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Clinical Pharmacology 2 > HTN > Flashcards

HTN Flashcards

1
Q

Review: normal BP

A

<120 and <80

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2
Q

Review: elevated BP

A

120-129 and <80

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3
Q

Review: stage 1 HTN

A

130-139 or 80-89

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4
Q

Review: stage 2 HTN

A

> 140 or >90

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5
Q

Symptoms in HTN are usually _____

A

nonexistent - don’t wait!

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6
Q

What are the four categories for HTN meds?

A
  • sympatholytics
  • diuretics
  • angiotensin inhibitors
  • vasodilators
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7
Q

Sympatholytics work best with _____

A

diuretics

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8
Q

What are central acting sympatholytics?

A

clonidine, a-methyldopa

inhibiting response –> lower BP

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9
Q

Clonidine is an ______ _____

A

alpha 2 agonist

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10
Q

Clonidine is a ____ agent in clinical use with HTN refractory to ____+ agents

A

third line, 2+

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11
Q

T/F: clonidine works well with withdrawal

A

T - from depressants such as alcohol or opioids

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12
Q

What are ADRs of clonidine

A
  • dry mouth
  • sedation
  • inhibition of ejaculation
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13
Q

What are CIs of clonidine?

A

depression, TCAs
do not stop abruptly at higher doses, because it can cause hypertensive crisis

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14
Q

Methyldopa is an ____ __ _____

A

alpha 2 agonist – reduces BP + HR, but does not affect CO or blood flow to vital organs

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15
Q

What are indications of methyldopa?

A

pregnancy, HTN complicated by kidney disease

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16
Q

clonidine

A

catapres

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17
Q

methyldopa

A

aldomet

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18
Q

What are ADRs of methyldopa?

A

could cause false + Coombs test
- long term effect
- sedation
- dry mouth
- foggy mind
- postural HOTN
- lactation
caution w/ depression

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19
Q

What’s another type of sympatholytic?

A

beta blockers, acting on B1 receptor

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20
Q

What are preferred beta blockers for HTN?

A

cardioselective (first part of the alphabet)

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21
Q

_____ was the first BB discovered and to work with ischemic heart disease

A

propanolol

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22
Q

Propanolol is not _____, so it’s not used for HTN anymore, but for reduced mortality post-MI and heart failure

