HTN 2 Flashcards
1
Q
What is MOA of ACE-I?
A
stops conversion of angiotensin I into angiotensin II
- vasodilators
- prevents LV remodeling
- reduces mortality
- blocks aldosterone and decreases Na and water retention
2
Q
What is MOA of ARB?
A
blocks AT1 receptor
- vasodilator
- same as ACE but no cough
3
Q
What are ADE of ACE/ARB (3)?
A
hyperkalemia
hypotension
angioedema and cough (ACE-I)
4
Q
T/F you can combine ACE and ARB
A
False
5
Q
What patient population benefits from ACE and ARBS?
A
white young men
6
Q
contraindications for ACE/ARB?
A
- pregnancy
- CKD
- cough
- hyperkalemia
7
Q
Drug interactions with ACE-I and ARBS?
A
NSAIDS
-PDE5/viagra
8
Q
What should be monitored in ACE and ARBS?
A
- serum creatinine
- K
9
Q
What is MOA for Aliskiren?
A
- blocks renin
- stops RAAS system
10
Q
When should you not use Aliskiren?
A
- when CrCL is less than 60
- pregnancy
11
Q
T/F Aliskiren works synergistically with ACE and ARBs?
A
TRUE
12
Q
T/F Aliskiren is first line treatment for HTN
A
False
13
Q
What is MOA of beta blockers?
A
blocks beta 1 and beta 2 receptors to slow HR down?
-stops renin release
14
Q
Name one non-selective B1 and B2 blocker?
A
Propranolol
15
Q
Name 1 selective B1 blocker?
A
Metoprolol
16
Q
Name alpha 1 and beta 1 blocker (3)?
A
Carvedilol and Nebivolol and Labetalol
17
Q
T/F Labetalol is safe in pregnancy
A
TRUE
18
Q
ADE with Beta blockers (3)
A
- bradycardia
- AV node blocks
- bronchospasm
19
Q
T/F Metoprolol and propranolol undergo extensive first pass effect?
A
TRUE
20
Q
What should you monitor in beta blockers (4)?
A
- HR
- BS in diabetes
- CHF
- edema
21
Q
Drug interactions with Beta Blockers (4)?
A
- NSAIDS
- CCB
- digoxin
- cardiac depressants
22
Q
What are the clinical uses of beta blockers (5)?
A
- angina
- post MI
- HF
- HTN
- antiarrhythmics (propranolol is used to treat atrial arrhythmias
23
Q
T/F Carvedilol is the go to treatment for HF?
A
TRUE
24
Q
T/F Propranolol is used to treat migraines because it is lipophilic
A
TRUE
25
What is the mechanism of Prazosin and Doxazosin?
Alpha 1 blocker
| -block NE and EPI from binding to alpha 1 receptor to prevent vasoconstriction
26
What are drug interactions of Prazosin and Doxazosin? (3)
decrease efficacy of dabigatran(anti-coagulant)
- linagliptin/ DM med
- vincristine cancer med)
27
what are the clinical uses if Alpha 1 blockers? (2)
- BPH
| - PTSD/reduces bad dreams
28
T/F Alpha 1 blockers induce the first dose phenomenon
-TRUE
29
What is MOA for clonidine and methyldopa?
- they are central alpha 2 agonist
- they bind alpha 2 receptors to decrease cAMP via G proteins
- decrease cAMP decrease intracellular Ca
- no release of NE
- decrease sympathetic outflow and increases vagal tone
30
What are ADE in alpha 2 agonists (3)?
anticholinergic effects
- rebound HTN
- hepatitis/hemolytic anemia
31
What is the clinical use of methyldopa/clonidine?
- 1t line TX for HTN in pregnancy and peds
32
T/F Diuretic should be given with alpha 2 agonist
TRUE
33
What are the drug interactions with alpha 2 agonists (4)?
- MOA
- PDE5
- lithium
- tricyclic antidepressants
34
What should you monitor when using C2AA?
