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Rx Prep > HTN - Quiz 3 > Flashcards

HTN - Quiz 3 Flashcards

1
Q

What is the difference between primary and secondary HTN?

A

Primary: unknown with combination of RF
Secondary: identifiable underlying cause

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2
Q

HTN includes the activation of ___ and ___?

A

SNS and RAAS

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3
Q

Describe the components of the RAAS system?

A
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4
Q

Drugs that can increase BP?

A

Increased sympathomimetic activity: ADHD drugs, recreational, antidepressants
Increased sodium and water retention: NSAIDs, immunosuppressants, systemic steroids
Increased blood viscosity: ESAs
Oral contraceptives, VGEF inhibitors

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5
Q

How is HTN diagnosed?

A

Based on the average of at least 2 readings on 2 separate occasions

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6
Q

What is normal BP?

A

<120/80

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7
Q

What is elevated BP?

A

SBP 120-129 and DBP <80

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8
Q

What is stage 1 HTN?

A

SBP 130-139 or DBP 80-89

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9
Q

What is stage 2 HTN?

A

SBP≥140 or DBP ≥90

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10
Q

Lifestyle management for HTN?

A
  1. Weight loss
  2. DASH diet
  3. Potassium intake
  4. Reduced sodium intake (<1500 mg QD)
  5. Physical activity
  6. Limited alcohol (≤1 drink QD for women, ≤2 drinks QD for men)
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11
Q

Natural products used for HTN?

A
  1. Garlic oil
  2. Fish oil
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12
Q

What are the preferred regimens for adherence?

A

QD regimens or combo products

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13
Q

When do you treat stage 1 HTN?

A

SBP 130-139 or DBP 80-89 and one of the following:
1. Clinical CVD
2. 10 yr ASCVD risk ≥10%
3. Hasn’t met BP goals after 6 months of lifestyle mods

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14
Q

When do you treat stage 2 HTN?

A

SBP≥140 or DBP ≥90

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15
Q

What is BO goal?

A

<130/80

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16
Q

What are the preferred drug classes?

A
  1. THiazides
  2. DHP CCB
  3. ACE
  4. ARBs
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17
Q

Preferred agents for CKD?

A
  1. ACEI
  2. ARBs
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18
Q

When do you start a second drug?

A

BP >20/10 above goal

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19
Q

What anti-HTN has fetal toxicity?

A
  1. ACEI
  2. ARBs
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20
Q

Anti-HTN used for pregnancy?

A
  1. Labetalol
  2. Nifedipine ER
  3. Methyldopa
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21
Q

Medication given to those at risk for preeclampsia?

A

Daily low-dose aspirin after first trimester

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22
Q

Lisinopril/HCTZ

A

Zestoretic

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23
Q

Losartan/HCTZ

A

Hyzaar

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24
Q

Olmesartan/HCTZ

A

Benicar HCT

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25
Q

Valsartan/HCTZ

A

Diovan HCT

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26
Q

Benazepril/Amlodipine

A

Lotrel

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27
Q

Valsartan/Amlodipine

A

Exforge

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28
Q

Atenolol/Chlorthalidone

A

Tenoretic

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29
Q

Bisoprolol/HCTZ

A

Ziac

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30
Q

Triamterene/HCTZ

A

Maxzide-25

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31
Q

Chlorthalidone

A

Thalitone

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31
Q

MOA for thiazides?

A

Inhibit sodium reabsoprtion in the DCT leading to the increased excretion of sodium, chloride, water, and potassium

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32
Q

HCTZ

A

Hydrodiuril

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33
Q

Dose of chlrothalidone?

A

12.5-25mg QD

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34
Q

Dose of HCTZ?

A

12.5-50mg QD

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35
Q

Chlorothiazide

A

Diuril

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36
Q

CI for thiazides?

A

Sulfonamide hypersensitivity
* Exacerbations of SLE, gout, dyslipidemia, diabetes

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37
Q

ADRs of thiazides?

A

Decreased: K, Mg, Na
Increased: Ca, UA, LDLD, TG, BG
Photosensitivity

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38
Q

Administration of thiazides?

A
  1. Take early in the morning to avoid nocturia
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39
Q

What is the only thiazed available as IV?

A

Chlorothiazide

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40
Q

What thiazide is considered the most effective at lowering BP due to longer DOA and increased potency?

A

Chlorothalidone

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41
Q

MOA of DHP CCBs?

A

More selective for vascular smooth muscle causing peripheral arterial vasodilation

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42
Q

ADRs of DHP CCBs?

