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Fall 2014 - Pharm Cardio > HTN > Flashcards

HTN Flashcards

1
Q

What is normal BP?

A

<80 diastolic

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2
Q

What is the BP for prehypertension?

A

120-139 systolic, 80-89 diastolic

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3
Q

What is the BP for Stage 1 HTN?

A

140-159 systolic, 90-99 diastolic

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4
Q

What is the BP for Stage 2 HTN?

A

> 160 systolic, >100 diastolic

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5
Q

According to JNC, what are the major cardiovascular dz risk factors?

A
  • HTN, DM, dyslipidemia
  • tobacco use
  • obesity, physical inactivity
  • age (>55 men, >65 women)
  • familial hx of premature CVD (MI or sudden death)
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6
Q

What are some causes of HTN?

A
  • sleep apnea
  • drug induced
  • chronic kidney dz
  • renovascualr dz
  • pheochromocytoma
  • coarctation of the aorta
  • thyroid or parathyroid dz
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7
Q

What are some medications that may increase BP?

A
  • NSAIDs
  • cocaine, amphetamines
  • sympathomimetics (decongestants)
  • oral contraceptives
  • corticosteroids
  • erythropoietin
  • cyclosporine, tacrolimus (anti-rejection meds)
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8
Q

What are some examples of target organ damage from CVD?

A
  • heart: LVH, angina, prior MI, heart failure
  • brain: TIA or stroke
  • nephropathy
  • peripheral arterial dz
  • retinopathy
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9
Q

What is the BP goal for a pt over 60?

A

<150/90

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10
Q

What is the BP goal for a pt under 60?

A

<140/90

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11
Q

What is the BP goal for a pt over 18 with chronic kidney dz?

A

<140/90

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12
Q

What is the BP goal for a pt over 18 with DM?

A

<140/90

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13
Q

What lifestyle changes are recommended to reduce cardiovascular risk?

A
  • heart healthy diet: veggies, fruits, whole grains, limited sodium
  • regular exercise
  • achieve and maintain healthy weight
  • avoid tobacco
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14
Q

Decreasing BP by 5-6 mmHg leads to what reduction in stroke and CHD?

A
  • Stroke: 42% reduction

- CHD: 14% reduction

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15
Q

What anti-HTN treatment is recommended for general nonblack, including those with DM?

A
  • thiazide diuretic
  • CCB
  • ACE-I
  • ARB
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16
Q

What anti-HTN treatment is recommended for general black, including those with DM?

A
  • thiazide diuretic

- CCB

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17
Q

What anti-HTN treatment is recommended for anyone >18 with chronic kidney dz?

A

ACE-I or ARB

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18
Q

What is the main goal of HTN treatment?

A

attain and maintain goal BP

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19
Q

What 2 types of anti-HTN meds should NOT be used together in the same patient?

A

ACE-I and ARB

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20
Q

If goal BP is not reached within one month of treatment, what should you do?

A
  • increase the dose of the initial drug

- OR add a second drug

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21
Q

What 4 things might cause resistant HTN?

A
  • improper BP measurement
  • volume overload (excess Na, volume retention from kidney dz, inadequate diuretic therapy)
  • medication (nonadherence, inadequate dose, drug interactions)
  • associated conditions (obesity, excess EtOH, secondary HTN)
22
Q

What types of interventions might improve adherence for HTN treatment?

A
  • identify problems w/ drug tolerance and switch
  • address increased urination with diuretics
  • use generics or combo products to decrease cost
  • educate pt about importance of BP control
23
Q

What is considered a hypertensive urgency?

A

DBP > 130 but no target organ damage

24
Q

What is considered a hypertensive emergency?

A

DBP > 130 and target organ damage present

25
Q

What is the goal of treatment in a hypertensive urgency?

A
  • reduce DBP to 100 within 24 hours

- can use oral agents

26
Q

What is the goal of treatment in a hypertensive emergency?

