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PHM601 UB Pharmacy > Hypertension > Flashcards

Hypertension Flashcards

1
Q

How do you treat primary HTN?

A

Medically managed, cannot be attributed to another cause

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2
Q

How do you treat secondary HTN?

A
  1. Treat underlying diseases (primary aldosteronism, obstructive sleep apnea etc.)
  2. Remove any medications causing HTN if possible (ex: SNRIs, TCA & MAOIs)
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3
Q

What is the general blood pressure goal for patients?

A

< 130/80 mm Hg

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4
Q

What is a normal blood pressure?

A

< 120 / < 80 mm Hg

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5
Q

What is an elevated BP?

A

120-129/ < 80 mm Hg

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6
Q

Stage 1 HTN BP readings:

A

130-139/80-89 mm Hg

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7
Q

Stage 2 HTN BP readings:

A

> 140/>90 mm Hg

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8
Q

3 Classes of First Line Anti-HTN

A
  1. CCB
  2. Thiazide/thiazide-like diuretics
  3. ACEi/ARB
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9
Q

Beta blockers to be used in pts with HTN and indication of HFrEF? (3)

A
  1. Carvedilol
  2. Metoprolol succinate
  3. Bisoprolol
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10
Q

Black patients with HTN but NO CKD or HF should be treated with which first line class(es) of anti-HTN?

A

Thiazide-type diuretics OR CCB
(ACEi/ARB can be added as a second agent if needed)

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11
Q

Safe anti-HTN in pregnant patients (3)

A
  1. Labetalol
  2. Nifedipine ER
  3. Methyldopa
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12
Q

Thiazide and thiazide-like diuretic mechanism of action

A

Inhibits Na and Cl reabsorption in the distal convoluted tubule leading to increased excretion of Na, Cl, H2O, and K

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13
Q

Examples of Thiazides

A

Hydrochlorothiazide, Chlorthalidone

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14
Q

Thiazide and thiazide-like diuretic monitoring

A
  1. Electrolyte and renal function 2-4 weeks after initiating or changing therapy
  2. BP Monitoring per Guidelines
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15
Q

Adverse Effects of Thiazide diuretics?

A

Hyper: Calcemia, uricermia, glycemia
Hypo: volemia, natremia, kalemia, magnesemia

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16
Q

Thiazide and thiazide-like use in patients with gout

A

OK if uric acid is within normal range/treated appropriately, avoid is uric acid elevated

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17
Q

Chlorthalidone (Hydroton) Dosing

A

12.5-25 mg Daily

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18
Q

Hydrochlorothiazide (Hydrodiuril) Dosing

A

25-50 mg Daily

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19
Q

DHP CCB Mechanism of Action

A

Inhibits Ca ions from entering vascular smooth muscle leading to peripheral arterial and coronary artery vasodilation

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20
Q

DHP CCB Examples

A

Amlodipine, nifedipine

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21
Q

DHP CCB onset of action

A

Up to one week to see the full BP effect

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22
Q

DHP CCB AE

A

Peripheral edema, headache, dizziness

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23
Q

DHP CCB that should be avoided in HTN

A

Nifedipine IR - increased hypotension, MI, and death!

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24
Q

Amlodipine (Norvasc) Dose?

A

2.5-10mg Daily (DHP)

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25
Q

Nifedipine ER (Procardia) Dose?

A

30-120 mg Daily (DHP)

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26
Q

Non-DHP CCB Mechanism of Action

A

Inhibits Ca ions from entering vascular smooth muscle and myocardial cells (more selective for the myocardium) leading to vasodilation, negative inotropy, and negative chronotropy

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27
Q

Non-DHP CCB Examples

A

Diltiazem, Verapamil

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28
Q

Major DDI for NON-DHP CCBs?

A

CYP3A4 (Adjust dose for simvastatin and lovastatin)

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29
Q

Non-DHP CCB should be avoided in which disease state?

A

HFrEF

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30
Q

Diltiazem ER (Cardizem) Dose?

A

120-360mg Daily (Non-DHP)

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31
Q

ACEi mechanism of action

A

Decreases angiotensin-II production leading to vasodilation and decreased aldosterone secretion

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32
Q

ACEi Examples

A

Lisinopril, Enalapril

33
Q

ACEi contraindications?

A
  1. Pregnancy
  2. Angioedema history
  3. Bilateral renal artery stenosis
34
Q

ACEi and ARBs major adverse effect

A

Hyperkalemia
Dizziness
Dry Cough

35
Q

Lisinopril (Prinivil/Zestril) dosing

A

10-40 mg Daily

36
Q

ARB mechanism of action

A

Blocks angiotensin-II activity at the angiotensin receptor in vascular smooth muscle preventing vasoconstriction

37
Q

ARB Examples

A

Valsartan, losartan, irbesartan

38
Q

Losartan (Cozar) dosing

A

50-100 mg in 1-2 divided doses

39
Q

Valsartan (Diovan) dosing?

A

80-320 mg daily

40
Q

Serum creatinine increase EXPECTED with ACEI/ARB?

A

Less than or equal to 35%

41
Q

Which class of drugs requires a wash-out before ANRI (Entresto) initiation, and for how long?