A
  1. Peripheral edema
  2. HA
  3. Palpitations
  4. Flushing
  5. Reflex tachycardia
  6. Gingivial hyperplasia
  7. Hypotension
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43
Q

Amlodipine

A

Norvasc

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44
Q

Nicardipine

A

Cardene IV

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45
Q

Nifedipine

A

Procardia XL, Adalat CC

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46
Q

Clevidipine

A

Cleviprex

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47
Q

IV DHP CCBs

A

Nicardipine, Clevidipine

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48
Q

DHP CCB drug of choice in pregnancy? HFrEF?

A

Nifedipine ER (Procardia XL)
Amlodipine

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49
Q

CI of clevidipine?

A

Allergy to soy and eggs

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50
Q

ADRs specific to clevidipine?

A
  1. Hypotension
  2. Reflex tachycardia
  3. Infections
  4. Hypertriglyceridemia
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51
Q

How many kcal are in clevidipine?

A

2kcal/mL

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52
Q

How should you administered clevidipine?

A

Use strict aseptic technique due to infection risk; maximum time of use after vial puncture is 12 hrs

53
Q

MOA of non-DHP CCBs?

A

Control HR in arrhythmias
* Sometimes used for HTN and chronic stable and vasospastic angina

54
Q

Examples of thiazides?

A
  1. Chlorthalidone
  2. HCTZ
  3. Chlorothiazide
  4. Indapamide
  5. Metolazone
55
Q

DHP CCB examples?

A
  1. Amlodipine
  2. Nicardipine
  3. Nifedipine
  4. Clevidipine
56
Q

Non-DHP examples?

A
  1. Diltiazem
  2. Verapamil
57
Q

Diltiazem

A

Cardizem, Tiazac

58
Q

Verapamil

59
Q

ADR of Non-DHP CCBs?

A
  1. HF may worsen
  2. Bradycardia
  3. Constipation (verapamil)
  4. Gingival hyperplasia
60
Q

Enzyme that metabolized Non-DHP?

A

CYP3A4
* They are inhibitors as well

61
Q

Statins that are metabolized by CYP3A4? Which are safe with Non-DHP?

A

Simvastatin, lovastatin, atorvastatin, fluvastatin

Pitavastatin, pravastatin, rosuvastatin

62
Q

MOA of ACEIs?

A

Blocks the conversion of AngI to AngII to decrease vasoconstriction and aldosterone secretion

63
Q

Why is coughing a sx of ACEIs?

A

Blocks the degradation of bradykinins

64
Q

CI of ACEis?

A
  1. Risk for angioedema
  2. Within 36hrs of entresto
65
Q

ADR of ACEis?

A
  1. Angioedema
  2. Hyperkalemia
  3. Hypotension
  4. Renal impairment (bilateral renal artery stenosis)
  5. Cough
66
Q

Types of ACEIs?

A
  1. Benazepril
  2. EnalaprilLisinopril
  3. Quinapril
  4. Ramipril
67
Q

Benazepril

68
Q

Enalapril

69
Q

Enalaprilat

A

Vasotec IV

70
Q

Lisinopril

71
Q

Quinapril

72
Q

Ramipril

73
Q

MOA of ARBs?

A

Block AngII form binding to AT1 receptor on vascular smooth muscle preventing vasoconstriction, prevents aldosterone secretion

74
Q

How are the benefits of using ARBs over ACEIs?

A
  1. Less cough
  2. Less angioedema
  3. No washout period with Entresto
75
Q

Types of ARBs?

A
  1. Irbesartan
  2. Losartan
  3. Olmesartan
  4. Valsartan
76
Q

Irbesartan

77
Q

Losartan

78
Q

Olmesartan

79
Q

Valsartan

80
Q

ADRs specific to ARBs?

A
  1. Sprue-like enteropathy (olmesartan)
  2. Diarrhea with weight loss
81
Q

What is the only renin inhibitor?

82
Q

Aliskirin

83
Q

Electrolyte imbalance associated with RAAS inhibitors?

A

Hyperkalemia

84
Q

Where do K-sparing diuretics act?

A

Late DCT and collecting duct

85
Q

When are K-sparing diurectics used?

A

Preferred add-on drugs for resistant HTN

86
Q

K-sparing diuretics examples?

A
  1. Spironolactone
  2. Triamterene
  3. Ailoride
  4. Aplerenone
87
Q

Spironolactone

88
Q

Triamterene

89
Q

Eplerenone

90
Q

CI for K-sparing?

A
  1. Hyperkalemia >5.5
  2. Severe renal impairment
  3. Addison’s dx
91
Q

ADRs of K-sparing?

