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HTN Flashcards

1
Q

MAP equation

A

(CO) x (SVR)

CO = (HR) x (SV)

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2
Q

Pre-synaptic alpha 2: _____ reduces blood pressure.

A

Stimulation

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3
Q

Alpha 1: _____ reduces blood pressure

A

Inhibition

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4
Q

Beta 2: _____ reduces blood pressure.

A

Stimulation

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5
Q

Beta 1: _____ reduces blood pressure, HR & myocardial contractility

A

Inhibition

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6
Q

RAAS _____ reduces blood pressure

A

Inhibition

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7
Q

Natrtiuretic hormone _____ decreases blood pressure

A

Stimulation

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8
Q

“Elevated” BP

A

121-129 & <80

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9
Q

Stage I HTN

A

130-139 or 80-89

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10
Q

Stage II HTN

A

> /= 140 or >/= 90

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11
Q

HTN crisis

A

> /=180 or >/= 120

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12
Q

JNC VII Cardiovascular risk factors (7)

A
  • Smoking
  • Obesity
  • Hyperlipidemia
  • DM
  • Renal insufficiency (CrCl <60ml/min or proteinuria)
  • Men >55y & women >60y
  • 1st degree relative w/ CVD (men <55y, women<65y)
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13
Q

Target organ damage (5)

A
  • Heart dz (LVH, angina/prior MI, prior stent, heart failure)
  • Stroke/TIA
  • Nephropathy
  • PAD
  • Retinopathy
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14
Q

Treatment recommendations for normal BP

A
  • Yearly eval

- Encourage healthy lifestyle to maintain BP

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15
Q

Treatment recommendations for “Elevated” BP

A
  • Re-eval 3-6 mo

- Recommend healthy lifestyle changes

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16
Q

Treatment recommendations for stage I HTN

A
  • Assess 10-yr risk for heart dz/stroke
    <10%: healthy lifestyle mods & reeval in 3-6 mo
    >10% or known CVD: lifestyle changes + 1 BP med & reeval in 1 mo
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17
Q

Treatment recommendations for stage II HTN

A
  • Lifestyle modifications + 2 BP lowering meds + reeval in 1 mo
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18
Q

BP goal for previous stroke/TIA, atherosclerosis (PAD, stable angina, ACS), CKD w/ no or A1 proteinuria, DM, general population <60 w/ no comorbidities

A

<140/90

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19
Q

BP goal for heart failure, CKD w/ A2-A3 proteinuria

A

<130/80

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20
Q

BP goal for general population >60 w/o comorbid condition

A

<150/90

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21
Q

Lifestyle mod: Na restriction

A

<2.4g/day = 2-8mmHg BP reduction

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22
Q

Lifestyle mod: DASH diet

A

Fruit, veggies, low fat dairy, reduced sat & total fat = 8-14mmHg BP reduction

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23
Q

Lifestyle modification: weight loss

A

Maintain normal body weight (BMI of 18.5-24.9) = 5-20 mmHg per 10 kg reduction

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24
Q

Lifestyle modification: physical activity

A

Aerobic activity >30 mins most days of week = 4-9mmHg reduction

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25
Q

Lifestyle modification: ETOH moderation

A

Men: 2 drinks/day
Women: 1 drink/day
= 2-4mmHg reduction

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26
Q

Thiazide MOA

A
  • Inhibits Na/H2O re absorption in distal tubule

- Long-term: vasodilation

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27
Q

Thiazide role in therapy

A
  • 1st line for most pts
  • More effective in AA
  • Less effective in severe renal insufficiency
  • Additive/synergistic effects
  • Best response w/ Na restriction
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28
Q

Thiazide adverse effects

A
  • Hypokalemia/hypomagnesemia
  • Hyponatremia
  • Glucose intolerance
  • Hyperuricemia
  • Metabolic alkalosis
  • May increase lipids (LDL by 15%)
  • Photosensitivity
  • Impotence
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29
Q

chlorthalidone dosing

A

12.5-25mg QD

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30
Q

Beta blocker MOA

A

Beta receptors of heart:

  • Competitive inhibition of Beta receptors
  • Decreases HR & contractility

Beta receptors of kidney:
- Decreases renin secretion

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31
Q

Beta blocker role in therapy

A
  • Preferred for white>AA & young>old
  • Added benefits in pts with: ischemic heart dz/MI, migraines/tachyarrhythmias, tremor, diastolic CHF, systolic CHF (cautious use)
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32
Q

Beta blocker cautious use in pts with:

A
  • DM
  • Severe PAD
  • Bradycardia
  • Asthma/COPD
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33
Q

propranolol (Inderal/LA) dosing

A

160-480mg BID

80-320 mg QD

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34
Q

Beta blocker adverse effects

A
  • CNS depression
  • Cardiovascular
  • Hyper/hypoglycemia (can mask hypoglycemic episodes)
  • Increase triglycerides
  • Bronchospasm (cautious use in asthmatics)
  • Peripheral vascular effects (cautious use in pts w/ PAD)
  • Sexual dysfunction
  • Withdrawl syndrome (titrate slowly)
35
Q

Calcium channel blockers MOA

A
  • Decrease influx of Ca into vascular smooth muscle resulting in vasodilation & reduced SVR
36
Q

Calcium channel blocker role in therapy

A
  • Equal efficacy in AA & whites
  • better in elderly

Added benefits in pts w/:

  • Ischemic heart dz/MI
  • Diastolic CHF
  • Asthma
37
Q

DHP CCB

A

amlodipine (Norvasc), nifidepine (Adalat CC, Procardia) -

increase HR, +++ vasodilation (minimal lowering of CO, contractility)

38
Q

Calcium channel blocker adverse effects

A
  • HA
  • Peripheral edema
  • Palpitations (DHP)
  • Constipation (verapamil)
  • Bradycardia (non-DHP)
  • GERD exacerbation
39
Q

nifedipine (Adalat CC, Procardia XL) dosing

A

DHP CCB

30-60mg/day

40
Q

Alpha-1 blockers MOA

A

vasodilation &decrease SVR from competitively blocking post-synaptic alpha 1 receptors

41
Q

Alpha-1 blockers role in therapy

A
  • 2nd line
  • Effective in combo
  • May improve lipid profile
  • May improve insulin sensitivity
  • Tolerance possible
  • May improve BPH symptoms
42
Q

Alpha-1 blocker adverse effects

A
  • 1st dose syncope, orthostasis
  • HA
  • Possible urinary incontinence
43
Q

doxazosin (Cardura) dosing/admin

A

1-16mg/day QD Alpha-1

44
Q

Central sympatholytics MOA:

A

Stimulates pre-synaptic alpha-2 receptors, decreasing release of neurotransmitter & amp; decreasing sympathetic outflow resulting in vasodilation

45
Q

Central sympatholytics role in therapy

A
  • not first line
  • Avoid using w/ alpha blocker
  • Topical admin w/ patch available
46
Q

Central sympatholytics adverse effects

A
  • methyldopa may decrease HDL & increase TG, make ANA positive
  • Rebound HTN (titrate down to d/c)
  • Sedation
  • Drym mouth
  • Constipation
  • Sexual dysfunction
  • Bradycardia
  • Depression, drug-induced liver dz
47
Q

clonidine (Catapres/TTS) dosing

A

0.1-0.8mg/day BID
0.1-0.3 mg/day once weekly
Central sympatholytic

48
Q

ACE Inhibitors MOA

A

Inhibits conversion of angiotensin I to angiotensin II (angiotensin II is potent vasoconstrictor & stimulates aldosterone secretion)

ACE reduces both preload & afterload

49
Q

ACE inhibitor rol in therapy

A
  • Diabetic nephropathy
  • CHF
  • post MI
50
Q

ACE adverse effects (7)

A
  • Hypotension
  • Hypokalemia
  • Cough
  • Acute renal failure
  • Angioedema
  • Taset distrubances
  • Contridicated in pregnancy
51
Q

lisinopril (Prinivil) dosing

A

10-40 mg/day QD ACE Inhibitor

52
Q

Angiotensin II receptor antagonist MOA

A

vasodilation Blocks the effect of angiotensin II (vasoconstrictor) @ receptor, thus causing

53
Q

Angiotensin II receptor antagonist role in therapy

A
  • more efficacious in whites>blacks
  • synergy w/ diuretics
  • useful in DM pts
54
Q

