monitoring

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7
Q

What is the basic testing you should order for patients with primary HTN?

A

Fasting blood glucose, CBC, lipid profile, serum creatinine with GFR, serum sodium/K+/Ca+, TSH, urinalysis, and EKG

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8
Q

What should you order in patients with DM or CKD when testing for primary HTN?

A

Urinary albumin

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9
Q

What is the first line treatment for all patients with essential HTN?

A

Lifestyle changes

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10
Q

What are the 4 first line medications for treatment for HTN?

A

Diuretics, Angiotensin Converting Enzyme Inhibitors (ACE inhibitors), Angioteninogen Receptor Blockers (ARB), and calcium channel blockers (CCB)

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11
Q

For stage 1 HTN, what is the recommended pharmacologic treatment?

A

A single antihypertensive drug, titrations up or adding a second medication as needed to reach target BP

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12
Q

For stage 2 HTN, what is the recommended pharmacologic treatment?

A

2 first line agents of different classes

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13
Q

If the patient has CKD and albuminuria, what should the first medication be for HTN?

A

An Ace inhibitor

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14
Q

If a patient has DM and albuminuria, what medications should be given for HTN?

A

ACE or ARB

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15
Q

If a patient has heart failure, what medication for HTN should be avoided if the EF is low?

A

CCBs

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16
Q

What are the 4 types of diuretics?

A

Thiazide-type diuretics, loops diuretics, potassium sparing diuretics, and aldosterone antagonists

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17
Q

What is the MOA of Diuretics?

A

Decreases the body’s sodium stores by inhibiting sodium reabsorption in the nephron.

They reduce plasma volume and peripheral vascular resistance

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18
Q

What are the contraindications for thiazide type and loop diuretics?

A

Hypersensitivity to sulfas

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19
Q

What is the preferred diuretic in heart failure?

A

Loop diuretics

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20
Q

What is the preferred diuretic in primary aldosteronism?

A

Aldosterone antagonists

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21
Q

What are the contraindications for aldosterone antagonists?

A

Renal impairment

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22
Q

What is the MOA of ACE inhibitors?

A

Inhibit the RAAS system and stimulate bradykinin which has a vasodilator effect

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23
Q

What kind of drug is spironolactone?

A

Aldosterone antagonist

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24
Q

What kind of drug is furosemide?

A

Loop diuretic

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25
Q

What kind of drug is triamterene?

A

Potassium sparing diuretic

26
Q

What kind of drug is chlorthalidone?

A

Thiazide type diuretic

27
Q

What kind of drugs are lisinopril, quinapil, and enalapril?

A

ACE inhibitors

28
Q

What are the contraindications of ACE inhibitors?

A

Pregnancy, angioedema, renal artery stenosis

YOU CANNOT COMBINE WITH ARB

29
Q

What are the compelling indications for ACE inhibitors?

A

DM, CKD, post MI, and heart failure

30
Q

What is the MOA of ARBs?

A

Inhibit the RAAS system

31
Q

What are the contraindications of ARBs?

A

CANNOT COMBINE WITH ACE INHIBITORS

Pregnancy and renal artery stenosis

32
Q

What are the two kind of calcium channel blockers?

A

Non-dihydropyridine (more of a cardiac depressant) and dihydropyridine (more of a vasodilator)

33
Q

What is the MOA of CCBs?

A

Inhibition of calcium influx into arterial smooth muscle cells, which reduces peripheral vascular resistance

34
Q

What are the contraindications of Non-dihydropyridines?

A

Avoid use with beta blockers, heart failure with reduced EF

35
Q

What are the contraindications of dihydropyridines?

A

Avoid in heart failure with reduced EF

36
Q

What are the two types of Beta blockers?

A

Cardioselective (B1) and noncardioselective (B1 and B2)

37
Q

What is the MOA of beta blockers?

A

Blocks the activity of catecholamines at B adrenoreceptors, which leads to decreased cardiac output, some decreased PVR, and decreased renin activity

38
Q

What kind of drugs are verapamil and diltiazem?

A

Non-dihydropyridine

39
Q

What kind of drugs are amlodipine, nifedipine, and felodipine?

A

Dihydropyridines

40
Q

What kind of drugs are propanalol, atenolol, and metoprolol?

A

Beta blockers

41
Q

What are the contraindications of beta blockers?

A

Bronchospastic disease, conduction abnormalities, and acute decomp of CHF

42
Q

What is the MOA of central alpha agonists?

A

Stimulate a2 adrenergic receptors in the brain which reduces CNS sympathetic outflow.

**generally reserved for last line due to CNS adverse effects

43
Q

What are the contraindications of central alpha agonists?

A

Methydopa in liver disease

44
Q

What is the MOA of alpha blockers?

A

Targets a1 receptors on vascular smooth muscle, causing peripheral vascular resistance to decrease, thus decreases BP

45
Q

What is the compelling indication for alpha blockers?

A

BPH

46
Q

What is the MOA of direct renin inhibitors?

A

Inhibit enzyme activity of renin, reducing the activity of angiotensin 1 and 2 and aldosterone

47
Q

What are the contraindications of direct renin inhibitors?

A

Use with an ACE or ARB in DM, pregnancy

48
Q

What are the side effects of direct renin inhibitors?

A

Hyperkalemia, renal impairment, hypersensitivity reactions

49
Q

What are the side effects of alpha blockers?

A

Orthostatic HTN, reflex tachycardia

50
Q

What are the side effects of beta blockers?

A

Bradycardia, bronchospasm

51
Q

What are the side effects for Ace inhibitors?

A

Hyperkalemia, acute renal failure, and angioedema

52
Q

What are the side effects of thiazide type loop diuretics?

A

Electrolytes imbalances and gout

53
Q

What are the side effects of ARBs?

A

Hyperkalemia, acute renal failure, and angioedema

54
Q

What are the side effects of CCBs?

A

Cardiodepressant, dizziness, HA

55
Q

What is hypertensive urgency?

A

Asymptomatic severe HTN and no evidence of end organ damage (Diastolic greater than 120)

56
Q

What is hypertensive emergency?

A

Severe HTN and evidence of acute end organ damage

57
Q

What is cardiogenic shock?

A

A status of cellular and tissue hypoxia that most commonly occurs when there is circulatory failure that manifests as hypotension

58
Q

What kind of drug is Aliskiren?

A

Direct renin inhibitor

59
Q

What kind of drugs are the “Zosins”?

A

Alpha blockers

60
Q

Wha kind of drugs are verapamil and diltiazem?

A

Non-dihydropyridines

Clinical Medicine 2 (22 decks)

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