HTN Flashcards
What is the recommended treatment for HTN w/CAD?
Beta blocker AND ACEI/ARB
Which diuretic causes increase vs decrease in calcium?
Thiazide increases calcium
Loops decrease calcium
How soon do you monitor after starting or changing BP med?
1 month
How do you calculate MAP?
SBP + (2 x DBP) / 3
What is the first line HTN med for 18-75 y.o with CKD?
What about in dialysis/ESRD?
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.
What medications are preferred for HTN in pregnancy?
What to avoid?
Methyldopa, nifedipine, labatalol
ACEI/ARB/DRI
If a patient was just diagnosed with stage 1 HTN and has ASCVD of 12%, what is the basic recommendation?
Lifestyle modification and start 1 medication
What are 5 examples of secondary HTN?
Endocrine (cushing’s, pheochromocytoma, thyroid)
Vascular disease
Renal diseases
Sleep apnea
Medications
Where in the nephron do the following medications work?
- Acetazolamide
- Loops
- Thiazides
- K+ sparing
- PCT
- Thick ascending LOH
- DCT
- CCD
How do RAAS antagonists work?
Decrease volume by decreasing aldosterone = increase Na+ excretion
Decrease BP by decreased angiotensin = vasodilation
What are some OTC/herbs that can increase BP?
Ephedra, ma huang, licorice (aldosterone agonist), bitter orange, decongestants, yohimbe
What meds help with morbidity and mortality in CHF?
Low dose BB
ACEi/ARB
Entresto
Aldosterone antagonists
Loops ONLY help with CHF symptoms
Which diuretics can be used in CrCl < 30?
All Loops and metolazone (thiazide-like)
Which allergy would cause caution with thiazides?
Sulfa
What are three thiazide/loop drug interactions?
Lithium increases due to the decrease in Na+
Digoxin increases due to decreases K+ and Mg2+
Allopurinol hypersensitivity due to increase in uric acid
Which thiazide-like diuretic is the most potent?
Chlorthalidone
Long-acting thus given QD
Which loop diuretic does not have a sulfa component?
Ethacrynic acid (Edecrin)
Bumetanide
Brand
Indication
ROA
MAX
Oral and IV conversion to furosemide
Bumex
Edema
IM/IV/PO
10mg/day
1mg oral bumex = 40mg oral lasix
1mg IV bumex = 20mg IV lasix
Which loop diuretic causes the most ototoxicity?
Ethacrynic acid (Edecrin)
Amiloride
Brand
MOA
Indications
Midamor
Potassium-sparing
To prevent hypokalemia since it has weak effects on BP
Triamterene
Brand
MOA
Indication
Dyrenium
Potassium-sparing
Edema
Spironolactone
Brand
MOA
Indication
Dose for HTN
Aldactone / Carospir oral suspension
Aldosterone antagonist
Edema, HTN, hypoK+, CHF ; off-label for acne and hirsutism in women
50-100mg QD/BID
Eplerenone
Brand
MOA
Indication
Dose for HTN
Dose for CHF
Inspra
Aldosterone antagonist
HTN, CHF after MI
50mg QD
25mg QD
What can be an alternative diuretic for patients with gout and/or DM ?
Spironolactone
It doesn’t affect glucose or uric acid levels
Which beta blocker can cause drug-induced lupus and what is the brand name?
Acebutolol (Sectral)
Atenolol
Brand
Food interaction
Dosed
Tenormin
Orange/apple juice and green tea can decrease levels by 40% so counsel to separate by 4 hours
25-100mg QD
Betaxolol - Brand
Bisoprolol - Brand
Esmolol - Brand and indication
- Kerlone
- Zebeta
- Brevibloc ; IV used for SVT/ HTN emergency/ intraop/post op tachycardia/HTN
Propranolol
Brand
Food counseling
Indications
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
What are the three BB’s that have the highest rate of orthostatic hypotension?
Which one is a CYP2D6 substrate?
Nebivolol - CYP2D6 substrate
Carvedilol
Labetalol
Carvedilol
Brand
Food counseling
MOA
HTN dose
CHF dose
Coreg
Take WITH food
Alpha 1 and beta 1 activity
6.25mg BID
3.125mg BID
Beta-1 selective beta blockers?
