HTN Flashcards
Review: normal BP
<120 and <80
Review: elevated BP
120-129 and <80
Review: stage 1 HTN
130-139 or 80-89
Review: stage 2 HTN
> 140 or >90
Symptoms in HTN are usually _____
nonexistent - don’t wait!
What are the four categories for HTN meds?
- sympatholytics
- diuretics
- angiotensin inhibitors
- vasodilators
Sympatholytics work best with _____
diuretics
What are central acting sympatholytics?
clonidine, a-methyldopa
inhibiting response –> lower BP
Clonidine is an ______ _____
alpha 2 agonist
Clonidine is a ____ agent in clinical use with HTN refractory to ____+ agents
third line, 2+
T/F: clonidine works well with withdrawal
T - from depressants such as alcohol or opioids
What are ADRs of clonidine
- dry mouth
- sedation
- inhibition of ejaculation
What are CIs of clonidine?
depression, TCAs
do not stop abruptly at higher doses, because it can cause hypertensive crisis
Methyldopa is an ____ __ _____
alpha 2 agonist – reduces BP + HR, but does not affect CO or blood flow to vital organs
What are indications of methyldopa?
pregnancy, HTN complicated by kidney disease
clonidine
catapres
methyldopa
aldomet
What are ADRs of methyldopa?
could cause false + Coombs test
- long term effect
- sedation
- dry mouth
- foggy mind
- postural HOTN
- lactation
caution w/ depression
What’s another type of sympatholytic?
beta blockers, acting on B1 receptor
What are preferred beta blockers for HTN?
cardioselective (first part of the alphabet)
_____ was the first BB discovered and to work with ischemic heart disease
propanolol
Propanolol is not _____, so it’s not used for HTN anymore, but for reduced mortality post-MI and heart failure
cardioselective
Metoprolol works best with _____ _____ ______
heart failure patients
Atenolol is excreted in ____ and needs ____ dosing
urine, renal dosing
What are indications for BBs?
- HTN + Ischemic heart disease
- HTN + HF
- situational anxiety, essential tremor
What are adverse effects of BBs?
bradycardia + reduced HR during exercise
HOTN
CNS - fatigue, lethargy, insomnia, hallucinations
ED
hypoglycemia unawareness
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)
DO NOT use BBs with what med to avoid causing severe bradycardia + AV block?
non-dihydropyridine CCBs
What is the MOA of alpha blockers?
vasodilation –> decreased HR –> decreased BP
What are some alpha blockers?
-zosins
What are SELECTIVE alpha blockers?
prazosin (minipress), terazosin (hytrin), doxazosin (cardura)
What are nonselective alpha blockers?
phentolamine, phenoxybenzamine
What are indications of alpha blockers?
selective = BPH
non-selective = HTN crisis, pheochromocytoma, MAO-I + tyramine
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
What are CIs of alpha blockers?
preload dependent (rothorstasis)
Alpha and beta blockers
labetalol and carvedilol
Labetelol reduces resistance via alpha blocking but does not affect ___ or ___ but is used for Pheo or HTN emergencies
HR, CO
Carvedilol can cause ____ _____ in HF patients
reduced mortality, HL 7-10 hours
Nebivolol’s vasodilation is not from alpha blocking, but from release of ____
Nitric oxide (less ED, sedation)
Esmolol is used in ______ and _____ HOTN
intraoperative and postoperative – very short halflife
Who should you not use beta/alpha blockers in?
asthmatics
What are the sympatholytics not really used that are ganglion-blocking agents (blocking acetylcholine) or adrenergic neuron-blocking agents?
reserpine, guanthedine, guanadrel
How do diuretics work?
excretion of sodium through urine –> BV + CO drops, HR increases…
Diuretics are ________ for mild, or combo with ____ or ____ blockers for moderate-severe
monotherapy or combo w/ alpha/beta blockers
10-15mmHg reduction
What are thiazides?
hydrochlorothiazide, chlorthalidone
- inhibits reabsorption of water + sodium in distal convulted tubule, excreting Na, water, Cl –> hyponatremia
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)
What are adverse effects of thiazides?
- gout flare, worsen dyslipidemia
- hyponatremia, hypkalemia, metabolic aklalosis
- nephrotoxic
avoid with sulfa allergy
What are some loop diuretics?
furosemide (lasix)
bumetanide
torsemide
-ex
inhibits sodium + water reabsorption at ascending loop – increases excretion of Na, K, Ca
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)
What are ADRs of loop diuretics?
hyponatremia, hypokalemia, metabolic alkalosis, hypocalcemia
CAN be used if CrCl<30 (nephrotoxic when combined w/ others)
What are CIs of loop diuretics?
increases uric acid, try to avoid with gout histroy
may be ototoxic
What are some ARAs
spirinolactone (aldactome) – K sparing diuretic, prevents Na and water reabsorption, prevents K and H excretion
What are indications for ARBs?
very mild diuretic, HF, ascites, acne, low K
What are ADRs of aldosterone antagonists
dry skin, hyperkalemia, gynecomastia
What are CIs of ARBs?
pregnancy
ACE-Is
lisinopril = zesteril
enalapril = vasotec
How do ACE-Is work?
reduce vasoconstrictio, aldosterone, ADH production, BP
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
Always use _____ in DM and/or CKD if no contraindications
ACE-Is
What are ADRs of ACE-Is?
- persistent, dry cough
- angioedema
- hyperkalemia (diet changes to avoid!)
- increased creatinine
What are CIs of ACE-Is?
prior angioedema, pregnancy, monitor needed for renal impairment
avoid supplements for potassium
What are other ARBs?
-sartan
Cozaar = losartan
Diovan = valsartan
ARBs block the action of
angiotensin II
What are indications for ARBs?
when patient has cough reaction to ACE-I (less adverse effects)
What are ADRs of ARBs?
hyperkalemia, increased creatinine
What are CIs of ARBs?
teratogenic
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
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
What is the MOA of Non-dihydropyridine CCBs?
reduce contractility –> reduce CO –> reduce BP
anti-anginal and anti-arrhythmic
t/f: Amlodipine is a common first agent >50yo or AA
t
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
What are contraindications of vasodilators?
decompensated HF = non-dihydropyridines, - inotropic effect, poor CO, reduce contractility, could cause shock
Hydralazine causes arterial _____
vasodilation
When is hydralazine recommended?
severe HTN, given w/ BB and diuretic, or with nitrates for HF esp AA
What are adverse effects of hydralazine?
reflex tachy, HA, angina, drug-induced SLE symptoms, orthorastasis, peripheral neuritis
What are CIs of hydralazine?
FH of lupus, but safe in pregnancy
______ 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
Vasodilators: nitrodilators
nitroprusside –> decreases preload + afterload, causing reflex tachycardia
used in HTN emergency, severe HF, aortic dissection
Nitroprusside can cause toxicity, leading to
lactic acidosis
Known CAD is a CI for
nitroprusside
Diazoxide leads to rapid reduction in
resistance and MAP
Diazoxide is used to treat
hypoglycemai due to hyperinsulinism
ADR of diazoxide
excessive HOTN
CI of diazoxide
ischemic heart disease
____ is an arterial dilator acting on D1 receptors in emergency use but can increase IOP
fenoldopam
Gestational HTN is
> 140/90
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
Eeclampisa
signs of preeclampsia with seizures, mouth twitching
treat with magnesium sulfate
can try midazolam, lorazepam, diazepam
deliver baby
always suspect preeclampsia if any of these symptoms within 2 weeks of delivery
HTN, HA, epigastric pain, visual changes
