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Pharm > Hypertension > Flashcards

Hypertension Flashcards

1
Q

MOA of Loop diuretics

A

block sodium and chloride reabsorption in the ascending loop of Henley

20% of NA and Cl typically reabsorbed here, inhibition leads to profound diuresis

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2
Q

What are the four loop diuretics

A 
"ide"
Furosemide
Torsemide
Bumetanide
Etharcrynic acid
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3
Q

Which loop diuretic can be used in a patient with a self allergy?

A

Etharcrynic Acid

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4
Q

For what indications (diseases) are loop diuretics used?

A

Congestive heart failure
Pulmonary edema
Peripheral edema
Hypertension

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5
Q

What adverse effects must be monitored in loop diuretics?

A 
Dehydration
Electrolyte abnormalities
Hypotension
Ototoxicity
Hyperuricemia
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6
Q

Why should IV for loop diuretics be given slowly?

A

to avoid ototoxicity

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7
Q

What is the mechanism of action for Thiazide diuretics?

A

Block reabsorption of Na+ and Cl- at the early segment of the distal convoluted tubule (DCT)

10% of NA and Cl reabsorbed from DCT; inhibition leads to diuresis

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8
Q

What are the four thiazide diuretics?

A

Hydrochlorothiazide (HCTZ)
Chlorthiazide
Chlorhalidone
Metolazone

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9
Q

Which thiazide diuretic is IV?

A

Chlorothiazide

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10
Q

For what indications (diseases) are thiazide diuretics used?

A

Hypertension (first-line)
Edema
Diabetes insipidus

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11
Q

What are adverse effects of thiazide diuretics that must be monitored?

A

Dehydration
Electrolyte abnormalities
hyperglycemia
hyperuricemia

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12
Q

What are common drug interactions with thiazide diuretics?

A 
Digoxin
Potassium-sparing diuretics
Lithium
Anti-hypertensive drugs
NSAIDs
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13
Q

Can thiazide diuretics be used in patients with self allergies?

A

Yes, use caution

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14
Q

Potassium-sparing diuretics types

A 
Aldosterone Antagonists (spironolactone)
Non-aldosteron Antagonists (amiloride and Triamterene)
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15
Q

What are the MOA for Spironolactone

A

Aldosterone Antagonist

Blocks aldosterone (typically causes sodium retention and potassium excretion) in the distal convolute tubule

Increased excretion of sodium and retention of potassium

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16
Q

What are the MOA for Amiloride and Triamterene

A

Non-aldosteron Antagonists

Direct inhibitor of the NA/K ion exchange transporter

Increased excretion of sodium and retention of potassium

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17
Q

What indications call for Spironolactone?

A

Hypertension and edema
Heart failure
Acne
Polycystic ovarian syndrome

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18
Q

What indications call for Amiloride and Triamterene?

A

Hypertension

Edema

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19
Q

What are adverse effects of Spironolactone?

A

Hyperkalemia (elevated potassium)

Endocrine effects

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20
Q

What are adverse effects of Amiloride and Triamterene?

A

Hyperkalemia

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21
Q

Which is associated with endocrine effects like gynecomastia?

A

Spironolactone

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22
Q

What are common drug interactions for all three potassium-sparing diuretics

A

Thiazide and loop diuretics

Agents that raise potassium

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23
Q

What is the MOA for Mannitol

A

filtered by the glomerulus
Does not undergo reabsorption and remains in the lumen
Increased osmotic pressure keeps water from being reabsorbed

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24
Q

For what indications is Mannitol used?

A

Reduce elevated intracranial pressure

Reduce elevated intraocular pressure

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25
Q

Why does mannitol require a filter for administration

A

To remove micro crystals (0.22 micron filter)

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26
Q

What time of day should loop diuretics be administered?

A

avoid taking before bed

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27
Q

What is the MOA for ACE inhibitors ?

A

inhibit angiotensin converting enzyme (ACE) from converting angiotensin I to angiotensin II

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28
Q

What are the physiologic effects of ACE inhibitors?

A 
Vasodilation
Low blood volume
Low cardiac and vascular remodeling
Potassium retention
Fetal injury
29
Q

What four-letter syllable do all ACE Inhibitors share?

A

“pril”

30
Q

Which ACE inhibitor is IV?

A

Enalaprilat

31
Q

For what indications (diseases) are ACE inhibitors used for?

A 
hypertension
heart failure
Myocardial Infarction
diabetic nephropathy
prevention of MI, stroke and death in patients at high risk for CV disease
32
Q

What adverse effects must be monitored when using ACE inhibitors?

A 
first-dose hypotension
dry cough
hyperkalemia
renal failure in patients with bilateral renal artery stenosis
Fetal injury
Angiodema
33
Q

What is a rare but life threatening adverse reaction that can be seen with ACE inhibitors?

A

Angiodema

34
Q

What are common drug interactions with ACE inhibitors?

A 
Diuretics
Antihypertensive Agents
Drugs that raise potassium
Lithium
NSAIDs
35
Q

Can ACE inhibitors be used in pregnant patients?