What patients would prefer this?
MAN-BABE
Metoprolol
Atenolol
Nebivolol
Bisoprolol
Acebutolol
Betaxolol
Esmolol
Patients with COPD
Beta blockers that come in IV?
MAPLES
Metoprolol
Atenolol
Propranolol
Labetalol
Esmolol
Sotalol
Which beta blockers are preferred in CHF?
Carvedilol
Metoprolol XL (NOT IR)
Bisoprolol
What is the counseling point for Diltiazem IR?
What about dilacor XR/ Diltia XT?
Taztia XT and Tiazac?
Before meals at bedtime
Take on empty stomach
Are capsules and can be opened/sprinkled
What is the difference in effect between verapamil and diltiazem?
Verapamil has most effects on the heart and less on vessels
Diltiazem affects both heart and vessels
When should you be cautious with non-DHP CCB?
CHF
Heart block
Additive bradycardia
Severe liver dysfunction
pregnancy
PGX of verapamil and diltiazem?
They are 3A4 substrates and inhibitors
What are the two DHP CCB’s that come IV?
Nicardipine and clevidipine
When do you take nifedipine on empty stomach?
ER formulations
Clevidipine
Brand
ROA
Indication
Dosage form
Contraindications
Cleviprex
IV only
BP control in hospital
Lipid emulsion
Soy/egg allergies.
What is the DOC for Raynaud’s?
DOC for Prinzemetal’s angina?
Nifedipine, amlodipine, felodipine, or isradipine
Nifedipine, diltiazem, verapamil
When do you use nimodipine?
Oral solution for subarachnoid hemorrhage
T/F: CCB’s can increase serum lipids/glucose
False
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.
Captopril and moexipril (Univasc)
Captopril (Capoten)
Enaloprilat (Vasotec)
Rampiril (Altace)
Captopril (that’s why it’s the only TID one)
Fosinopril
When should a ACEI/ARB be prescribed for DM patients?
All DM patients who have any level of proteinuria REGARDLESS if they have high BP or not.
Aliskriren
Brand
MOA
Max dose
Indication
Pregnancy?
ADE
Food interactions
What 4 medications can increase aliskiren levels significantly?
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
Which alpha 1 blocker is for HTN only? How is it dosed?
Which for BPH only?
Which two are for both?
Prazosin (minipress) - BID/TID because its short acting
Doxazosin extended release
Doxazsin (cardura) and terazosin (hytrin)
What are the food counseling points for :
Tamsulosin
Alfuzosin ER
Sildosin
30 minutes after same meal each day
After same meal each day and swallow whole
With meals
What are the four formulations of clonidine and what are they used for?
Catapress tablets for HTN
Catapress PATCH WEEKLY for HTN
Kapvay ER tabets for ADHD
Duraclon Epidural for pain management in cancer patients
Other than clonidine, what are two other alpha 2 agonists for HTN?
Guanfacine and methyldopa
ADE of alpha 2 agonists
Dry mouth, constipation, orthostasis, rebound HTN,
sedation, bradycardia, depression
Reserpine
MOA
Indications
ADE
Peripheral adrenergic antagonist - central monoamine depleting agent
HTN and schizophrenia
OH and depression
Hydralazine
Brand
ROA
Pregnancy?
MOA
ADE
Apresoline
PO/IV
Can be used parentally
Increases cGMP = arterial vasodilation
Reflex tachycardia, lupus-like syndrome
Aprocitentan
brand
MOA
Indication
Safety test
Tryvio
Endothelin receptor antagonist (vasodilator)
Resistant HTN
Confirm negative pregnancy test prior, monthly, and 1 month after discontinuation
What’s the difference between HTN emergency and urgency?
Both are with high numbers >180/>120 but urgency is no symptoms whereas emergency shows end target organ damage symptoms
Sodium Nitroprusside
Brand
MOA
Onset
Compatibility
When to discard
ADE
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)
Fenoldopam Mesyllate
Brand
MOA
Indication
Corlopam IV
Selective DA-1R agonist
Renal HTN emergencies