A
  • reduce DBP to 110 within 30 minutes then to 100 within 12-24 hours
  • requires IV drug therapy
27
Q

MOA of Thiazide Diuretics

A

Work at distal tubule to:

  • increase Na excretion
  • decrease plasma volume and cardiac output
  • decrease extracellular fluid volume
  • some decrease peripheral resistance over time
28
Q

MOA of K+ Sparing Diuretics

A
  • weak effects at collecting duct and distal tubule
  • conserve potassium
  • spironolactone is an aldosterone antagonist
29
Q

MOA of Loop Diuretics

A
  • more potent diuretic effects at loop of Henle

- more effective than thiazides in heart failure

30
Q

Adverse Effects of Thiazide Diuretics

A
  • hypokalemia, hypomagnesemia
  • hyperglycemia, hyperuricemia
  • effective in renal insufficiency
  • may cause mild cholesterol and TG increase
31
Q

AE of K+ Sparing Diuretics

A
  • used mainly in combo with thiazides to offset K+ loss
  • may cause hyperkalemia
  • gynecomastia in aldosterone antagonists like spironolactone
32
Q

AE of Loop Diuretics

A

-more potent effects than thiazides on K+ and Mg2+ loss, overdiuresis and metabolic alkalosis

33
Q

MOA of ACE-I

A
  • block formation of angiotensin II, which is a vasoconstrictor
  • decrease aldosterone (decreases Na retention)
  • increase bradykinin (vasodilation)
34
Q

MOA or Angiotensin II Receptor Blockers

A
  • cause vasodilation

- decrease Na+ retention

35
Q

MOA of Direct Renin Inhibitors

A
  • vasodilation

- decrease Na+ retention

36
Q

AE of ACE-I

A
  • may cause hyperkalemia
  • cough, HoTN, rash, angioedema
  • may cause acute renal failure
  • CI in pregnancy
37
Q

AE or ARBs

A
  • hyperkalemia

- HoTN, angioedema

38
Q

AE of Direct Renin Inhibitors

A
  • diarrhea
  • cough, angioedema
  • do not use during pregnancy
39
Q

MOA of Calcium Channel Blockers as a Class

A
  • block intracellular reflux of Ca = prevent vascular smooth muscle contraction
  • vascular smooth muscle relaxation and vasodilation
40
Q

Effect of Dihydropyridine CCBs on Contractility and Peripheral Vasodilation

A
  • contract: minimal effect -

- peripheral vaso: significant effect +++

41
Q

Effect of Diltiazem Non-dihydropyridine CCBs on Contractility and Peripheral Vasodilation

A
  • contract: medium effect - -

- peripheral vaso: medium effect ++

42
Q

Effect of Verapamil Non-dihydropyridine CCBs on Contractility and Peripheral Vasodilation

A
  • contract: sig negative effect - - -

- peripheral vaso: medium effect ++

43
Q

AE of CCBs

A
  • HA, dizziness, peripheral edema
  • eczema in elderly
  • should be avoided in pts with HF
44
Q

AE of Dihydropyridine

A

-may cause tachycardia

45
Q

AEs of Non-Dihydropyridines

A

-diltiazem and verapamil slow down heart rate so avoid use in pts with bradycardia, heart block or sinus node dz

46
Q

MOA of Beta Blockers

A
  • decrease HR and cardiac output

- decrease BP

47
Q

AE of Beta Blockers

A
  • may aggravate asthma
  • CI in pts w/ bradycardia, heart block, sinus node dz
  • may cause fatigue, insomnia, depression, nightmares, bradycardia
48
Q

What is methyldopa used for?

A

-HTN control in pregnancy

49
Q

How does clonidine work?

A

-stimulate alpha 2 receptors to decrease peripheral sympathetic activity and BP

50
Q

What type of HTN drugs are hydralazine and minoxidil?

A

direct vasodilators

Fall 2014 - Pharm Cardio (9 decks)

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