HTN/Shock Flashcards
What does doxazosin increase risk for?
risk of stroke & CHF
What are alpha 1 antagonists primarily used for?
pts w/ BPH
What is the characteristic of urine excreted w/ max effective doses of furosemida?
urine is ISOTONIC
irrespective of plasma ADH levels
What should be promptly administered in cases of suspected septic shock?
antibiotics
What is a potential adverse effect of B blockers (esp if non selective like propranolol)?
bronchospasm
What cation is lost w/ loop & most w/ thiazide diuretics?
Mg
MOA, indication, adverse effects of CLONIDINE
alpha 2 adrenergic agonist
to lower BP (& for ADHF, pain via epidural)
AEs of drowsiness, xerostomia
What is the significance of remodeling of the vasculature?
increased wall to lumen ratio that leads to vasc stiffness & loss of parallel resistance
sustained increase in TPR in HTN
What must BP be for thrombolysis in stroke pt?
BP should be lowered to <185/110
What defines the setpoint of arterial blood pressure?
infinite gain relationship btwn Na+ intake & renal excretion of sodium
What co-transporter in the DCT further dilutes the tubular fluid and is targeted by THIAZIDE diuretics?
NaCl co-transporter
What alpha 2 agonist is drug of choice for gestational HTN?
methyldopa
What type of shock does NOT require a drug like NE?
blood loss (hypovolemic shock)
What is HTN urgency?
HTN w/ no evidence of end organ damage
conventional means to lower BP
What is the most common reason for discontinuing use of ACEi?
COUGH
What is obstructive shock?
something extrinsic to heart is physically disrupting CO (large PE or cardiac tamponade)
When is blood used in tx of shock?
if blood loss exceeds 30-40% when concern of Hct & clotting factor dilution becomes concern
What form of HTN is more common in elderly?
isolated systolic (when walls of blood vessels become stiff & less compliant)
What is the loop diuretic that can be used by pts w/ sulfa allergies?
ethacrynic acid
What are adverse effects of CCB use (esp verapamil & dilitazem)?
CONSTIPATION
facial flushing
HA
ankle edema
What is distributive shock?
loss of arterial vascular tone and/or too much venous capacitance for adequate venous return
What adrenergic receptors in brain reduce sympathetic outflow?
alpha 2 receptors
What greatly increases risk for HTN?
low socioeconomic status
How is renovascular HTN treated?
tx w/ RAS inhibitors (v cautiously) and statins
What improves outcome of SEPTIC shock?
corticosteroids
How does unilateral renal stenosis present?
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)
When is phenylephrine administered?
an alpha1 agonist given if need for peripheral vasoconstriction when B1 stimulation causes arrhythmias or TPR remains low
What is major AE of loop and thiazide diuretics?
hyponatremia b/c excessive urinary loss of Na+
What is a potentially deadly consequence of suddenly stopping drugs like clonidine or propanolol?
rebound hypertension
How does pheocytomocytoma present?
causes resistant HTN w/ spells of HA, sweating, palpitations
excess of catecholamines
What stimulates B @ low dose & alpha @ higher doses?
dopamine
What is the MOA of amiloride?
diuretic that blocks epithelial Na+ channels in principal cells of collecting ducts
more rapid action compared to spironolactone
What is hyponatremia?
plasma Na+ conc <135
What is the most common electrolyte abnormality seen in clinical practice?
hyponatremia
What is lisinopril & its MOA?
ACEi w/ longer 1/2 life widely used to tx HTN
What is nebivolol & its MOA?
2nd line drug for tx of HTN
B blocker that also induces NO mediated vasodilation
How do loop and thiazide diuretics differ in risk of kidney stone formation?
loop diuretics INCREASE risk while thiazide diuretics DECERASE risk
b/c differing effects on Ca2+ reabsorption
What is an undesirable side effect of alpha1 blockers like prazosin?
retrograde ejaculation
What is contraindication for all drugs that interfere w/ RAS?
PREGNANCY (lethal to fetus)
What is the tx/management of aortic dissection?
