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CPRII > HTN/Shock > Flashcards

HTN/Shock Flashcards

1
Q

What does doxazosin increase risk for?

A

risk of stroke & CHF

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2
Q

What are alpha 1 antagonists primarily used for?

A

pts w/ BPH

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3
Q

What is the characteristic of urine excreted w/ max effective doses of furosemida?

A

urine is ISOTONIC

irrespective of plasma ADH levels

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4
Q

What should be promptly administered in cases of suspected septic shock?

A

antibiotics

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5
Q

What is a potential adverse effect of B blockers (esp if non selective like propranolol)?

A

bronchospasm

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6
Q

What cation is lost w/ loop & most w/ thiazide diuretics?

A

Mg

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7
Q

MOA, indication, adverse effects of CLONIDINE

A

alpha 2 adrenergic agonist

to lower BP (& for ADHF, pain via epidural)

AEs of drowsiness, xerostomia

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8
Q

What is the significance of remodeling of the vasculature?

A

increased wall to lumen ratio that leads to vasc stiffness & loss of parallel resistance

sustained increase in TPR in HTN

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9
Q

What must BP be for thrombolysis in stroke pt?

A

BP should be lowered to <185/110

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10
Q

What defines the setpoint of arterial blood pressure?

A

infinite gain relationship btwn Na+ intake & renal excretion of sodium

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11
Q

What co-transporter in the DCT further dilutes the tubular fluid and is targeted by THIAZIDE diuretics?

A

NaCl co-transporter

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12
Q

What alpha 2 agonist is drug of choice for gestational HTN?

A

methyldopa

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13
Q

What type of shock does NOT require a drug like NE?

A

blood loss (hypovolemic shock)

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14
Q

What is HTN urgency?

A

HTN w/ no evidence of end organ damage

conventional means to lower BP

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15
Q

What is the most common reason for discontinuing use of ACEi?

A

COUGH

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16
Q

What is obstructive shock?

A

something extrinsic to heart is physically disrupting CO (large PE or cardiac tamponade)

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17
Q

When is blood used in tx of shock?

A

if blood loss exceeds 30-40% when concern of Hct & clotting factor dilution becomes concern

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18
Q

What form of HTN is more common in elderly?

A

isolated systolic (when walls of blood vessels become stiff & less compliant)

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19
Q

What is the loop diuretic that can be used by pts w/ sulfa allergies?

A

ethacrynic acid

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20
Q

What are adverse effects of CCB use (esp verapamil & dilitazem)?

A

CONSTIPATION
facial flushing
HA
ankle edema

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21
Q

What is distributive shock?

A

loss of arterial vascular tone and/or too much venous capacitance for adequate venous return

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22
Q

What adrenergic receptors in brain reduce sympathetic outflow?

A

alpha 2 receptors

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23
Q

What greatly increases risk for HTN?

A

low socioeconomic status

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24
Q

How is renovascular HTN treated?

A

tx w/ RAS inhibitors (v cautiously) and statins

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25
Q

What improves outcome of SEPTIC shock?

A

corticosteroids

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26
Q

How does unilateral renal stenosis present?

A

lower post-stenosis renal perfusion pressure drives HIGH renin levels

high perfusion of contralateral kidney results in increased Na/H2O excretion

AngII dependent form of HTN (RAS blockade lowers BP & GFR in post-stenotic kidney)

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27
Q

When is phenylephrine administered?

A

an alpha1 agonist given if need for peripheral vasoconstriction when B1 stimulation causes arrhythmias or TPR remains low

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28
Q

What is major AE of loop and thiazide diuretics?

A

hyponatremia b/c excessive urinary loss of Na+

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29
Q

What is a potentially deadly consequence of suddenly stopping drugs like clonidine or propanolol?

A

rebound hypertension

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30
Q

How does pheocytomocytoma present?

A

causes resistant HTN w/ spells of HA, sweating, palpitations

excess of catecholamines

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31
Q

What stimulates B @ low dose & alpha @ higher doses?

