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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
Nifedipine ER (Procardia) Dose?
30-120 mg Daily (DHP)
26
Non-DHP CCB Mechanism of Action
Inhibits Ca ions from entering vascular smooth muscle and myocardial cells (more selective for the myocardium) leading to vasodilation, negative inotropy, and negative chronotropy
27
Non-DHP CCB Examples
Diltiazem, Verapamil
28
Major DDI for NON-DHP CCBs?
CYP3A4 (Adjust dose for simvastatin and lovastatin)
29
Non-DHP CCB should be avoided in which disease state?
HFrEF
30
Diltiazem ER (Cardizem) Dose?
120-360mg Daily (Non-DHP)
31
ACEi mechanism of action
Decreases angiotensin-II production leading to vasodilation and decreased aldosterone secretion
32
ACEi Examples
Lisinopril, Enalapril
33
ACEi contraindications?
1. Pregnancy 2. Angioedema history 3. Bilateral renal artery stenosis
34
ACEi and ARBs major adverse effect
Hyperkalemia Dizziness Dry Cough
35
Lisinopril (Prinivil/Zestril) dosing
10-40 mg Daily
36
ARB mechanism of action
Blocks angiotensin-II activity at the angiotensin receptor in vascular smooth muscle preventing vasoconstriction
37
ARB Examples
Valsartan, losartan, irbesartan
38
Losartan (Cozar) dosing
50-100 mg in 1-2 divided doses
39
Valsartan (Diovan) dosing?
80-320 mg daily
40
Serum creatinine increase EXPECTED with ACEI/ARB?
Less than or equal to 35%
41
Which class of drugs requires a wash-out before ANRI (Entresto) initiation, and for how long?
ACEi - 36 hours Does NOT apply to ARBs
42
Direct Renin Inhibitor (DRI) adverse effects
Hyperkalemia Dizziness
43
Direct renin inhibitor mechanism of action
Inhibits renin leading to an overall decrease in angiotensin II
44
Aliskiren (Tekturna) dosing?
150-300 mg daily
45
Beta-blocker mechanism of action
Inhibits B1/B2 receptors leading to a decrease in inotropy and chronotropy
46
Beta Blockers adverse effects
Dizziness Fatigue Reduced exercise tolerance Bronchospasm Insomnia Impotence Heart Block Worsening HF (if given in acute HF exacerbation)
47
What must be done when discontinuing a beta blocker?
Taper down dose
48
Metoprolol Succinate (Toprolol XL) dose
50-200mg daily (cardioselective)
49
Bisoprolol (Zebeta) dose
2.5-10mg daily (cardioselective-)
50
Carvedilol (coreg) dose
12.5-50mg over two divided doses (alpha and beta blockade)
51
Alpha1-blocker mechanism of action
Blocks alpha-1 adrenergic receptors leading to peripheral vasodilation
52
Alpha1 Blocker Example
Doxazosin
53
Alpha1 blocker adverse effects
Orthostatic hypotension Drowsiness Dizziness Headache Syncope
54
Doxazosin (Cardura) dose
1-16 mg daily
55
Central Alpha-2 agonist mechanism of action
Stimulates central alpha2 adrenergic receptors leading to a decrease in sympathetic outflow (norepinephrine), leading to vasodilation and decrease inotropy/chronotropy
56
Central Alpha-2 agonist Example
Clonidine, methyldopa
57
Central alpha2-agonists method of discontinuation
Slow taper to avoid rebound hypertension
58
Clonidine Dosing
0.1-0.8 mg/day in 2-3 divided doses
59
Loop diuretic mechanism of action
Inhibits Na, K, Cl reabsorption in the thick ascending loop of henle
60
Loop diuretic example
Furosemide, bumetanide, torsemide
61
Loop diuretic AE
Hypo: natremia, kalemia, magnesemia, calcemia, chloremia, Metabolic alkalosis Hyperuricemia Orthostatic hypotension (if dehydrated) Dizziness Acute Kidney Injury (AKI) Ototoxicity
62
Furosemide Dosing
20-160 mg/day in 2 divided doses
63
Potassium sparing diuretic mechanism of action
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
Potassium-sparing diuretic example
triamterene, amiloride
65
Potassium Sparing Diuretic AE
Dehydration Hyponatremia Dizziness Hyperkalemia Stevens Johnson Syndrome
66
Mineralocorticoid receptor antagonist mechanism of action
Competitive antagonist of the mineralocorticoid receptor which decreases reabsorption of Na and increases reabsorption of K Eplerenone = selective Spironolactone = non-selective
67
MRA Examples
Spironolactone, eplerenone
68
MRA adverse effects
Both: Dehydration, hyperkalemia, hyponatremia, dizziness Spironolactone: gynecomastia, breast tenderness, impotence - if these occur, switch to eplerenone! Eplerenone: Increase TG
69
Spironolactone Dosing
25-100 mg daily
70
Direct vasodilators mechanism of action
Direct vasodilation of arteries
71
Direct vasodilator examples
Hydralazine, minoxidil
72
Direct Vasodilators AE
Reflex tachycardia, peripheral edema Minoxidil: hirsutism Hydralazine: DILE
73
Which anti-hypertensives require renal/electrolyte monitoring in 2-4 weeks after initiation? (6)
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
Hypertensive crisis BP readings:
>180/>120 mm Hg
75
What occurs in HTN emergency that does not occur in HTN urgency?
End organ damage! Look for things like elevated SCr, LFTs, etc!
76
Treatment approach for HTN urgency
Timing: Lower BP slowly in 24-48 hours of presentation Agent: ORAL anti-HTN Location: No ICU
77
Treatment approach HTN emergency (Timing!)
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
Treatment approach hypertensive emergency (Route + Location)
IV agents ICU admission

PHM601 UB Pharmacy (6 decks)

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