A

ACEi - 36 hours
Does NOT apply to ARBs

42
Q

Direct Renin Inhibitor (DRI) adverse effects

A

Hyperkalemia
Dizziness

43
Q

Direct renin inhibitor mechanism of action

A

Inhibits renin leading to an overall decrease in angiotensin II

44
Q

Aliskiren (Tekturna) dosing?

A

150-300 mg daily

45
Q

Beta-blocker mechanism of action

A

Inhibits B1/B2 receptors leading to a decrease in inotropy and chronotropy

46
Q

Beta Blockers adverse effects

A

Dizziness
Fatigue
Reduced exercise tolerance
Bronchospasm
Insomnia
Impotence
Heart Block
Worsening HF (if given in acute HF exacerbation)

47
Q

What must be done when discontinuing a beta blocker?

A

Taper down dose

48
Q

Metoprolol Succinate (Toprolol XL) dose

A

50-200mg daily (cardioselective)

49
Q

Bisoprolol (Zebeta) dose

A

2.5-10mg daily (cardioselective-)

50
Q

Carvedilol (coreg) dose

A

12.5-50mg over two divided doses (alpha and beta blockade)

51
Q

Alpha1-blocker mechanism of action

A

Blocks alpha-1 adrenergic receptors leading to peripheral vasodilation

52
Q

Alpha1 Blocker Example

53
Q

Alpha1 blocker adverse effects

A

Orthostatic hypotension
Drowsiness
Dizziness
Headache
Syncope

54
Q

Doxazosin (Cardura) dose

A

1-16 mg daily

55
Q

Central Alpha-2 agonist mechanism of action

A

Stimulates central alpha2 adrenergic receptors leading to a decrease in sympathetic outflow (norepinephrine), leading to vasodilation and decrease inotropy/chronotropy

56
Q

Central Alpha-2 agonist Example

A

Clonidine, methyldopa

57
Q

Central alpha2-agonists method of discontinuation

A

Slow taper to avoid rebound hypertension

58
Q

Clonidine Dosing

A

0.1-0.8 mg/day in 2-3 divided doses

59
Q

Loop diuretic mechanism of action

A

Inhibits Na, K, Cl reabsorption in the thick ascending loop of henle

60
Q

Loop diuretic example

A

Furosemide, bumetanide, torsemide

61
Q

Loop diuretic AE

A

Hypo: natremia, kalemia, magnesemia, calcemia, chloremia,
Metabolic alkalosis
Hyperuricemia
Orthostatic hypotension (if dehydrated)
Dizziness
Acute Kidney Injury (AKI)
Ototoxicity

62
Q

Furosemide Dosing

A

20-160 mg/day in 2 divided doses

63
Q

Potassium sparing diuretic mechanism of action

A

Competitive inhibition of epithelial sodium channels in the collecting duct of the nephron, leading to a decrease in sodium reabsorption and increase in potassium reabsorption

64
Q

Potassium-sparing diuretic example

A

triamterene, amiloride

65
Q

Potassium Sparing Diuretic AE

A

Dehydration
Hyponatremia
Dizziness
Hyperkalemia
Stevens Johnson Syndrome

66
Q

Mineralocorticoid receptor antagonist mechanism of action

A

Competitive antagonist of the mineralocorticoid receptor which decreases reabsorption of Na and increases reabsorption of K
Eplerenone = selective
Spironolactone = non-selective

67
Q

MRA Examples

A

Spironolactone, eplerenone

68
Q

MRA adverse effects

A

Both: Dehydration, hyperkalemia, hyponatremia, dizziness
Spironolactone: gynecomastia, breast tenderness, impotence - if these occur, switch to eplerenone!
Eplerenone: Increase TG

69
Q

Spironolactone Dosing

A

25-100 mg daily

70
Q

Direct vasodilators mechanism of action

A

Direct vasodilation of arteries

71
Q

Direct vasodilator examples

A

Hydralazine, minoxidil

72
Q

Direct Vasodilators AE

A

Reflex tachycardia, peripheral edema
Minoxidil: hirsutism
Hydralazine: DILE

73
Q

Which anti-hypertensives require renal/electrolyte monitoring in 2-4 weeks after initiation? (6)

A
  1. ACEi/ARB
  2. Thiazides and thiazide-type diuretics
  3. Direct renin inhibitors
  4. Loop diuretics
  5. Potassium sparing diuretics
  6. Mineralocorticoid receptor antagonists
74
Q

Hypertensive crisis BP readings:

A

> 180/>120 mm Hg

75
Q

What occurs in HTN emergency that does not occur in HTN urgency?

A

End organ damage! Look for things like elevated SCr, LFTs, etc!

76
Q

Treatment approach for HTN urgency

A

Timing: Lower BP slowly in 24-48 hours of presentation
Agent: ORAL anti-HTN
Location: No ICU

77
Q

Treatment approach HTN emergency (Timing!)

A

1st hour: decrease DBP 10-15% or MAP by 25% with goal DBP >/ 100 mm Hg
2-6 hours: SBP 160 mm Hg and/or DBP 100-110 mm Hg
6-24 hours: maintain
24-48 hours: Gradually decrease to outpatient goal

78
Q

Treatment approach hypertensive emergency (Route + Location)

A

IV agents
ICU admission

PHM601 UB Pharmacy (6 decks)

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