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SHPCPJEN5 > HTN2 > Flashcards

HTN2 Flashcards

1
Q

Thiazides increase and decrease what electrolytes

What pregnancy category

A

↓Na
↓Cl
↓K
↓Mg
↑
&

↑Ca
↑Uric acid

Thiazides also increase glucose and lipids. Can cause sexual dysfunction, sulfa rash , photosensitivity

Pregnancy category B

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2
Q

Loops and electrolytes

A

↓Na
↓Cl
↓K
↓Mg ↓
↑
&

↓Ca
↑Uric

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3
Q

Loops vs thiazides and Ca

A

Thiazides increase calcium

Loops decrease calcium

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4
Q

Epogen tacrolimus ( prograf ) , cyclosporine are increase BP

A

T

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5
Q

Normal BMI

A

18.5 to 24.9

Goal of BMI < 25 if you have HTN

Physical activity
< 2 drinks per day for men < 1 for women

Increase potassium 4.7 per day in DASH
Decrease sodium < 2.4

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6
Q

Black patient with CAD

A

CCB or thiazide diuretic initially mono therapy

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7
Q

Low risk CAD HTN med

Goal BP

A

Thiazide ace arb CCB ( most often DHP like amlodipine )

BB not recommended for intial tx of uncomplicated HTN

< 130/ <80

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8
Q

Patient with ( not low risk ) CAD and HTN

A

Meds: BB first line ( improve outcomes )

BB improve outcomes in angina, systolic HF and after a heart attack

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9
Q

CFH BB meds

Goal BP

A

Goal <130 / 80 if possible < 120 < 80

1) low dose BB
2) ACE I / ARB
3) entresto ( Neprilysin inhibitor ( sacubitril ) + valsartan )
4) aldosterone antagonist ( aldactone & inspra )

Loops for CHF symptoms

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10
Q

Non- dihydropyridines

A

Verapamil + diltiazem

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11
Q

Dihydropyridines

A

Amlodipine

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12
Q

Thiazides work on part of nephron

A

Proximal DCT
HCTZ ( microzide)
Chlorothiazide ( diuril)

And thiazide like dirutiecs
Chlorthalidone
Indapamide ( Lozol )
Metolazone ( zaroxyln)

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13
Q

Loops work on what part of nephron?

A

Thick ascending limb of loop of henle

Bumex - bumetanide
Ethacyric acid ( edecrin)
Furosemide ( lasix )
Torsemide ( demadex)

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14
Q

K+ sparing diuretics work on what part of nephron?

A

Distal DCT & works on collecting ducts

Amiloride ( Midamor )
Triamterene ( dyrenium )
Spironolactone ( aldactone )
Eplerenone ( inspra )

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15
Q

What cr cl is thiazide ineffective?

A

CrCl < 30

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16
Q

DDI thiazide and lithium?

A

Decrease Na and that will increase lithium : Li toxicity

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17
Q

DDI thiazide and digoxin?

A

Decreases K + and Mg : that will causes digoxin toxicity

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18
Q

Allopurinol and HCTZ?

A

Hypersensitivity risk increased

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19
Q

Chlorthalidone benefit vs HCTZ

A

Longer acting than HCTZ and more potent

Once a day dosing

HCTZ can be qd to bid dosing

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20
Q

What is the only loop without a sulfa group

A

Edecrin

Ethacrynic acid

Drawback edecrin causes more ototoxcity than other loops

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21
Q

What is the only loop with a sulfa group

A

Edecrin

Ethacrynic acid

Drawback edecrin causes more ototoxcity than other loops

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22
Q

Bumex
max dosing
1 mg

1mg bumex = __ furosemide

A

bumetanide
10 mg max per day

Comes IV IM and oral

1mg oral bumetanide = 40 mg oral furosemide
1mg IV bumetanide = 20 mg IV furosemide

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23
Q

Potassium sparing diuretics

A

Amiloride ( midamor )
Triamterene ( Dyrenium )

Spironolactone ( aldactone ) —-[ aldosterone antagonist ]
Eplerenone ( Inspra ) ————- [ aldosterone antagonist ]

24
Q

Potassium sparing diuretics are usually not used alone

A

T

Used with thiazides( ↓K) , loop diuretics ( ↓K ) or digoxin to reduce chance of hypokalemia

25
Q

Loop diuretic DDI with lithium ?

A

Yes increase lithium toxicity bc decrease sodium

Loop also has a DDI with digoxin —> digoxin toxicity is exacerbated by hypokalemia

26
Q

Sprinolactone chemically resembles some sex steroids

A

T it’s anti androgenic

Can cause gynecomastia in men
Menstrual irregularity in women

27
Q

Spironolactone does not affect glucose or uric acid

A

T

HCTZ does ( increases both )
Loops do ( Increases both glucose and uric acid )

Therefore can be used as alternative diuretic in gout and patients with DM

28
Q

Eplerenone

A

Inspra

Dont used in CrCl < 30
Dont use if k > 5.5

It is a Cyp3a4 substrate
GPAC inhibitors - if strong inhibitor start at 25mg QD normally 50 mg qd max 50. Bid
SRCOP inducers