HTN emergency when need RAPID lowering of SBP<140
What is cardiogenic shock?
due to cardiac arrhythmia, myocardial ischemia, heart valve failure
What is MOA & adverse effects of nitroprusside?
dilates arterial & venous circulation
given IV for immediate control of HTN
toxic cyanide & thiocyanate metabolites
When is NOT a good time to take a diuretic?
bedtime
What is MOA and indication of K+ sparing diuretics?
acts in collecting duct to block Na+/K+ exchange
counterbalance adverse effects of loop & thiazide diuretics
What are the primary agents to tx HTN?
Thiazide diuretics
ACEi, ARB
CCBs (dihydropyridines & non)
What is furosemide?
prototypical loop diuretic
What is hypovolemic shock?
shock due to extensive blood loss or extracellular fluid loss
How does bilateral renal stenosis present?
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
What channels are directly blocked by amiloride & triamterence in collecting duct?
epithelial Na+ channels (ENaC)
What is a relatively fixed risk factor that is common cause of HTN?
obstructive sleep apnea
What is Stage 1 HTN?
HTN w/ SBP 130-139 or DBP 80-89
Which drugs are commonly administered IV in HTN emergencies?
nitroprusside, nicardipine & clevidipine (CCBs), esmolol (B blocker)
b/c of short 1/2 life
What commonly causes anaphylactic shock?
penicillin & cephalosporin
bee sting, peanuts, etc
What is ALWAYS the first choice for tx of HTN?
non-pharmacological interventions
Which transporter in TAL dilutes tubular fluid and is target of loop diuretics?
Na-K-2Cl
What may preserve renal function during shock if given after saline?
diuretics
What is bumetanide?
loop diuretic w/ similar AEs as furosemide
more predictable oral absorption
What drug class is no longer used for tx of HTN?
B blockers
b/c other drugs more effective in protect v stroke, HF & MI
What is a major reason to avoid non-dihydropyridine CCBs in tx HTN?
heart failure
What is major adverse effect of B blocker as consequence of hyperK?
bradycardia
b/c increase K+ conductance in SA node leads to hyperpolarization (more potential for arrhythmias)
What is MOA & indication of minoxidil?
causes profound arterial vasodilation in RESISTANT HTN
must also use diuretic & B blocker to avoid cardiac effusion or tamponade
What is contraindication for B blockers in pts w/ peripheral vascular dz?
cold extremities
What B1 blocker has the highest specificity for receptors?
bisoprolol
What is released by mast cells when triggered by an IgE bound allergen?
histamine
What unusual form of hyperplasia is seen with CCB use?
gingival hyperplasia
When is HTN more likely to be secondary?
abrupt onset or worsening of HTN
What is a long-acting thiazide diuretic favored by cardiologists as adjunt tx of CHF?
metolazone
What is are modifiable risk factors for HTN?
smoking
DM
obesity
How can you assess central venous pressure?
measure JVD
What is the most widely used B1 blocker and its uses?
metoprolol
used for HTN & HF
When does incidence of HTN markedly increase in women?
after menopause
What is an indication of brain hypoperfusion?
coma
What is the level of renin like in African American HTN pts?
LOW renin levels
What is tx choice for HTN African Americans?
initial monotherapy w/ thiazide diuretics or CCB
What ethnic group has highest incidence of HTN in US?
African Americans
What does use of ACEi & ARBs increase in serum?
serum creatinine
not a concern if no hyperK
What is triamterene & its MOA?
K+ sparing diuretic
blocks ENaC channels in collecting tubule
What is MOA of phentolamine & phenoxybenzamine?
non-selective alpha adrenergic antagonists
poorly tolerated as antiHTN agents
How can acidosis cause hyperK+?
b/c H+ exchanges w/ cellular K+
What alpha/beta blocker is used for HTN emergencies?
labetalol
What increases risk of gout in pts on loop & thiazide diuertics?
hyper uricemia
What is a common occurrence in diabetic HTN and how is it tx?
albuminuria
use of ACEi or ARB to tx HTN
What is notable about NSAIDs?
ability to increase BP
What is Stage 2 HTN?
HTN w/ SBP>140 or DBP>90
What is administered at 30mg/kg body weight in shock?
CRYSTALLOID
unless shock is cardiogenic
What type of metabolic alkalosis is seen w/ thiazide & loop diuretics?
hypochloremic
due to secondary K+ loss
What ultrashort acting dihydropyridine CCB is used for HTN emergency
clevidipine
What is considered elevated BP?
