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Therapeutics P2 > Exam 6 lecture 3 > Flashcards

Exam 6 lecture 3 Flashcards

1
Q

direct vasodilator agents

A

Minoxidil, hydralazine

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2
Q

Direct vasodilators are reserved for pts with

A

Severe CKD/hemodialysis

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3
Q

Which is more potent direct vasodilator

A

Minoxidil

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4
Q

Can vasodilators be a monotherapy?

A

NO, concomitant use with BB or diuretic needed

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5
Q

frequency of minoxidil

A

1-3f

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6
Q

requency of hydralazine

A

2-4

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7
Q

adverse effects of direct vasodilators

A

Palpitations, tachycardia, chest pain, headache, GI side effects, fluid retention

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8
Q

Specific hydralazine adverse effects

A

Lupus (joint pain and generalized weakness)

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9
Q

Boxed warning for minoxidil

A

May cause pericarditis and pericardial effusion that may progress to tamponate
May increase )2 demand and exacerbate angina

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10
Q

A-1 blocker drugs

A

Doxasozin, Prazosin, Terazosin

all end with sin

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11
Q

side effects for a-1 blockers

A

Orthostatic HTN

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12
Q

Central a-2 agonist drugs

A

Clonidine, methyldopa, Guanfacine

last line due to adverse ffects

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13
Q

side effects of central a-2 agonist

A

CNS, depression, dizzinessm fatugue

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14
Q

which a-2 drug is the most preferred in pregnancy

A

Methyldopa

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15
Q

Which form of clonidine is preferred and why

A

Patch is preferred due to reduced risk of rebound HTN

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16
Q

How many times a day is methyldopa dosed

A

BID

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17
Q

How many times a day is guanfacine dosed

A

QD

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18
Q

what to monitor for BB

A

HR

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19
Q

monitoring parameters for ACE/ARB, Aldosterone antagonist

A

BUN/Scr/K+

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20
Q

What to do if patient is not at HTN goal

A

Consider switching to night time dosing for ACE/ARB/CCB
assess adherence
Educate on diet, exercise and smoking
Rule out white coat HTN

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21
Q

What is resistant HTN

A

Failure to attain BP goal while adherent to regimen that include atleast 3 agents at MAX doses or when 4 or more agents are needed to control it

22
Q

STepwise treatment for tx reistant HTN

A
  1. Maximize LSM
    Optimize 3 drug (ACE/ARB, CCB, thiazide) at max dose
  2. if uncontrolled substitute optimized thiazide-like diuretics (chlorthalidone, indapamide) (stop hydrochlorothiazide and switch to these.
  3. Add mineralcorticoid receptor antagonist (spironolactone, eplerenone)
  4. Add BB if HR>70

Guanfacine at bedtime or clonidine patch if BB contraindicated (HR<70)

  1. Hydralazine
  2. minoxidil substitue for hydralizine
23
Q

Goals for hypertensive emergency

A

Hour 1- reduce BP by a max of 25%
Hour 2- Reduce BP<160/100-110
hours 6-48- reduce BP to goal

24
Q

What are the two types of hypertensive crisis

A

Urgency vs emergency

25
Q

difference between hypertensive urgency vs emergency

A

urgency- Systolic BP>180 and or diastolic BP>120
no evidence of target organ damage.

Emergency- Systolic BP>180 and or diastolic >120
evidence of target organ damage

26
Q

symptoms patients report with target organ damage

A

H/a
chest pain
SOB
back pain
nummbness/weakness
change in vision
speaking difficulty

27
Q

do more people have hypertensive crisis or emergency?

A

60-75% crisis

28
Q

Most common causes of hypertensive emergency

A

Non-adherence

others- Chronic HTN
MEdication/substance
pregnancy
renal disease

29
Q

Is there a need for the ER for urgency? what about emergency?

A

Urgency- no need for ER
HTN emergency- send to ER

30
Q

why should BP be lowered gradually

A

Risk for cerebral edema

31
Q

WHat are some medications used in hypertensive emergencies

A

DHP CCBs
Vasodilators
BB
others

32
Q

What is the gold standard for hypertensive emergencies

A

Nicardipine IV

33
Q

CI of nicardipine IV

A

reflex tachycardia
aortic stenosis

34
Q

What are the two DHP CCBs used in hypertensive emergencies

A

Nicardipine
Clevdipine

35
Q

Clevdipine CI

A

Soy/egg allergies
Severe aortic stenosis

36
Q

Vasodilators used in hypertensive emergenices

A

Nitroglycerin
SNP
Hydralazine

37
Q

What type of hypertensive crisis patients have benefits for nitroglycerin

A

Coronary ischemia

38
Q

What is something to note about nitroglycerin and SNP

A

Both cause tolerance in 24-48 hours

39
Q

WHat B blockers should be used in hypertensive emergencies

A

Labetalol IV push
Esmolol

40
Q

What are other drugs that can be used for hypertensive emergencies

A

Enalaprilat IV push
Clonidine oral

41
Q

What drug used in hyoertensive emergency is most likely to cause bradycardia

A

B blockers

42
Q

is hydralazine available as IV?

A

No

43
Q

What drugs to use to treat Acute decompensated HF with pumlonary edema? What drugs to avoid

A

Nitrate class (nitroglycerin or nitroprusside)
Nicardipine and clevdipine are acceptable alternatives

Avoid BB and non DHP CCBs

44
Q

How to treat Aortic dissection with hypertensive emergency

A

Initiate BB then vasodilator (nicardipine, clevdipine, Nitroprusside

45
Q

How to treat acute coronary syndrome with hypertensive emergency

A

Esmolol, labetalol, nitroglycerin, nicradipine, SNP

Avoid BB if reduced HR (<60), heart block or airway disease

46
Q

What drugs should we avoid in AKI

A

SNP and Enalaprilat

47
Q

What BB does not cause a decrease in BP

A

Esmolol

48
Q

If patient has hypertensive emergency and stroke how to treat

A

Nicardipine, clevdipine, labetalol

49
Q

If patient has eclampsia /severe pre eclampsia how to treat

A

Hydralazine, labetalol, nicardipine

50
Q
A

Therapeutics P2 (41 decks)

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