HTN Urgency/Emergency Flashcards
What is the renin level of most causes of primary hypertension?
Normal
Which drug do we want to avoid if you have renal artery stenosis?
ARBs and ACEi and direct renin inhibitor:
but can help preserve renal function in diabetics
If you have hx of angioedema do not use these drugs
ACEi and ARBs
Do we give ACE or ARB during pregnancy?
no
We have HFrEF, what do we not give?
CCB dihydropyridines
What do we not give with nondihydropyridine CCBs?
B blockers because too much bradycardia
If you have thiazide therapy, what can we give to minimize side effects?
K+ sparing diuretics like amiloride and triamterone
Do we want to give loops or thiazides first?
Loops, better
A patient has CKD, what do we not give?
K+ sparing diuretics like amiloride and triamterone
What do we avoid when giving aldosterone antagonists?
K+ sparing meds/diuretics
Preferred agents in primary aldosteronism and resistant hypertension
Aldosterone antagonists like spironolactone and epleronone
A patient has HFrEf what do we give?
Bisoprolol and metoprolol
Carvedilol preferred
Beta blockers are not first line unless..
ischemic heart disease or heart failure
UNLESS partial beta blockers, do NOT give if you have these (pindolol, acebutolol)
Nebivolol induces…
NO induced vasodilation
What drugs are associated with orthostatic hypotension?
Alpha-1 blocker, second line agents for benign prostatic hyperplasia
Why do we not want to abruptly stop clonidine?
Induces hypertensive crisis, must taper to avoid rebound hypertension
This drug is associated with hirsutism and induces pericardial effusion
Minoxidil
What drugs are direct vasodilators and what are the side effects associated with this? How do we treat?
Sodium and water retention with reflex tachycardia so use with a diuretic and beta blocker
The drugs are hydralazine and minoxidil
What makes HCTZ not effective?
Low GFR
What is amiloride used for?
Counteracting K+ loss induced by other diuretics treating HTN or heart failure… however can cause hyperkalemia
What rises due to ACEi?
Serum creatinine increases and GFR falls
Is ACEi used in pregnancy?
NO, really bad
What drops hypertensive vascular remodeling?
ACEi, ARB, CCB
This drug causes gingival hyperplasia and pulm. HTN
Nifedipine
Explain the difference between nifedipine and verapamil /diltiazem?
Nifedipine binds to inactivated state to keep it from becoming open so it is voltage-dependent so tissues that are more depolarized are more effected like arterial blood vessels
Verapamil (inside), diltiazem (outside) are use/frequency dependent because bind to swinging gate so target channels that cycle regularly like myocardium, faster means more block
KEY: Nifedipine exerts smaller inotropic effects on the myocardium and no chronotropic effects but larger vasodilatory effects, HR and CO are increased because of reflex SNS
What drug can we give to help pass kidney stones?
Tamsulosin, Terazosin
What are the side effects of clonidine?
Drowsiness, xerostomia, REBOUND HTN IF DOSE IS MISSED, urinary/sexual dysfunction
What is the best drug for gestational hypertension?
Alpha methyldopa
What are the 3 toxicities of methyldopa?
Positive Coombs test, SLE syndrome, Bell’s palsy
Beta blockers cause cold extremities… this leads to the contraindication for?
PVD
What are the unfortunate side effects of metoprolol compared to other B1 selective blockers?
CNS effects like lethargy and confusion, nightmares
When would we get rebound hypertension with medications?
Alpha 2 agonist or B blocker stopped abruptly
Why don’t we use B blockers as often now?
Higher risk of stroke and doesn’t really help prevent MI
What are the 3 drugs that activate the NO/guanylate pathway?
Hydralazine, Nitroglycerin, Nitroprusside
What are the 3 syndromes associated with renovascular HTN?
- Flash PE
- Progressive renal failure
- Refractory congestive cardiac failure
This all suggest B/L involvement
Do we do renal revascularization on patients with stenosis?
Nah, doesn’t recover renal function and no better than drugs that block RAS and statin therapy
Patient has egg, soy product allergy and lipid issues. What drug do we not give?
Clevidipine
Fenoldapam is contraindicated when?
Glaucoma or intracranial pressure is high or sulfite allergy
Why is hydralazine not a desirable first line agent?
Unpredictable and prolonged action duration
Do not give nitro to…
Volume depleted patients