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pharm II exam 2 > HTN > Flashcards

HTN Flashcards

1
Q

1 drug treatment reduces HTN by

A

15 mmHg

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2
Q

what lifestyle modifications can be done to reduce hypertension

A
  • exercise
  • weight reduction
  • moderation of dietary salts, fats, alcohol
  • avoid or reduce smoking
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3
Q

once a patient is on a HTN drug, can he/she come off of it?

A

no, once on it, on it for life

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4
Q

in elderly hypertensives, why would you not want to decrease BP to diastolic < 90 mmHg

A
  • at this BP, coronary perfusion may become inadequate; could cause increase in morbidity and mortality
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5
Q

DOC: HTN

A

thiazide diuretics

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6
Q

What is special about the thiazide Indapamide

A

can also cause vasodilation

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7
Q

explain MOA of thiazide diuretics and how they reduce BP

A
  • 2 pronged attack: increase sodium and water excretion
  1. short term effect: decrease body Na+ -> decreased blood volume -> decreased CO -> lowers BP
  2. long term effect: decrease sodium content of smooth muscle cells -> decrease muscle sensitivity to vasopressors, activate K+ channels -> decrease peripheral vascular resistance -> lowers BP
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8
Q

list the common side effects of diuretics

A
  • impotence (E.D)
  • gout due to hyperuricemia
  • hypokalemia -> muscle cramps, arrhythmia
  • reduced glucose tolerance (decreased insulin release)
  • increased plasma lipid concentration
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9
Q

most side effects of thiazide diuretics can be avoided by using lower doses. can you use a lower dose to treat HTN

A

yes, antihypertensive doses are much lower than those for diuresis

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10
Q

contraindication to thiazide

A

sulfa allergy

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11
Q

thiazides are often used in combination with B-blockers. Why?

A
  • thiazides decrease BP and will cause reflex tachycardia
  • B-blockers help to inhibit that reflex
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12
Q

thiazide diuretics are more effective in what patient populations

A
  • african american
  • elderly
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13
Q

when should loop diuretics by used to treat HTN

A
  • when patient has severe renal insufficiency or CHF
  • most thiazides do not work with low kidney function
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14
Q

thiazides are often used in combo with what drugs to prevent hypokalemia

A

potassium sparing

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15
Q

MOA of sympatholytics

A
  • decrease BP by reducing sympathetic vasomotor tone
    • only system that is affected: BV due to sympathetic tone prevalence
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16
Q

sympatholytics work best when used in combo with diuretics? why?

A
  • sympatholytics activate baroreflexes and generally cause Na+ and H2O retention
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17
Q

list alpha 2 agonists that are centrally acting sympatholytics

A
  • clonidine
  • methyldopa
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18
Q

MOA of clonidine and methyldopa

A
  • stimulate alpha2 receptors -> decrease in peripheral sympathetic nerve activity
  • effect
    • decreased sympathetic outflow
    • decreased renin secretion
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19
Q

which of clonidine and methyldopa decreases HR and CO more

A

clonidine

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20
Q

route of administration of clonidine and methyldopa

A
  • orally
  • clonidine may be used as a patch
21
Q

DOC HTN in pregnancy

A

methyldopa

22
Q

adverse effects common to both clonidine and methyldopa

A
  • sedation
  • xerostomia (dry mouth)
23
Q

adverse effect of methyldopa

A

hemolytic anemia with a positive coombs test

24
Q

sudden withdrawal of clonidine can cause

A

hypertensive crisis

25
Q

List the alpha 1 adrenergic antagonists that are used for treatment of HTN

A
  • Prazosin
  • Terazosin
  • Doxazosin
26
Q

indications/theraputic effects of a1 adrenergic antagonists

A
  • a1 blockers: reduce NE caused vasoconstrction -> dilate arteries and veins ->BP falls due to decreased peripheral resistance
  • does not adversely effect plasma lipids
  • beneficial in BPH
27
Q

adverse effects of alpha1 antagonists

A
  • first dose phenomenon: postural HTN may be pronounced with the first dose
  • Na+ and water retention (increase in renin)
  • reflex tachycardia
28
Q

list the non-selctive B antagonists used in treatment of HTN

A
  • propranolol
  • nadolol
  • timolol
29
Q

list the Beta 1 antagonists used in treatment of HTN

A
  • metoprolol
  • atenolol
  • nebivolol
  • acebutolol
30
Q

how does B-blockers reduce BP

A
  • B1: reduce CO
  • B1: reduce renin secretion
31
Q

beta blockers are most effective in what patient population

A
  • caucasian
  • young
32
Q

beta blockers are preferred for patients with what conditions

A
  • angina
  • post MI
  • migraine
33
Q

beta blockers are least preferred for patients with what conditions

A
  • high physical activity
  • african
  • asthma
  • DM
  • hypercholesterolemia
  • peripheral vascular disease
34
Q

MOA of Carvedilol and Labetalol

A

block alpha 1, beta 1 and beta 2 receptors

35
Q

indications of Labetalol? route of administration

A
  • IV
  • decrease BP in
    • hypertensive emergencies
    • pregnancy; use if methyldopa isn’t working
36
Q

indications of Carvedilol

A
  • HTN and CHF, especially after an MI
  • lipid neutral
37
Q

adverse effects of carvedilol and labetalol

A
  • orthostatic hypotension
  • bronchospasm
  • hepatotoxicity (labetalol)
38
Q

All vasodilators relax arterial smooth muscle, which vasodilator also relaxes veins

A

sodium nitroprusside

39
Q

effects of drugs that vasodilate decrease with time due to

A
  • reflex tachycardia
  • increased renin secretion
40
Q

which vasodilators are used for chronic oral treatment

A
  • hydralazine
  • minoxidil
41
Q

which vasodilators are used IV for emergenies

A
  • Nitroprusside
  • Fenoldopam
42
Q

List the drugs that act through nitric oxide

A
  • Hydralazine
  • Sodium nitroprusside
43
Q

MOA of hydralazine

A
  • dilates arterioles but not veins through NO
44
Q

indications of Hydralazine

A
  • chronic therapy of severe hypertension
  • combination therapy
  • used in severe HTN or hypertensive emergencies in pregnancy
45
Q

adverse effects of Hydralazine

A
  • HA, N, palpitations, sweating, flushing (from vasodilation)
  • causes SLE in slow acetylators
46
Q

list the three drugs that can cause SLE in a slow acetylator

A
  1. Hydralazine
  2. Isoniazid
  3. Procainamide
47
Q

Indications of sodium nitroprusside

A
  • rapidly lowers BP and effect disappears in minutes after discontinuation
  • used for emergency hypertensive situations
48
Q

sodium nitroprusside route of administration? what is it metabolized into

A
  • IV (press it in)
  • metabolized to thiocyanate (cyanide)
49
Q

adverse effects of sodium nitroprusside

A
  • cyanide accumulation

pharm II exam 2 (9 decks)

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