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Pharm > First line HTN meds > Flashcards

First line HTN meds Flashcards

1
Q

What is BP?

A

Surrogate marker for CV risk

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2
Q

What is the cause of HTN in most pts?

A

Primary/essential HTN

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3
Q

What is HTN w/ an identifiable cause?

A

Secondary HTN

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4
Q

What is the MAP formula?

A

Cardiac output x Total peripheral resistance

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5
Q

What hormonal aspects are involved in HTN?

A

Renin
Angiotensis
Aldosterone
Bradykinin

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6
Q

When does pharmacotherapy start for HTN?

A

SBP > 130

DPB > 80

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7
Q

What do the new guidelines mean for HTN pts?

A

Lots more need meds

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8
Q

What is the 1st line agent for HTN?

A

Thiazide diuretics

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9
Q

What are examples of thiazide diuretics?

A

Chlorthalidone

Hydrochlorthizade

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10
Q

Which thiazide diuretics are effective for CrCl <30?

A

Indapamide

Metolazone

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11
Q

Is the hypotensive effect of thiazide diuretics longer or shorter than the half life?

A

Longer

*not sure why

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12
Q

What is the half life of chlorthalidone?

A

45-60 hours

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13
Q

What is the half life for hydrochlorthiazide?

A

8-15 hours

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14
Q

What time of day do you give thiazides and why?

A

AM

Minimize nocturnal diureses

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15
Q

Are chlorthalidone and hydrochlorthizaide effective at CrCl<30?

A

No

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16
Q

For what populations do you use thiazides with caution in?

A

Pts > 65
Females
Pts w/ low or borderline low serum Na+

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17
Q

What is the max of hydrochlorthiazide and chlorthalidone?

A

HCTZ: 25-50 mg
C: 25 mg

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18
Q

What do ACEIs do?

A

Block RAAS-mediated conversion of AT to ATII (potent constrictor)

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19
Q

What do ACEIs prevent?

A

LV hypertrophy

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20
Q

When are ACEIs 1st line?

A

LV dysfunction
CKD
DM
Prevention of ischemic stroke

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21
Q

How many times daily are ACEIs dosed? What is an exception?

A

1/day

Catopril

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22
Q

At higher doses of which ACEI meds do pts require BID dosing?

A

Enalapril
Benazepril
Moexipril

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23
Q

What do ALL ACEIs do?

A

Increase serum K+

24
Q

What is an SE of ACEIs?

A

GFR decrease

25
Q

What happens to SCr when on ACEI that does not call for DC?

A

Increase of 30% or absolute increase of < 1 mg/dL

26
Q

What happens if SCr increases more than previously listed while on ACEIs?

A

Discontinuation or dose reduction

27
Q

What populations is the SE of angioedema more prevalent?

A

African Americans

Smokers

28
Q

What does angioedema do w/ ACEIs?

A

Precludes any future ACEIs

29
Q

What % of pts develop dry, persistent cough?

A

20%

30
Q

What does the ACEI cough warrant?

A

Switching to an ARB

31
Q

When are ACEIs completely contraindicated?

A

Pregnancy

Category X

32
Q

What do you not combine w/ ACEIs?

A

ARBs

Aliskiren

33
Q

How is Enalapril administered, what is the dose, and how often (ACEI)?

A

IV, PO
5-40 mg
1-2/day

34
Q

What is the dosing of Lisinopril and how often is it given?

A

10-40 mg

1/day

35
Q

Do ARBs block bradykinin metabolism?

A

No

36
Q

What does the lack of bradykinin metabolism do to make ARBs more preferable for some pts?

A

Little to no bradykinin induced cough

37
Q

What are ARBs missing due to continued bradykinin metabolism?

A

Myocardial remodeling

Regression of myocyte hypertrophy and fibrosis

38
Q

Should you use ACEIs and ARBs together?

A

No duh

39
Q

Why shouldn’t you use ACEI and ARBs together?

A

Increased risk of hyperkalemia

40
Q

When can you not use ARBs?

A

Pregnancy

41
Q

What is the rate of SEs with ARBs?

A

The lowest incidence of SEs of all hypertensives

42
Q

Give two examples of ARBs

Is there generic availability?

A

Losartan
Valsartan
Yes

43
Q

What are the two classes of calcium channel blockers?

A

Dihydropyridines

Non-dihydropyridines

44
Q

Are dihydropyridines vasodilators or rate controllers?

A

Vasodilators

45
Q

Are non-dihydropyridines vasodilators or rate controllers?

A

Rate controllers

46
Q

What is a SE of dihydropyridine CCB?

A

Reflex tachycardia due to potent vasodilation

47
Q

With what agents is CCB reflex tachycardia more likely?

A

More pronounced w/ 1st generation DHP

48
Q

With what agents is reflex tachycardia less likely?

A

Much less pronounced with newer agents

49
Q

What is IR nifedipine associated with?

What is an example? What does this mean?

A

Increased adverse CV advents
Ex: AMI in angina pts
Means not approved for HTN

50
Q

What are some examples of dihydroperidine that are dosed once per day?

A

Amlodipine
Felodipine
Nifedipine LA
Nisoldipine

51
Q

What are some examples of non-dihydropyridine CCBs?

A

Verapamil

Diltiazem

52
Q

What is a negative SE of verapamil?

A

Constipation

53
Q

When is combination therapy recommended for HTN?

A

Stage 2 HTN pts

54
Q

What is an advantage of combination BP pharmacotherapy?

A

Better BP control w/ fewer SEs

55
Q

What are some examples of dihydroperidine that are dosed twice per day?

A

Isradipine

Nicardipine SR

Pharm (32 decks)

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