A

No

36
Q

MOA of Angiotensin II receptor blockers (ARBs)

A

block angiotensin II from binding to its receptor

37
Q

Physiologic effects of ARBs

A

vasodilation
decrease production of aldosterone
reduce cardiac remodeling
dilation of renal blood vessels

38
Q

What ending do all ARBs share?

A

“sartan”

39
Q

For what indications (diseases) are ARBs used?

A

*identical to ACE inhibitors

hypertension
heart failure
Myocardial Infarction
diabetic nephropathy
prevention of MI, stroke and death in patients at high risk for CV disease
40
Q

What adverse effects must be monitored when taking ARBs

A

*identical to ACE inhibitors

angiodema
fetal harm
renal failure

41
Q

What is a rare but life threatening adverse reaction that can be seen with ACE inhibitors

A

Angioedem

42
Q

What are common drug interactions for ARBs

A

*identical to ACE inhibitors

Diuretics
Antihypertensives
Drugs that raise potassium levels

43
Q

Can ACE inhibitors be used in pregnant patients?

A

no

44
Q

MOA for Direct Renin Inhibitors (DRI)

A

binds to renin and prevents it from cleaving Angiotensinogen to angiotensin I

Cannot create angio II without angio I

Angio II is the problematic element that increases blood pressure

45
Q

Physiologic Actions for DRI

A

Vasodilation
Decrease production of aldosterone
Reduce cardiac remodeling
Dilation of renal blood vessels

46
Q

What is the only direct renin inhibitor

A

Aliskiren

47
Q

For what indications (diseases) are DRIs used for

A

Hypertension

48
Q

What adverse effects must be monitored when administering DRIs?

A 
Angiodema
Dry Cough
Diarrhea * only thing dif from ACE or ARB
Hyperkalemia
Fetal Injury
49
Q

What is the difference between dihyropyridine and non-dihydropyridine calcium channel blockers?

A

Dihydropyridines: several drugs, work only on the vascular smooth muscle

Non-Dihydropyridines: two drugs, work on heart and vascular smooth muscle

50
Q

MOA of Dihydropyridine CCB

A

block calcium channels in the vascular smooth muscle, decrease blood pressure, prevent ism from contracting

51
Q

Physiologic Effects of Dihydropyridine CCB

A

Vasodilitation of the arteries and arterioles which decrease blood pressure

Vasodilation cardiac vasculature which increases myocardial perfusion (improved oxygen and blood supply)

Reflex tachycardia

52
Q

What ending do all Dihyropyridine CCB drugs share?

A

“dipine

53
Q

For what indications (diseases) are Dihydropyridine Calcium Channel Blockers used for?

A

Angina Pectoris and hypertension

54
Q

Which Dihydropyridine CCB would be preferred in an emergency when bp must be reduced right away?

A

Nicardipine and Clevidipine

55
Q

Which dihydropyridine CCBs are administered IV

A

Nicardipine and Clevidipine

56
Q

What adverse effects must be monitored for dihydropyridine CCBs

A 
flushing
dizziness
headache
peripheral edema
reflex tachycardia
57
Q

Which dihydropyridine CCB is only indicated for SAH (bleeding in brain)

A

Nimodipine - not used for BP

58
Q

MOA for Non-dihydropyridine CCB

A

block of calcium channels in the vascular smooth muscle and heart

59
Q

Physiologic Effects for Non-dihydropyridine CCB

A

decrease BP
Increase Myocardial Perfusion
Decreases Heart Rate
Decreased force of myocardial contraction

60
Q

What are the Non-dihydropyridine CCBs?

A

Verapamil

Diltiazem

61
Q

For what indications (diseases) are Non-dihydropyridine CCBs used?

A

angina pectoris
hypertension
cardiac dysrhthmias

62
Q

What adverse effects must be monitored for Non-dihydropyridine CCBs and how?

A 
constipation (verapamil)
dizziness
flushing
headache
bradycardia
AV nodal block
Peripheral edema

Monitor BP, ECG, and heart rate

63
Q

What are common drug interactions for Non-dihydropyridine CCBs?

A

digoxin and beta-blockers

possible interaction with grapefruit juice

64
Q

What is an important counseling point regarding ER products?

A

Do not crush or chew

65
Q

What lifestyle modifications can be implemented to help treat high blood pressure?

A 
Sodium restriction - max 2grams/day
Dash Diet - high in fruits, veg, low-fat dairy, low in sat fats and chol
Alcohol Restriction
Weight loss
Smoking Cessation
Exercise
66
Q

What strategies can be used to improve patient adherence to therapy?

A 
simplify regimen
establish a collaborative relationship
minimize side effects
teach self-monitoring
teach importance of med for pt to take
67
Q

Which blood pressure medications are preferred in pregnant patients?

A

magnesium, labatelol, methyldopa

68
Q

What drugs cause hypokalemia?

A

Loop diuretics

Thiazide Diuretics

69
Q

What drugs cause Hyperkalemia?

A

K-sparing diuretics, ACE-inhibitors, Direct Renin Inhibitors, ARBs, Aldosterone antagonists

Pharm (5 decks)

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