LFTS
35
T/F C2AA are 2nd or 3rdd line treatments in non pregnant people?
TRUE-due to side effects
36
What is MOA of Reserpine?
- peripheral adrenergic antagonist
| - blocks reuptake of NE into its storage vesicles to decrease vascular resistance and CO
37
What are ADE of Reserpine?
- sedation
- depression
- increase parasympathetic NS- congestion, diarrhea, increased gastric secretion
38
when should you adjust dose of Reserpine?
when CrCl is < 10
39
T/F Reserpine causes increased Na and H20 retention and must be given with a diuretic?
TRUE
40
What is MOA of CCB's?
they block L type calcium channels and thus induce peripheral and coronary artery vasodilation
41
Where on the heart do CCB's work?
SA node: decrease HR and O2 demand
ventricular myocardium: decreases O2 demand and contractility
-coronary arteries: increase vasodilation and O2 supply
42
When is CCB's considered 1st line treatment?
-in blacks who do not have HF or CKD
43
where do DHP work? Name 2?
- they work on blood vessels
| - Amlodipine and Nifedipine
44
Name 2 Non-DHP and where do they work?
- in heart
| - Veramipil and Diltiazem
45
What are the clinical uses of Non-DHP (4)?
- SVT
- angina
- HTN
- rate control in a-fib
46
What are the clinical uses of DHP (5)?
- Amlodipine in HF
- angina
- Raynaud's syndrome
- Nifedipine used in premature labor
- stroke and CHD prevention
47
What are ADE with DHP (4)?
- reflex tachycardia
- gingival hyperplasia
- peripheral edema
- flushing
48
What are ADE with non-DHP?
Verapimil-constipation
49
T/F You should you Nifedipine in emergent/urgent HTN?
False-don't use Nifedipine
50
What should you monitor in when using CCB's (4)?
- EKG
- HR
- BP
- LFT's
51
What are the drug interactions with CCB's (5)?
reduces metabolism of:
- cyclosporin
- theophylline
- simvastatin
- tacrolimus
- digoxin
- CP40 system
52
T/F Grapefruit juice inhibits metabolism of Nifedipine
TRUE
53
What is MOA of Hydralazine/Minoxidil?
- Direct Arterial Vasodilator
- direct smooth muscle relaxers
- arterial dilators
- increases NO production in endothelium
54
T/F Hydralazine isosorbide dinitrate is used in blacks to tx HF?
TRUE
55
T/F Hydralazine can cause lupus like syndrome in women?
TRUE
56
What should you monitor when using direct arterial vasodilators?
Renal function
57
What are ADE for Hydralazine/Minoxidil (2)?
- reflex tachycardia
| - angina with CAD patients
58
T/F Hydralazine decrease after load and increases CO
TRUE
59
What medication can you give to prevent reflex tachycardia?
BB or clonidine
60
What are other uses for DAV?
- hypertrichosis
| - minoxidil is used to treat male pattern baldness
61
What is MOA for desmopressin/vasopressin?
- ADH agonists
- they bind V2 receptor in collecting tubule and increases cAMP
- this signals increased aquaporins into luminal cell to increase H20 re-absorption
62
What are the clinical uses of ADH agonist?
- pituitary diabetes insipidus
| - bed wetters
63
What are ADE with ADH agonists?
-dilutional hyponatermia
64
T/F ADH agonist increase urine concentration and reduce its volume
TRUE
65
What is MOA of ADH antagonists?
- Demeclocycline blocks cAMP
| - block V1 and V2 receptors (Conivaptan and Tolvaptan)
66
T/F Demeclocycline is a tetracycline derivative
TRUE
67
What are ADE for ADH antagonists?
- demeclocycline: bone and teeth abnormalities
| - conivaptan: demyelination
68
What are the clinical uses of ADH antagonists?
-SIADH (too much water)/Conivaptan