A

cardioselective

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23
Q

Metoprolol works best with _____ _____ ______

A

heart failure patients

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24
Q

Atenolol is excreted in ____ and needs ____ dosing

A

urine, renal dosing

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25
What are indications for BBs?
- HTN + Ischemic heart disease - HTN + HF - situational anxiety, essential tremor
26
What are adverse effects of BBs?
bradycardia + reduced HR during exercise HOTN CNS - fatigue, lethargy, insomnia, hallucinations ED hypoglycemia unawareness
27
What are CIs of BBs?
- cardiogenic shock - non-selective = avoid in asthma - decompensated HF - avoid abrupt cessation or initiation (start slow + titrate q1-2 weeks, wean slowly at least over 2-3w)
28
DO NOT use BBs with what med to avoid causing severe bradycardia + AV block?
non-dihydropyridine CCBs
29
What is the MOA of alpha blockers?
vasodilation --> decreased HR --> decreased BP
30
What are some alpha blockers?
-zosins
31
What are SELECTIVE alpha blockers?
prazosin (minipress), terazosin (hytrin), doxazosin (cardura)
32
What are nonselective alpha blockers?
phentolamine, phenoxybenzamine
33
What are indications of alpha blockers?
selective = BPH non-selective = HTN crisis, pheochromocytoma, MAO-I + tyramine
34
What are ADRs of alpha blockers?
reflex tachycardia (compensatory) first dose phenomenon = postural HOTN w/ first dose, starting low and at bedtime, HA, dizziness, HOTN
35
What are CIs of alpha blockers?
preload dependent (rothorstasis)
36
Alpha and beta blockers
labetalol and carvedilol
37
Labetelol reduces resistance via alpha blocking but does not affect ___ or ___ but is used for Pheo or HTN emergencies
HR, CO
38
Carvedilol can cause ____ _____ in HF patients
reduced mortality, HL 7-10 hours
39
Nebivolol's vasodilation is not from alpha blocking, but from release of ____
Nitric oxide (less ED, sedation)
40
Esmolol is used in ______ and _____ HOTN
intraoperative and postoperative -- very short halflife
41
Who should you not use beta/alpha blockers in?
asthmatics
42
What are the sympatholytics not really used that are ganglion-blocking agents (blocking acetylcholine) or adrenergic neuron-blocking agents?
reserpine, guanthedine, guanadrel
43
How do diuretics work?
excretion of sodium through urine --> BV + CO drops, HR increases...
44
Diuretics are ________ for mild, or combo with ____ or ____ blockers for moderate-severe
monotherapy or combo w/ alpha/beta blockers 10-15mmHg reduction
45
What are thiazides?
hydrochlorothiazide, chlorthalidone - inhibits reabsorption of water + sodium in distal convulted tubule, excreting Na, water, Cl --> hyponatremia
46
What are indications for thiazides?
mild HTN w/ normal renal + cardiac function Iatrogenic volume overload (fluids during hospitalization) Mild edema Calcium nephrolithiasis (REDUCES calcium in urine)
47
What are adverse effects of thiazides?
- gout flare, worsen dyslipidemia - hyponatremia, hypkalemia, metabolic aklalosis - nephrotoxic **avoid with sulfa allergy**
48
What are some loop diuretics?
furosemide (lasix) bumetanide torsemide -ex inhibits sodium + water reabsorption at ascending loop -- increases excretion of Na, K, Ca
49
What are indications of loop diuretics?
- volume overload (CHF, cirrhosis) - moderate to severe HTN - sodium-retaining meds - acute hypercalcemia - helps more w/ symptomatic volume overload (peripheral edema, breathing/pulmonary edema)
50
What are ADRs of loop diuretics?
hyponatremia, hypokalemia, metabolic alkalosis, hypocalcemia CAN be used if CrCl<30 (nephrotoxic when combined w/ others)
51
What are CIs of loop diuretics?
increases uric acid, try to avoid with gout histroy may be ototoxic
52
What are some ARAs
spirinolactone (aldactome) -- K sparing diuretic, prevents Na and water reabsorption, prevents K and H excretion
53
What are indications for ARBs?
very mild diuretic, HF, ascites, acne, low K
54
What are ADRs of aldosterone antagonists
dry skin, hyperkalemia, gynecomastia
55
What are CIs of ARBs?
pregnancy
56
ACE-Is
lisinopril = zesteril enalapril = vasotec
57
How do ACE-Is work?
reduce vasoconstrictio, aldosterone, ADH production, BP
58
What are indications for ACE-Is?
HTN + heart disease (can start 24hrs after MI, improves function, lowers mortality, used w/ BBs) HTN + CKD HTN + diastolic dysfunction HF = +BBs, decreasing mortality
59
Always use _____ in DM and/or CKD if no contraindications
ACE-Is
60
What are ADRs of ACE-Is?
- persistent, dry cough - angioedema - hyperkalemia (diet changes to avoid!) - increased creatinine
61
What are CIs of ACE-Is?
prior angioedema, pregnancy, monitor needed for renal impairment avoid supplements for potassium
62
What are other ARBs?
-sartan Cozaar = losartan Diovan = valsartan
63
ARBs block the action of
angiotensin II
64
What are indications for ARBs?
when patient has cough reaction to ACE-I (less adverse effects)
65
What are ADRs of ARBs?
hyperkalemia, increased creatinine
66
What are CIs of ARBs?
teratogenic
67
What are vasodilators?
dihydropyridine CCBs - amlodipine (norvasc), nifepdipine (procardia) for angina or cardiac vasospasms can add w/ beta blockers --> can lead to brady and AV block
68
Non-dihydropyridine CCBs
on cardiac myocytes AND smooth muscle Verapamil = calan diltiazem = cardizem for chronic stable angina + printzmetal's angina, rate control, RARE for HTN
69
What is the MOA of Non-dihydropyridine CCBs?
reduce contractility --> reduce CO --> reduce BP anti-anginal and anti-arrhythmic
70
t/f: Amlodipine is a common first agent >50yo or AA
t
71
What are adverse effects of CCBs?
reflex tachy, peripheral swelling, dizziness/fatigue, gingival hyperplasia nonD = brady, major DDI w/ 3A4 inhibts all CCB = orthostatic HOTN, constipation
72
What are contraindications of vasodilators?
decompensated HF = non-dihydropyridines, - inotropic effect, poor CO, reduce contractility, could cause shock
73
Hydralazine causes arterial _____
vasodilation
74
When is hydralazine recommended?
severe HTN, given w/ BB and diuretic, or with nitrates for HF esp AA
75
What are adverse effects of hydralazine?
reflex tachy, HA, angina, drug-induced SLE symptoms, orthorastasis, peripheral neuritis
76
What are CIs of hydralazine?
FH of lupus, but safe in pregnancy
77
______ is used when maxed doses of hydralazine is reached
minoxidil - potent arterial vasodilator must be used w. BB or lop diuretic usually only used topically ADRs: sodium/water retention
78
Vasodilators: nitrodilators
nitroprusside --> decreases preload + afterload, causing reflex tachycardia used in HTN emergency, severe HF, aortic dissection
79
Nitroprusside can cause toxicity, leading to
lactic acidosis
80
Known CAD is a CI for
nitroprusside
81
Diazoxide leads to rapid reduction in
resistance and MAP
82
Diazoxide is used to treat
hypoglycemai due to hyperinsulinism
83
ADR of diazoxide
excessive HOTN
84
CI of diazoxide
ischemic heart disease
85
____ is an arterial dilator acting on D1 receptors in emergency use but can increase IOP
fenoldopam
86
Gestational HTN is
>140/90
87
preeclampsia HTN is
HTN after 20 weeks gestation and proteinuria, thormbocytpenia, impaired liver function, renal insufficiency, pulmonary edema, visual or cerebral disturbances, severe >160/110 and HELLP syndrome deliver baby
88
Eeclampisa
signs of preeclampsia with seizures, mouth twitching treat with magnesium sulfate can try midazolam, lorazepam, diazepam deliver baby
89
always suspect preeclampsia if any of these symptoms within 2 weeks of delivery
HTN, HA, epigastric pain, visual changes

Clinical Pharmacology 2 (13 decks)

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