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Pharm CPR > HTN Urgency/Emergency > Flashcards

HTN Urgency/Emergency Flashcards

1
Q

What is the renin level of most causes of primary hypertension?

A

Normal

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2
Q

Which drug do we want to avoid if you have renal artery stenosis?

A

ARBs and ACEi and direct renin inhibitor:

but can help preserve renal function in diabetics

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3
Q

If you have hx of angioedema do not use these drugs

A

ACEi and ARBs

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4
Q

Do we give ACE or ARB during pregnancy?

A

no

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5
Q

We have HFrEF, what do we not give?

A

CCB dihydropyridines

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6
Q

What do we not give with nondihydropyridine CCBs?

A

B blockers because too much bradycardia

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7
Q

If you have thiazide therapy, what can we give to minimize side effects?

A

K+ sparing diuretics like amiloride and triamterone

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8
Q

Do we want to give loops or thiazides first?

A

Loops, better

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9
Q

A patient has CKD, what do we not give?

A

K+ sparing diuretics like amiloride and triamterone

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10
Q

What do we avoid when giving aldosterone antagonists?

A

K+ sparing meds/diuretics

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11
Q

Preferred agents in primary aldosteronism and resistant hypertension

A

Aldosterone antagonists like spironolactone and epleronone

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12
Q

A patient has HFrEf what do we give?

A

Bisoprolol and metoprolol

Carvedilol preferred

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13
Q

Beta blockers are not first line unless..

A

ischemic heart disease or heart failure

UNLESS partial beta blockers, do NOT give if you have these (pindolol, acebutolol)

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14
Q

Nebivolol induces…

A

NO induced vasodilation

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15
Q

What drugs are associated with orthostatic hypotension?

A

Alpha-1 blocker, second line agents for benign prostatic hyperplasia

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16
Q

Why do we not want to abruptly stop clonidine?

A

Induces hypertensive crisis, must taper to avoid rebound hypertension

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17
Q

This drug is associated with hirsutism and induces pericardial effusion

A

Minoxidil

18
Q

What drugs are direct vasodilators and what are the side effects associated with this? How do we treat?

A

Sodium and water retention with reflex tachycardia so use with a diuretic and beta blocker

The drugs are hydralazine and minoxidil

19
Q

What makes HCTZ not effective?

A

Low GFR

20
Q

What is amiloride used for?

A

Counteracting K+ loss induced by other diuretics treating HTN or heart failure… however can cause hyperkalemia

21
Q

What rises due to ACEi?

A

Serum creatinine increases and GFR falls

22
Q

Is ACEi used in pregnancy?

A

NO, really bad

23
Q

What drops hypertensive vascular remodeling?

A

ACEi, ARB, CCB

24
Q

This drug causes gingival hyperplasia and pulm. HTN

A

Nifedipine

25
Q

Explain the difference between nifedipine and verapamil /diltiazem?

A

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

26
Q

What drug can we give to help pass kidney stones?

A

Tamsulosin, Terazosin

27
Q

What are the side effects of clonidine?

A

Drowsiness, xerostomia, REBOUND HTN IF DOSE IS MISSED, urinary/sexual dysfunction

28
Q

What is the best drug for gestational hypertension?

A

Alpha methyldopa

29
Q

What are the 3 toxicities of methyldopa?

A

Positive Coombs test, SLE syndrome, Bell’s palsy

30
Q

Beta blockers cause cold extremities… this leads to the contraindication for?

A

PVD

31
Q

What are the unfortunate side effects of metoprolol compared to other B1 selective blockers?

A

CNS effects like lethargy and confusion, nightmares

32
Q

When would we get rebound hypertension with medications?

A

Alpha 2 agonist or B blocker stopped abruptly

33
Q

Why don’t we use B blockers as often now?

A

Higher risk of stroke and doesn’t really help prevent MI

34
Q

What are the 3 drugs that activate the NO/guanylate pathway?

A

Hydralazine, Nitroglycerin, Nitroprusside

35
Q

What are the 3 syndromes associated with renovascular HTN?

A
  1. Flash PE
  2. Progressive renal failure
  3. Refractory congestive cardiac failure

This all suggest B/L involvement

36
Q

Do we do renal revascularization on patients with stenosis?

A

Nah, doesn’t recover renal function and no better than drugs that block RAS and statin therapy

37
Q

Patient has egg, soy product allergy and lipid issues. What drug do we not give?

A

Clevidipine

38
Q

Fenoldapam is contraindicated when?

A

Glaucoma or intracranial pressure is high or sulfite allergy

39
Q

Why is hydralazine not a desirable first line agent?

A

Unpredictable and prolonged action duration

40
Q

Do not give nitro to…

A

Volume depleted patients

Pharm CPR (9 decks)

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