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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?

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
Q

What are indications for BBs?

A
  • HTN + Ischemic heart disease
  • HTN + HF
  • situational anxiety, essential tremor
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26
Q

What are adverse effects of BBs?

A

bradycardia + reduced HR during exercise
HOTN
CNS - fatigue, lethargy, insomnia, hallucinations
ED
hypoglycemia unawareness

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27
Q

What are CIs of BBs?

A
  • 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)
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28
Q

DO NOT use BBs with what med to avoid causing severe bradycardia + AV block?

A

non-dihydropyridine CCBs

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29
Q

What is the MOA of alpha blockers?

A

vasodilation –> decreased HR –> decreased BP

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30
Q

What are some alpha blockers?

A

-zosins

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31
Q

What are SELECTIVE alpha blockers?

A

prazosin (minipress), terazosin (hytrin), doxazosin (cardura)

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32
Q

What are nonselective alpha blockers?

A

phentolamine, phenoxybenzamine

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33
Q

What are indications of alpha blockers?

A

selective = BPH
non-selective = HTN crisis, pheochromocytoma, MAO-I + tyramine

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34
Q

What are ADRs of alpha blockers?

A

reflex tachycardia (compensatory)
first dose phenomenon = postural HOTN w/ first dose, starting low and at bedtime, HA, dizziness, HOTN

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35
Q

What are CIs of alpha blockers?

A

preload dependent (rothorstasis)

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36
Q

Alpha and beta blockers

A

labetalol and carvedilol

37
Q

Labetelol reduces resistance via alpha blocking but does not affect ___ or ___ but is used for Pheo or HTN emergencies

A

HR, CO

38
Q

Carvedilol can cause ____ _____ in HF patients

A

reduced mortality, HL 7-10 hours

39
Q

Nebivolol’s vasodilation is not from alpha blocking, but from release of ____

A

Nitric oxide (less ED, sedation)

40
Q

Esmolol is used in ______ and _____ HOTN

A

intraoperative and postoperative – very short halflife

41
Q

Who should you not use beta/alpha blockers in?

A

asthmatics

42
Q

What are the sympatholytics not really used that are ganglion-blocking agents (blocking acetylcholine) or adrenergic neuron-blocking agents?

A

reserpine, guanthedine, guanadrel

43
Q

How do diuretics work?

A

excretion of sodium through urine –> BV + CO drops, HR increases…

44
Q

Diuretics are ________ for mild, or combo with ____ or ____ blockers for moderate-severe

A

monotherapy or combo w/ alpha/beta blockers
10-15mmHg reduction

45
Q

What are thiazides?

A

hydrochlorothiazide, chlorthalidone

  • inhibits reabsorption of water + sodium in distal convulted tubule, excreting Na, water, Cl –> hyponatremia
46
Q

What are indications for thiazides?

A

mild HTN w/ normal renal + cardiac function
Iatrogenic volume overload (fluids during hospitalization)
Mild edema
Calcium nephrolithiasis (REDUCES calcium in urine)

47
Q

What are adverse effects of thiazides?

A
  • gout flare, worsen dyslipidemia
  • hyponatremia, hypkalemia, metabolic aklalosis
  • nephrotoxic

avoid with sulfa allergy

48
Q

What are some loop diuretics?

A

furosemide (lasix)
bumetanide
torsemide
-ex

inhibits sodium + water reabsorption at ascending loop – increases excretion of Na, K, Ca

49
Q

What are indications of loop diuretics?

A
  • 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
Q

What are ADRs of loop diuretics?

A

hyponatremia, hypokalemia, metabolic alkalosis, hypocalcemia
CAN be used if CrCl<30 (nephrotoxic when combined w/ others)

51
Q

What are CIs of loop diuretics?

A

increases uric acid, try to avoid with gout histroy
may be ototoxic

52
Q

What are some ARBs?

A

spirinolactone (aldactome) – K sparing diuretic, prevents Na and water reabsorption, prevents K and H excretion

53
Q

What are indications for ARBs?

A

very mild diuretic, HF, ascites, acne, low K

54
Q

What are ADRs of ARBs?