Angiotensin II receptor antagonist adverse effects

A
  • Hyperkalemia
  • Acute renal insufficiency
  • Contraindicated in pregnancy
    NO cough or taste disturbances & lower risk of angioedema
55
Q

losartin (Cozaar) dosing

A

25-100mg/day QD/BID Angiotensin II receptor antagonist

56
Q

Direct renin Inhibitor MOA

A

Directly inhibits the binding of renin to angiotensinogen, thus decreasing plasma renin activity by 50-80% & prevening conversion to angiotensin I

57
Q

Direct renin inhibitor role in therapy

A
  • TBD

- BP reduction SBP 10-15 mmHg & DBP 8-10mmHg

58
Q

Direct renin inhibitor pharmacokinetics

A
  • oral bioavailability: 2.5%
  • 25% eliminated in urine
  • t1/2 = 24 hours
  • Max BP reduction w/i 2 wks
59
Q

Direct renin inhibitor adverse effects

A
  • Diarrhea
  • Hyperkalemia
  • Increased CK
  • Cough (less than ACE)
  • Rash
  • Hyperuricemia
  • Contraindicated in pregnancy
60
Q

aliskiren (Tekturna) dosing/admin

A

150-300mg QD

Direct renin inhibitor

61
Q

Direct acting vasodilator MOA

A
  • Decreased SVR via direct arterial vasodilation
  • NO venous effect
  • Potent vasodilation stimulates renin secretion
  • Activation of baroreceptor reflexes stimulates reflex tachycardia
62
Q

Direct acting vasodilator role in therapy

A
  • NOT first line
  • May decrease DBP>SBP
  • Pts w/ heart failure: possible benefit in combo w/ nitrates
  • Useful in pts w/ renal insufficiency
63
Q

Direct acting vasodilator adverse effects

A
  • orthostasis
  • tachycardia
  • lupus-like syndrome (hydralazine)
  • hirsutism (minoxidil)
64
Q

minoxidil (Loniten) dosing

A

minoxidil (Loniten): 2.5-80mg/day QD/BID

Direct acting vasodilator

65
Q

Peripheral adrenergic inhibitors MOA

A
  • Decreased release of catecholamines in peripheral sympathetic nerve endings
  • Decreased peripheral vascular resistance, HR & CO
66
Q

Peripheral adrenergic inhibitors role in therapy

A

Refractory HTN

67
Q

Peripheral adrenergic inhibitor adverse effects

A
  • orthostatics
  • pseudotolerance
  • depression
  • sexual dysfunction/impotence
  • nasal congestion & increased gastric acid secretion (reserpine)
  • diarrhea
  • bradycardia
68
Q

guanadrel (Hylorel) dosing

A

20-100mg BIDperipheral adrenergic inhibitor dosing/admin

69
Q

atenolol (Tenormin) dosing

A

25-100mg BID - B1 selective

70
Q

carvedilol (Coreg) dosing

A

12.5-50mg BID - A1 inhib

71
Q

labetalol (Trandate/Normodyne) dosing

A

200-800mg BID - A1 inhib

72
Q

metoprolol (Lopressor/(Toprol XL) dosing

A

B1 selective
25-100mg QD
25-100mg BID

73
Q

hydrochlorothiazide dosing

A 
12.5mg/day = 85% max effect
25mg/day = 95% max effect
>25mg/day = same effect + more adverse effects
74
Q

non DHP CCB

A

verapamil (Calan), diltiazem (Cardizem) -

decreases HR, CO & contractility, ++ vasodilation

75
Q

captopril (Capoten) dosing

76
Q

diltiazem (Cardizem LA) dosing

A

Non DHP CCB

77
Q

hydralazine (Apresoline) dosing

A

direct acting vasodilator

78
Q

enalapril (Vasotec) dosing

A

ACE inhibitor

79
Q

prazosin (Minipress)

80
Q

verapamil (Calan, Isoptin) dosing

A

nonDHP CCB

81
Q

reserpine dosing

A

peripheral adrenergic inhibitor

82
Q

guanethidine (Ismeilin)

A

peripheral adrenergic inhibitor

83
Q

amlodipine (Norvasc)

Pharmacology (10 decks)

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