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NAPLEX > HTN > Flashcards

HTN Flashcards

1
Q

What is the recommended treatment for HTN w/CAD?

A

Beta blocker AND ACEI/ARB

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2
Q

Which diuretic causes increase vs decrease in calcium?

A

Thiazide increases calcium
Loops decrease calcium

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3
Q

How soon do you monitor after starting or changing BP med?

A

1 month

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4
Q

How do you calculate MAP?

A

SBP + (2 x DBP) / 3

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5
Q

What is the first line HTN med for 18-75 y.o with CKD?
What about in dialysis/ESRD?

A

ACEI/ARB

Thiazide/CCB - this is because ACEI/ARB have nephroprotective effects but once they need dialysis there is no benefit and it may actually be doing harm.

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6
Q

What medications are preferred for HTN in pregnancy?
What to avoid?

A

Methyldopa, nifedipine, labatalol

ACEI/ARB/DRI

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7
Q

If a patient was just diagnosed with stage 1 HTN and has ASCVD of 12%, what is the basic recommendation?

A

Lifestyle modification and start 1 medication

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8
Q

What are 5 examples of secondary HTN?

A

Endocrine (cushing’s, pheochromocytoma, thyroid)
Vascular disease
Renal diseases
Sleep apnea
Medications

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9
Q

Where in the nephron do the following medications work?

  1. Acetazolamide
  2. Loops
  3. Thiazides
  4. K+ sparing
A
  1. PCT
  2. Thick ascending LOH
  3. DCT
  4. CCD
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10
Q

How do RAAS antagonists work?

A

Decrease volume by decreasing aldosterone = increase Na+ excretion
Decrease BP by decreased angiotensin = vasodilation

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11
Q

What are some OTC/herbs that can increase BP?

A

Ephedra, ma huang, licorice (aldosterone agonist), bitter orange, decongestants, yohimbe

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12
Q

What meds help with morbidity and mortality in CHF?

A

Low dose BB
ACEi/ARB
Entresto
Aldosterone antagonists

Loops ONLY help with CHF symptoms

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13
Q

Which diuretics can be used in CrCl < 30?

A

All Loops and metolazone (thiazide-like)

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14
Q

Which allergy would cause caution with thiazides?

A

Sulfa

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15
Q

What are three thiazide/loop drug interactions?

A

Lithium increases due to the decrease in Na+

Digoxin increases due to decreases K+ and Mg2+

Allopurinol hypersensitivity due to increase in uric acid

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16
Q

Which thiazide-like diuretic is the most potent?

A

Chlorthalidone

Long-acting thus given QD

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17
Q

Which loop diuretic does not have a sulfa component?

A

Ethacrynic acid (Edecrin)

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18
Q

Bumetanide

Brand
Indication
ROA
MAX
Oral and IV conversion to furosemide

A

Bumex

Edema

IM/IV/PO

10mg/day

1mg oral bumex = 40mg oral lasix
1mg IV bumex = 20mg IV lasix

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19
Q

Which loop diuretic causes the most ototoxicity?

A

Ethacrynic acid (Edecrin)

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20
Q

Amiloride

Brand
MOA
Indications

A

Midamor

Potassium-sparing

To prevent hypokalemia since it has weak effects on BP

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21
Q

Triamterene

Brand
MOA
Indication

A

Dyrenium
Potassium-sparing
Edema

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22
Q

Spironolactone

Brand
MOA
Indication
Dose for HTN

A

Aldactone / Carospir oral suspension

Aldosterone antagonist

Edema, HTN, hypoK+, CHF ; off-label for acne and hirsutism in women

50-100mg QD/BID

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23
Q

Eplerenone

Brand
MOA
Indication
Dose for HTN
Dose for CHF

A

Inspra

Aldosterone antagonist

HTN, CHF after MI

50mg QD

25mg QD

24
Q

What can be an alternative diuretic for patients with gout and/or DM ?

A

Spironolactone

It doesn’t affect glucose or uric acid levels

25
Q

Which beta blocker can cause drug-induced lupus and what is the brand name?

A

Acebutolol (Sectral)

26
Q

Atenolol

Brand
Food interaction
Dosed

A

Tenormin

Orange/apple juice and green tea can decrease levels by 40% so counsel to separate by 4 hours

25-100mg QD

27
Q

Betaxolol - Brand

Bisoprolol - Brand

Esmolol - Brand and indication

A
  1. Kerlone
  2. Zebeta
  3. Brevibloc ; IV used for SVT/ HTN emergency/ intraop/post op tachycardia/HTN
28
Q

Propranolol

Brand
Food counseling
Indications

A

Inderal. innopran, Hemangeol

IR - Take WITH food
ER - Take with or without food

Post-MI, tachyarrythmia, HTN, stable angina, migraine prevention, essential tremor, pheochromocytoma, hemangioma

29
Q

What are the three BB’s that have the highest rate of orthostatic hypotension?

Which one is a CYP2D6 substrate?

A

Nebivolol - CYP2D6 substrate
Carvedilol
Labetalol

30
Q

Carvedilol

Brand
Food counseling
MOA
HTN dose
CHF dose

A

Coreg

Take WITH food

Alpha 1 and beta 1 activity

6.25mg BID

3.125mg BID

31
Q

Beta-1 selective beta blockers?