A

dry skin, hyperkalemia, gynecomastia

55
Q

What are CIs of ARBs?

A

pregnancy

56
Q

ACE-Is

A

lisinopril = zesteril
enalapril = vasotec

57
Q

How do ACE-Is work?

A

reduce vasoconstrictio, aldosterone, ADH production, BP

58
Q

What are indications for ACE-Is?

A

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
Q

Always use _____ in DM and/or CKD if no contraindications

A

ACE-Is

60
Q

What are ADRs of ACE-Is?

A
  • persistent, dry cough
  • angioedema
  • hyperkalemia (diet changes to avoid!)
  • increased creatinine
61
Q

What are CIs of ACE-Is?

A

prior angioedema, pregnancy, monitor needed for renal impairment
avoid supplements for potassium

62
Q

What are other ARBs?

A

-sartan
Cozaar = losartan
Diovan = valsartan

63
Q

ARBs block the action of

A

angiotensin II

64
Q

What are indications for ARBs?

A

when patient has cough reaction to ACE-I (less adverse effects)

65
Q

What are ADRs of ARBs?

A

hyperkalemia, increased creatinine

66
Q

What are CIs of ARBs?

A

teratogenic

67
Q

What are vasodilators?

A

dihydropyridine CCBs - amlodipine (norvasc), nifepdipine (procardia) for angina or cardiac vasospasms
can add w/ beta blockers –> can lead to brady and AV block

68
Q

Non-dihydropyridine CCBs

A

on cardiac myocytes AND smooth muscle
Verapamil = calan
diltiazem = cardizem
for chronic stable angina + printzmetal’s angina, rate control, RARE for HTN

69
Q

What is the MOA of Non-dihydropyridine CCBs?

A

reduce contractility –> reduce CO –> reduce BP
anti-anginal and anti-arrhythmic

70
Q

t/f: Amlodipine is a common first agent >50yo or AA

A

t

71
Q

What are adverse effects of CCBs?

A

reflex tachy, peripheral swelling, dizziness/fatigue, gingival hyperplasia
nonD = brady, major DDI w/ 3A4 inhibts
all CCB = orthostatic HOTN, constipation

72
Q

What are contraindications of vasodilators?

A

decompensated HF = non-dihydropyridines, - inotropic effect, poor CO, reduce contractility, could cause shock

73
Q

Hydralazine causes arterial _____

A

vasodilation

74
Q

When is hydralazine recommended?

A

severe HTN, given w/ BB and diuretic, or with nitrates for HF esp AA

75
Q

What are adverse effects of hydralazine?

A

reflex tachy, HA, angina, drug-induced SLE symptoms, orthorastasis, peripheral neuritis

76
Q

What are CIs of hydralazine?

A

FH of lupus, but safe in pregnancy

77
Q

______ is used when maxed doses of hydralazine is reached

A

minoxidil - potent arterial vasodilator
must be used w. BB or lop diuretic
usually only used topically
ADRs: sodium/water retention

78
Q

Vasodilators: nitrodilators

A

nitroprusside –> decreases preload + afterload, causing reflex tachycardia
used in HTN emergency, severe HF, aortic dissection

79
Q

Nitroprusside can cause toxicity, leading to

A

lactic acidosis

80
Q

Known CAD is a CI for

A

nitroprusside

81
Q

Diazoxide leads to rapid reduction in

A

resistance and MAP

82
Q

Diazoxide is used to treat

A

hypoglycemai due to hyperinsulinism

83
Q

ADR of diazoxide

A

excessive HOTN

84
Q

CI of diazoxide

A

ischemic heart disease

85
Q

____ is an arterial dilator acting on D1 receptors in emergency use but can increase IOP

A

fenoldopam

86
Q

Gestational HTN is

A

> 140/90

87
Q

preeclampsia HTN is

A

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
Q

Eeclampisa

A

signs of preeclampsia with seizures, mouth twitching

treat with magnesium sulfate
can try midazolam, lorazepam, diazepam
deliver baby

89
Q

always suspect preeclampsia if any of these symptoms within 2 weeks of delivery

A

HTN, HA, epigastric pain, visual changes

Clinical Pharmacology 2 (4 decks)

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