A
  1. Hyperkalemia
  2. Increase sCr
  3. DZ
92
Q

Why do Spironolactone have unique ADRs?

A

Non-selective antagonsist
* Gynecomastia
* Breast tenderness
* Impotence

93
Q

When are beta-blockers recommended for HTN?

A
  1. Post-MI
  2. Stable angina
  3. HF
94
Q

Beta blockers used for HFrEF?

A
  1. Bisoprolol
  2. Carvedilol
  3. Metoprolol succinate
95
Q

Beta-1 sective blockers?

A
  1. Atenolol
  2. Metoprolol
  3. Esmolol
  4. Bisoprolol
  5. Betaxolol
  6. Acebutolol

AMEBBA

96
Q

Atenolol

97
Q

Esmolol

98
Q

Metoprolol

A

Lopressor, Toprol XL

99
Q

BBW for beta-1 selective blockers?

A

Don’t DC abruptly (taper dose)

100
Q

ADRs of beta-1 selective blockers?

A
  1. Bradycardia
  2. Hypotension
  3. CNS effects (fatigue, dz, depression)
  4. impotence
  5. exacerbate Raynauds
  6. Exacerbate asthma, COPD
  7. Mask hypoglycemia
101
Q

How do you administer metoprolol?

A

Taken with or immediately following food
* Metoprolol tartrate IV to PO (1:2.5)
* Toprol XL can be cut in half

102
Q

How is nebivolol different from other beta 1 selective blockers?

A

Has nitric oxide vasodilation

103
Q

Types of non-selective beta blockers?

A
  1. Propranolol
  2. Naolol
104
Q

Nebivolol

105
Q

Propranolol

A

Inderal LA, XL

106
Q

Nadolol

107
Q

CI for nonselective beta blockers?

A

Bronchial asthma

108
Q

Indications for propranolol?

A

Highly lipid solubility
* Migraine prophylaxis -> CNS ADRs
* Portal HTN

109
Q

Non selective beta blockers and alpha-1 blockers?

A

Carvedilol (Coreg)
Labetalol (Normadyne)

110
Q

Administration of carvedilol?

A

Take all forms with food

111
Q

MOA of a2 agonists?

A

Stimulates presynaptic a2 adrenergic receptors in the brain that decreases sympathetic outflow of NE

112
Q

Carvedilol

113
Q

Labetalol

114
Q

Types of a2 agonsits?

A
  1. Clonidine
  2. Guanfacine
  3. Methyldopa
115
Q

Clonidine brand names

A

Patch: Catapress TTS QW
Kapvay: ADHD

116
Q

Guanfacine brand names?

A

ER (Intuniv)
IR

117
Q

ADRs of clonidine and guanfacine?

A
  1. Rebound hypertension (must taper)
  2. Dry mouth
  3. Somnolence
  4. Fatigue
  5. DZ
  6. Constipation
  7. Bradycardia
  8. Hypotension
  9. Impotence

Patch: skin rash, pruritus, erythema

118
Q

How do you administer clonidine patch?

A

QW
* Remove MRI

119
Q

CI of methyldopa?

A

MOAI
Hemolytic anemia

120
Q

ADR of methyldopa?

121
Q

Direct vasodilators used for HTN?

A
  1. Hydralazine
  2. Minoxidil
122
Q

ADRs of hydralazine?

A
  1. DILE
  2. Peripheral edema
  3. HA
  4. Palpitiations
  5. Reflex tachycardia
123
Q

ADRs of minoxidil?

A
  1. Potent VD
  2. Harigrowth
  3. Tachycardia
  4. Fluid retention
124
Q

When are alpha blockers used for HTN?

A

Men with BPH and HTN

125
Q

What is HTN crisis?

A

> 180/120 that is life threatening

126
Q

DX states that can lead to HTN emergency?

A
  1. acute target organ damage
  2. Encephalopathy
  3. Stroke
  4. AKI
  5. ACS
127
Q

How do you treat HTN emergency?

A
  1. IV medications
  2. Decrease BP by no more than 25% (within 1st hr), then stable, decrease to 160/100 in next 2-6hrs
128
Q

How do you treat HTN urgency?

A
  1. Short acting PO meds
  2. Decrease BP gradually over 24-48hrs
129
Q

IV HTN medications for emergencies?

A
  1. Clevidipine
  2. Enalaprilat
  3. Esmolol
  4. Hydralazine
  5. Labetalol
  6. Nicardipine
  7. Nitroglycerin
  8. Nitroprusside
130
Q

Anti-HTN that has a ghost tablet?

A

Procardia XL

Rx Prep (15 decks)

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