What patients would prefer this?

A

MAN-BABE

Metoprolol
Atenolol
Nebivolol
Bisoprolol
Acebutolol
Betaxolol
Esmolol

Patients with COPD

32
Q

Beta blockers that come in IV?

A

MAPLES

Metoprolol
Atenolol
Propranolol
Labetalol
Esmolol
Sotalol

33
Q

Which beta blockers are preferred in CHF?

A

Carvedilol

Metoprolol XL (NOT IR)

Bisoprolol

34
Q

What is the counseling point for Diltiazem IR?

What about dilacor XR/ Diltia XT?

Taztia XT and Tiazac?

A

Before meals at bedtime

Take on empty stomach

Are capsules and can be opened/sprinkled

35
Q

What is the difference in effect between verapamil and diltiazem?

A

Verapamil has most effects on the heart and less on vessels

Diltiazem affects both heart and vessels

36
Q

When should you be cautious with non-DHP CCV?

A

CHF
Heart block
Additive bradycardia
Severe liver dysfunction
pregnancy

37
Q

PGX of verapamil and diltiazem?

A

They are 3A4 substrates and inhibitors

38
Q

What are the two DHP CCB’s that come IV?

A

Nicardipine and clevidipine

39
Q

When do you take nifedipine on empty stomach?

A

ER formulations

40
Q

Clevidipine

Brand
ROA
Indication
Dosage form
Contraindications

A

Cleviprex

IV only

BP control in hospital

Lipid emulsion

Soy/egg allergies.

41
Q

What is the DOC for Raynaud’s?

DOC for Prinzemetal’s angina?

A

Nifedipine, amlodipine, felodipine, or isradipine

Nifedipine, diltiazem, verapamil

42
Q

When do you use nimodipine?

A

Oral solution for subarachnoid hemorrhage

43
Q

T/F: CCB’s can increase serum lipids/glucose

A

False

44
Q

Which ACEI’s are given on empty stomach?

Which is the only TID one?

Which is the only IV one?

Which is the only that comes in capsules?

What is the shortest acting?

Which one is safest for renal impairement?

List brand. names for all above.

A

Captopril and moexipril (Univasc)

Captopril (Capoten)

Enaloprilat (Vasotec)

Rampiril (Altace)

Captopril (that’s why it’s the only TID one)

Fosinopril

45
Q

When should a ACEI/ARB be prescribed for DM patients?

A

All DM patients who have any level of proteinuria REGARDLESS if they have high BP or not.

46
Q

Aliskriren

Brand
MOA
Max dose
Indication
Pregnancy?
ADE
Food interactions
What 4 medications can increase aliskiren levels significantly?

A

Tekturna

Direct renin inhibitor

300mg/day

HTN only

Category D

Diarrhea

Orange/apple/grapefruit juice so separate by 4 hours and avoid high FAT

Cyclosporine, itraconazole, ketoconazole, atorvastatin

47
Q

Which alpha 1 blocker is for HTN only? How is it dosed?

Which for BPH only?

Which two are for both?

A

Prazosin (minipress) - BID/TID because its short acting

Doxazosin extended release

Doxazsin (cardura) and terazosin (hytrin)

48
Q

What are the food counseling points for :

Tamsulosin

Alfuzosin ER

Sildosin

A

30 minutes after same meal each day

After same meal each day and swallow whole

With meals

49
Q

What are the four formulations of clonidine and what are they used for?

A

Catapress tablets for HTN

Catapress PATCH WEEKLY for HTN

Kapvay ER tabets for ADHD

Duraclon Epidural for pain management in cancer patients

50
Q

Other than clonidine, what are two other alpha 2 agonists for HTN?

A

Guanfacine and methyldopa

51
Q

ADE of alpha 2 agonists

A

Dry mouth, constipation, orthostasis, rebound HTN,

sedation, bradycardia, depression

52
Q

Reserpine

MOA
Indications
ADE

A

Peripheral adrenergic antagonist - central monoamine depleting agent

HTN and schizophrenia

OH and depression

53
Q

Hydralazine

Brand
ROA
Pregnancy?
MOA
ADE

A

Apresoline

PO/IV

Can be used parentally

Increases cGMP = arterial vasodilation

Reflex tachycardia, lupus-like syndrome

54
Q

Aprocitentan

brand
MOA
Indication
Safety test

A

Tryvio

Endothelin receptor antagonist (vasodilator)

Resistant HTN

Confirm negative pregnancy test prior, monthly, and 1 month after discontinuation

55
Q

What’s the difference between HTN emergency and urgency?

A

Both are with high numbers >180/>120 but urgency is no symptoms whereas emergency shows end target organ damage symptoms

56
Q

Sodium Nitroprusside

Brand
MOA
Onset
Compatibility
When to discard
ADE

A

Nitropress

Direct acting aterial and venous dilator

Rapid onset

D5W - wrap in aluminum

After 24H or discoloration (if it turns blue it has been broken down all the way to cyanide)

N/V/H, cyanide ir thiocyanate toxicity (especially in those with renal.liver dysfunction)

57
Q

Fenoldopam Mesyllate

Brand
MOA
Indication

A

Corlopam IV

Selective DA-1R agonist

Renal HTN emergencies

NAPLEX (3 decks)

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