A

dopamine

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32
Q

What is the MOA of amiloride?

A

diuretic that blocks epithelial Na+ channels in principal cells of collecting ducts

more rapid action compared to spironolactone

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33
Q

What is hyponatremia?

A

plasma Na+ conc <135

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34
Q

What is the most common electrolyte abnormality seen in clinical practice?

A

hyponatremia

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35
Q

What is lisinopril & its MOA?

A

ACEi w/ longer 1/2 life widely used to tx HTN

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36
Q

What is nebivolol & its MOA?

A

2nd line drug for tx of HTN

B blocker that also induces NO mediated vasodilation

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37
Q

How do loop and thiazide diuretics differ in risk of kidney stone formation?

A

loop diuretics INCREASE risk while thiazide diuretics DECERASE risk

b/c differing effects on Ca2+ reabsorption

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38
Q

What is an undesirable side effect of alpha1 blockers like prazosin?

A

retrograde ejaculation

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39
Q

What is contraindication for all drugs that interfere w/ RAS?

A

PREGNANCY (lethal to fetus)

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40
Q

What is the tx/management of aortic dissection?

A

HTN emergency when need RAPID lowering of SBP<140

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41
Q

What is cardiogenic shock?

A

due to cardiac arrhythmia, myocardial ischemia, heart valve failure

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42
Q

What is MOA & adverse effects of nitroprusside?

A

dilates arterial & venous circulation

given IV for immediate control of HTN

toxic cyanide & thiocyanate metabolites

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43
Q

When is NOT a good time to take a diuretic?

A

bedtime

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44
Q

What is MOA and indication of K+ sparing diuretics?

A

acts in collecting duct to block Na+/K+ exchange

counterbalance adverse effects of loop & thiazide diuretics

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45
Q

What are the primary agents to tx HTN?

A

Thiazide diuretics

ACEi, ARB

CCBs (dihydropyridines & non)

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46
Q

What is furosemide?

A

prototypical loop diuretic

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47
Q

What is hypovolemic shock?

A

shock due to extensive blood loss or extracellular fluid loss

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48
Q

How does bilateral renal stenosis present?

A

HTN due to initial surge in renin release from poor renal perfusion

results in volume expansion which decreases RAS

RAS blockers will lower BP once extracellular volume is contracted

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49
Q

What channels are directly blocked by amiloride & triamterence in collecting duct?

A

epithelial Na+ channels (ENaC)

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50
Q

What is a relatively fixed risk factor that is common cause of HTN?

A

obstructive sleep apnea

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51
Q

What is Stage 1 HTN?

A

HTN w/ SBP 130-139 or DBP 80-89

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52
Q

Which drugs are commonly administered IV in HTN emergencies?

A

nitroprusside, nicardipine & clevidipine (CCBs), esmolol (B blocker)

b/c of short 1/2 life

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53
Q

What commonly causes anaphylactic shock?

A

penicillin & cephalosporin

bee sting, peanuts, etc

54
Q

What is ALWAYS the first choice for tx of HTN?

A

non-pharmacological interventions

55
Q

Which transporter in TAL dilutes tubular fluid and is target of loop diuretics?

A

Na-K-2Cl

56
Q

What may preserve renal function during shock if given after saline?

A

diuretics

57
Q

What is bumetanide?

A

loop diuretic w/ similar AEs as furosemide

more predictable oral absorption

58
Q

What drug class is no longer used for tx of HTN?

A

B blockers

b/c other drugs more effective in protect v stroke, HF & MI

59
Q

What is a major reason to avoid non-dihydropyridine CCBs in tx HTN?

A

heart failure

60
Q

What is major adverse effect of B blocker as consequence of hyperK?

A

bradycardia

b/c increase K+ conductance in SA node leads to hyperpolarization (more potential for arrhythmias)

61
Q

What is MOA & indication of minoxidil?