29
Q

MAPLES

A

IV bb

Metoprolol
Atenolol ( injection form d/c in US )
Propranolol
Labetolol
Esmolol
Sotalol ( only indicated for arrhythmia )

30
Q

Acebutol

A

BB
Spectral

Can cause drug induced lupus +ANA test

31
Q

Atenolol and orange apple green tea

A

Decreases levels by 40%. Separate by 4 hours

32
Q

Nadolol

A

Corgard

Decrease dose in renal function

Separate by OATP inhibitors

33
Q

Nadolol

34
Q

Medication for infantile hemagiomas ( benign tumors of vascular endothelium ( most common tumors of childhood ) )

A

Hemangeol oral solution : propranolol

35
Q

Beta blocker with alpha 1 and beta 1 activity

A

Carvedilol Coreg

Labetalol ( trandate)

36
Q

What kind of BB is better tolerated for COPD patients ?

A

Beta 1 selective
MANBABES

Metoprolol
Atenolol
Nebivolol
Bisoprolol
Acebutol
Betaxolol
Esmolol

37
Q

When do you use BB?

A

CHF: BB ace/arb, arni, aldosterone antagonist

Post myocardial infarction: BB, ACE/ARB, aldosterone antagonist

Angina pectoris : BB, CCB

atrial fibrillation rate control : BB, NDH CCB

Portal HTN : BB decrease pressure and decrease risk of bleeding from esophageal varicose : non selective BB

38
Q

Cardinal met the bishop

A

Carvedilol
Metoprolol XL
Bisoprolol

BB Drugs used in CHF

39
Q

Cardinal met the bishop

A

Carvedilol
Metoprolol XL
Bisoprolol

BB Drugs used in CHF

40
Q

BB side effects

A

BLOCKER

Bradycardia/ brochospasm
Lipid increase/ libido decrease
Orthostatic Hypotension —> dizziness
Conduction abnormalities—> AV block
K- K( C)onstriction of peripheral vasculature ( raynaud’s)
K- k increase hyperkalemia
Exhaustion / emotional depression
Reduced recognition of hypoglycemia

41
Q

Difference between DHP and NON DHP regarding specific area of activity

A

DHP more specifically work on smooth muscle cells around vessels —> vasodilation

Non DHP ( VERAPamil diltiazem ) more specific for cardiac muscle cells ( more negative ionotrope and negative chronotropic effects )

42
Q

Verapamil vs diltiazem

Both of these have caution what what disease states?

A

Both CCB non DHP

Verapamil: most effects on the heart , less on vessels

Diltiazem : affects both heart and vessels ( arteries )

CHF
Heart blocks
Additive bradycardia / AV blocks with BB
Severe hepatic dysfunction
Pregnancy C

43
Q

Verapamil and dilt are both Cyp 3a4 inhibitors

A

GPAC

C is for CCB ( NON DHP ) and clarithromycin erythromycin ( marolides except azithro)

44
Q

DOC for arterial spasm

Raynauds

Prinzmetal’s angina

A

Raynauds: nifedipine, amlodipine, Isradipine, felodipine

Prinzemetal’s angina : nifedipine, diltiatzem, verapamil

45
Q

Qbrelis is an oral solution of what medicaiton?

A

Lisinopril

46
Q

Only ace I that is IV

A

Enalapril

Enalaprilat , vasotec IV

47
Q

ACE SE’s on electrolytes

A

Hyperkalemia

Hyponatremia

No effects on gluocose, lipids, uric acid , asthma COPD

48
Q

What is SCr max with ace I

A

SCR > 3 mg/dl —— if diabetic ——> then SCr > 2.5 mg /dl

CrCl < 30

Are both max. Increases risk of hyperkalemia

49
Q

ACE I and pregnancy

A

RAAS antagonists are preg D

50
Q

ACE I and lithium DDI

A

Hyponatremia so can increase lithium —-> lithium toxicity

51
Q

ACE I and allopurinol

A

maybe chance potential for allergic or hypersensitivity reactions to allopurinol
Risk D

Azathiopurine / 6MP toxicity too ( risk C ) : ACEI may enhance the myelosuppresive effect of Azathiopurine

52
Q

This alpha 1 blocker may cause a sulfa allergy?

A

Tamsulosin

53
Q

Alpha 2
SE
Brand

A

Clonidine ( catapres ; kapvay er forADHD ) & guanfacine ( tenex, intuniv )

SE: dry mouth, constipation, fatigue, sexual dysfunction, orthostatis , decrease mental concentration , rebound HTN , Bradycardia, depression

54
Q

Methyldopa

A

Possible alpha 2 agonists

Used in pregnancy and preeclampsia
PO tabs and IV

Mild antihypertensive with a slow onset of action ( 3-6 hours ). Many women will not achieve BP goals or are bothered by its sedative effect at high doses.

SE can cause drug induced LUPUS ( just like Acebutol( sectral) BB ) & hydralazine ( apresoline )
BMS, hemolytic anemia, hepatitis

55
Q

Hydralazine

A

MOA: vasodilator ( increases cGMP causes vasodilation ) —-reflex tachy —angina watch out ./ and orthostatic hypotension

Apresoline

Can be used in pregnancy

LUPUS like syndrome

SHPCPJEN5 (8 decks)

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