BP if SBP is 120-129 & DBP<80
What did hexamethonium and mecamylamine target for antiHTN tx?
autonomic ganglia
failed b/c many adverse effects
What is an indication of kidney hypoperfusion?
oliguria
What occurs when tissue lack oxygen?
acidosis (due to lactic acid buildup)
What is a potentially severe adverse effect of alpha-adrenergic receptor blockage?
postural hypotension
What aldosterone antagonist has greatest selectivity in its MOA?
eplerenone
What is MOA and AEs of reserpine?
blocks incorporation of NE into synaptic vesicles for release
first drug to target SNS for antiHTN tx
AEs of depression & suicidal ideation
What is vasopressin?
non-adrenergic vasoconstrictor used as adjunctive therapy in shock
How are thiazide, loop, and osmotic diuretics classified?
K+ losing
What is the AE assoc w/ effect of B blockers that enter CNS?
nightmares
What is atenolol?
B1 selective blocker used to tx HTN
does NOT cross BBB but same systemic AEs
What tends to be best inotropic/vasoconstrictor agent to tx shock?
norepenephrine (NE)
How do you tx HTN emergency due to intracranial hemorrhage?
use IV drugs to lower BP<220
do NOT lower below 140 b/c causes harm
What do OCPs cause?
increase BP
What ECG changes are seen w/ hypokalemia?
shallow T waves w/ U wave on ECG (b/c most cell membranes are hyperpolarized)
caused by K+ losing diuretics
What dihydropyridine CCB is primary drug choice for tx HTN?
amlodipine
What loop diuretic has longer 1/2 life & better oral absorption than furosemide?
torsemide
What is MOA of hydralazine & indication?
arterial vasodilator
used in HTN emergency (pre-eclampsia)
may cause drug induced SLE
What is a potentially deadly adverse consequence of using ACEi or anaphylactic shock rxn?
angioedema
What are thiazide diuretics used for?
hypertension
What occurs w/ in cells when are anoxic?
edema
What is an AE seen w/ anaphylactic shock tx w/ epi but NOT NE?
bronchoconstriction
What is important property of Bblockers like pindolol?
ISA (partial agonists)
What is aliskiren?
direct renin inhibitor w/ long 1/2 life
Prevalence of HTN increases w/
age
What is an issue w/ tx HTN w/ diuretics?
non-adherence to drugs (b/c urgent need to urinate)
What is the common term for diuretic class w/ high ceiling effects exerted on TAL?
LOOP diuretics
What is chlorthalidone?
thiazide diuretic w/ longer 1/2 life
favored by some HTN specialists b/c has CV benefits
What do antidepressants, alcohol, and recreational drugs w/ sympathomimetic effects increase?
can increase blood pressure
What is a frequent cause of secondary HTN assoc w/ hypoK?
primary aldosteronism
tx w/ spironolactone
What are clinical signs of hypomagnesia? What is seen on ECG?
muscle weakness, tremors, tetany, seizures
Torsades de Points
What is sudden onset hypoTN w/ start of antiHTN drugs?
first dose hypoTN
w/ ACEi, ARBs, alpha1 blockers
What can be administered as adjunct therapy in pts w/ anaphylactic shock?
diphenhydramine
What are primary target of K+ sparing drugs?
principal cells in collecting duct
What does epinephrine stimulate?
alpha1, alpha2, beta1, beta2
What can all pts w/ HTN benefit from?
LOW SALT diet
Inhalation of this can relieve breathing problems assoc w/ anaphylatic shock?
albuterol
What is a well known toxicity of loop diuretics?
ototoxicity
What is MOA of dobutamine?
stimulates B1 in heart to increase CO
also stimulates peripheral B2 receptors
What class IV antiarrhythmic CCB is used to tx HTN?
verapamil (b/c frequency dependence of action)
What is the difference in action of thiazide & loop diuretics in terms of GFR?
thiazides do NOT work @ low GFRs but loops diuretics work @ low GFRs to tx HTN
What is epinephrine reversal?
potentially lethal increase in BP when epi admin to someone taking a B blocker
What is increased during early phase in septic shock?
increase in CO
due to fall in systemic vascular resistance
Why should you still give B blockers in HTN?
for IHD tx
lower BP while also slowing HR or block reflex tachy assoc w/ dihydropyridine CCBs