A

causes profound arterial vasodilation in RESISTANT HTN

must also use diuretic & B blocker to avoid cardiac effusion or tamponade

62
Q

What is contraindication for B blockers in pts w/ peripheral vascular dz?

A

cold extremities

63
Q

What B1 blocker has the highest specificity for receptors?

A

bisoprolol

64
Q

What is released by mast cells when triggered by an IgE bound allergen?

A

histamine

65
Q

What unusual form of hyperplasia is seen with CCB use?

A

gingival hyperplasia

66
Q

When is HTN more likely to be secondary?

A

abrupt onset or worsening of HTN

67
Q

What is a long-acting thiazide diuretic favored by cardiologists as adjunt tx of CHF?

A

metolazone

68
Q

What is are modifiable risk factors for HTN?

A

smoking
DM
obesity

69
Q

How can you assess central venous pressure?

A

measure JVD

70
Q

What is the most widely used B1 blocker and its uses?

A

metoprolol

used for HTN & HF

71
Q

When does incidence of HTN markedly increase in women?

A

after menopause

72
Q

What is an indication of brain hypoperfusion?

A

coma

73
Q

What is the level of renin like in African American HTN pts?

A

LOW renin levels

74
Q

What is tx choice for HTN African Americans?

A

initial monotherapy w/ thiazide diuretics or CCB

75
Q

What ethnic group has highest incidence of HTN in US?

A

African Americans

76
Q

What does use of ACEi & ARBs increase in serum?

A

serum creatinine

not a concern if no hyperK

77
Q

What is triamterene & its MOA?

A

K+ sparing diuretic

blocks ENaC channels in collecting tubule

78
Q

What is MOA of phentolamine & phenoxybenzamine?

A

non-selective alpha adrenergic antagonists

poorly tolerated as antiHTN agents

79
Q

How can acidosis cause hyperK+?

A

b/c H+ exchanges w/ cellular K+

80
Q

What alpha/beta blocker is used for HTN emergencies?

A

labetalol

81
Q

What increases risk of gout in pts on loop & thiazide diuertics?

A

hyper uricemia

82
Q

What is a common occurrence in diabetic HTN and how is it tx?

A

albuminuria

use of ACEi or ARB to tx HTN

83
Q

What is notable about NSAIDs?

A

ability to increase BP

84
Q

What is Stage 2 HTN?

A

HTN w/ SBP>140 or DBP>90

85
Q

What is administered at 30mg/kg body weight in shock?

A

CRYSTALLOID

unless shock is cardiogenic

86
Q

What type of metabolic alkalosis is seen w/ thiazide & loop diuretics?

A

hypochloremic

due to secondary K+ loss

87
Q

What ultrashort acting dihydropyridine CCB is used for HTN emergency

A

clevidipine

88
Q

What is considered elevated BP?

A

BP if SBP is 120-129 & DBP<80

89
Q

What did hexamethonium and mecamylamine target for antiHTN tx?

A

autonomic ganglia

failed b/c many adverse effects

90
Q

What is an indication of kidney hypoperfusion?

A

oliguria

91
Q

What occurs when tissue lack oxygen?

A

acidosis (due to lactic acid buildup)

92
Q

What is a potentially severe adverse effect of alpha-adrenergic receptor blockage?

A

postural hypotension

93
Q

What aldosterone antagonist has greatest selectivity in its MOA?

A

eplerenone

94
Q

What is MOA and AEs of reserpine?

A

blocks incorporation of NE into synaptic vesicles for release

first drug to target SNS for antiHTN tx

AEs of depression & suicidal ideation

95
Q

What is vasopressin?

A

non-adrenergic vasoconstrictor used as adjunctive therapy in shock

96
Q

How are thiazide, loop, and osmotic diuretics classified?

A

K+ losing

97
Q

What is the AE assoc w/ effect of B blockers that enter CNS?

A

nightmares

98
Q

What is atenolol?

A

B1 selective blocker used to tx HTN

does NOT cross BBB but same systemic AEs

99
Q

What tends to be best inotropic/vasoconstrictor agent to tx shock?

A

norepenephrine (NE)

100
Q

How do you tx HTN emergency due to intracranial hemorrhage?

A

use IV drugs to lower BP<220

do NOT lower below 140 b/c causes harm

101
Q

What do OCPs cause?

A

increase BP

102
Q

What ECG changes are seen w/ hypokalemia?

A

shallow T waves w/ U wave on ECG (b/c most cell membranes are hyperpolarized)

caused by K+ losing diuretics

103
Q

What dihydropyridine CCB is primary drug choice for tx HTN?

A

amlodipine

104
Q

What loop diuretic has longer 1/2 life & better oral absorption than furosemide?

A

torsemide

105
Q

What is MOA of hydralazine & indication?

A

arterial vasodilator

used in HTN emergency (pre-eclampsia)

may cause drug induced SLE

106
Q

What is a potentially deadly adverse consequence of using ACEi or anaphylactic shock rxn?

A

angioedema

107
Q

What are thiazide diuretics used for?

A

hypertension

108
Q

What occurs w/ in cells when are anoxic?

A

edema

109
Q

What is an AE seen w/ anaphylactic shock tx w/ epi but NOT NE?

A

bronchoconstriction

110
Q

What is important property of Bblockers like pindolol?

A

ISA (partial agonists)

111
Q

What is aliskiren?

A

direct renin inhibitor w/ long 1/2 life

112
Q

Prevalence of HTN increases w/

A

age

113
Q

What is an issue w/ tx HTN w/ diuretics?

A

non-adherence to drugs (b/c urgent need to urinate)

114
Q

What is the common term for diuretic class w/ high ceiling effects exerted on TAL?

A

LOOP diuretics

115
Q

What is chlorthalidone?

A

thiazide diuretic w/ longer 1/2 life

favored by some HTN specialists b/c has CV benefits

116
Q

What do antidepressants, alcohol, and recreational drugs w/ sympathomimetic effects increase?

A

can increase blood pressure

117
Q

What is a frequent cause of secondary HTN assoc w/ hypoK?

A

primary aldosteronism

tx w/ spironolactone

118
Q

What are clinical signs of hypomagnesia? What is seen on ECG?

A

muscle weakness, tremors, tetany, seizures

Torsades de Points

119
Q

What is sudden onset hypoTN w/ start of antiHTN drugs?

A

first dose hypoTN

w/ ACEi, ARBs, alpha1 blockers

120
Q

What can be administered as adjunct therapy in pts w/ anaphylactic shock?

A

diphenhydramine

121
Q

What are primary target of K+ sparing drugs?

A

principal cells in collecting duct

122
Q

What does epinephrine stimulate?

A

alpha1, alpha2, beta1, beta2

123
Q

What can all pts w/ HTN benefit from?

A

LOW SALT diet

124
Q

Inhalation of this can relieve breathing problems assoc w/ anaphylatic shock?

A

albuterol

125
Q

What is a well known toxicity of loop diuretics?

A

ototoxicity

126
Q

What is MOA of dobutamine?

A

stimulates B1 in heart to increase CO

also stimulates peripheral B2 receptors

127
Q

What class IV antiarrhythmic CCB is used to tx HTN?

A

verapamil (b/c frequency dependence of action)

128
Q

What is the difference in action of thiazide & loop diuretics in terms of GFR?

A

thiazides do NOT work @ low GFRs but loops diuretics work @ low GFRs to tx HTN

129
Q

What is epinephrine reversal?

A

potentially lethal increase in BP when epi admin to someone taking a B blocker

130
Q

What is increased during early phase in septic shock?

A

increase in CO

due to fall in systemic vascular resistance

131
Q

Why should you still give B blockers in HTN?

A

for IHD tx

lower BP while also slowing HR or block reflex tachy assoc w/ dihydropyridine CCBs

CPRII (4 decks)

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