Hypertension Flashcards
1
Q
what is normal BP?
A
<80
2
Q
A Bp of 145/ 95 would be what classification?
A
Stage 1 HTN
3
Q
A BP of 180/102 would be what?
A
Stage 2 HTN
4
Q
A BP of 125/84 would be what?
A
Prehypertension
5
Q
how many BPs must you have to diagnose HTN?
A
2 or more blood pressures on 2 or more visits
6
Q
CVD risk doubles for each increment of ______ mmHg (beginning at 115/75 mmHg)
A
20/10 mmHg
7
Q
How do you calculate Mean Arterial Pressure?
A
Cardiac Output x Peripheral Vascular resistance
8
Q
what do antihypertensive drugs target?
A
Mean arterial pressure (CO or PVR)
9
Q
what do antihypertensive drugs control for long term control?
A
Renin-angiotensin-aldosterone system
10
Q
what is the kidneys response to not enough blood flow?
A
Release renin
11
Q
What does renin release cause
A
Angiotensin 1 which is converted to angiotensin II by angiotensin converting enzyme
12
Q
what is responsible on its own for peripheral vasoconstriction
A
Angiotensin II
13
Q
what is responsible for noradrenaline release?
A
angiotensin II
14
Q
what causes sodium and water retention?
A
Aldosterone release (by angiotensin II)
15
Q
where are organic solutes and sodium bicarb reaborbed?
A
proximal tubule (early)
16
Q
What occurs in the thin limb of the loop of henle?
A
No NaCl absorption Water absorption (osmotic)
17
Q
what happens in the thick ascending limb of loop of henle
A
active reabsorbs NaCl
impereable to water- dilutes tubular fluid
potassium increases in cell secondary to interstitial Na/K ATPase
18
Q
what does the distal convoluted tubule do?
A
Reabsorbs NacL
impermeable to water
no potassium recycling
19
Q
what drugs that cause HTN?
A
corticosteroids
thyroid hormone excess
OCPs
NSAIDs/ COX-2
20
Q
If a person if pre-hypertensive when do you start drug therapy?
A
Of they have a co-morbidity
21
Q
when are 2 drugs usually required for HTN?
A
stage 2 HTN
22
Q
If patients don’t have DM or kidney dz what is the goal of drug therapy?
A
<140/90
23
Q
If a person has DM or kidney dz what is their BP goal?
A
<130/80
24
Q
For stage 1 HTN what is the 1st choice.
A
Thiazide
25
for stage 1 HTN what is the 2nd choice
```
ACEI
ARB
BB
CCB or
combo
```
26
Stage 2 HTN what is the drug of choice?
2 drug combo of :
| thiazide + ACEI or ARB or BB or CCB
27
For heart failure what is the 1st choice for HTN tx?
ACEI + BB
28
1st choice for CAD w/ HTN?
BB + ACEI
29
DM 1st choice for HTN?
ACEI or ARB
30
CKD 1st choice for HTN?
ACEI or ARB
31
Recurrent stroke 1st choice for HTN?
ACEI + thiazide
32
Isolated systolic HTN DOC?
Thiazide
33
What may be used in patients unable to take ACEI?
ARBs
34
How often should SrCr be assessed for HTN?
1-2 times per year
35
Once BP is at goral and stable how often should you follow up?
Every 3-6 months
36
what is failure to reach goal BP in patients who are adhering to full doses of a 3 drug regimen that includes a diuretic?
Resistant HTN
37
If a patient has resistant HTN what should you do?
do a complete work up to look for underlying causes
38
what does excessive body sodium causes?
Vessel rigidity, fluid retention, increased release of norepinephrine and epi from sympathetic terminals and adrenal medulla
39
Does antihypertensive action correlate with diuretic activity?
No
40
HCTZ has a ____ diuretic effect but a potent antihypertensive.
low
41
A loop diuretic is a ________ diuretic but has low antihypertensive effect.
potent
42
MOA of HCTZ
Inhibit luminal NaCl transport in distal tubule
| Changes in urine ionic content –> increase loss of Na+, K+, water
43
In heart failure a thiazide diuretic + what has synergistic diuretic effect.
loop diuretic
44
thiazide diuretics are also used to prevent _____________ due to hypercalciuria.
kidney stones
45
ADRS of HCTZ
```
hypokalemia
hyperuricemia
hypomagnesia
impaired carb tolerance, hyperglycemia
hyperlipidemia
impotence
```
46
what are some other thiazide drugs?
Metolazone (usually for CHF)
47
what is a main loop diuretics?
Furosemide
48
where do loop diuretics work in the kidney?
ascending loop of Henle at chloride pump
49
Uses for loop diuretics
```
edema
heart failure
hypercalcemia
hyperkalemia
acute renal failure
```
50
ADRs of furosemide?
Ototoxicity
| allergic rxn
51
what is a potassium-sparing diuretic?
Spironolactone
52
MOA of spironolactone?
Synthetic steroid antagonist of aldosterone
| inhibits Na+ reabsorption and K+ secretion in collecting tubules
53
Therapeutic uses of spironolactone
primary aldosteronism
| blunt K+ wasting tendencies of other diuretics
54
ADRs of spironolactone
Gynecomastia
menstrual irregularities
hyperkalemia
hypercholermic metabolic acidosis
55
what supplements should you d/c before starting spironolactone?
potassium supplements
56
What is a potassium sparing diuretics that isn't an antagonist of aldosterone. Has an ADR of kidney stones
Triamterene
57
What is triamterene usually combined with?
A thiazide diuretic
58
How do NSAIDs interact w/ diuretics?
decrease diuretic activity
59
What drugs decrease the absorption of furosemide (loop diuretics)?
Cholestyramine and sucralfate
60
What does the combo of diuretics with ACEI cause?
exaggerated hypotension
61
what does the combo of thiazides and digoxin lead to?
Incrased risk of arrhythmias
62
Diabetic meds plus diuretic can lead to what?
decreased glucose tolerance
63
Potassium sparing diuretics and ACEI will cause what?
exaggerated hyperkalemia
64
what is the prototype of ACEI?
Enalapril
65
MOA of ACEI
block conversion of angiotensin I --> angiotensin II
66
What does ACEI stand for?
Angtiotensin Converting Enzyme Inhibitor
67
What do ACEI do?
stimulate synthesis of vasodilatory prostaglandins
decrease aldosterone & Na/H2O retention
inhibit breakdown of bradykinin --> increased No and prostacycline
68
how do you get aldosterone while on an ACEI
Angiotensin I --> Angiotensin II via non-ACE enzymes
69
Contraindications of ACEI
pregnancy
| renovascular hypertension
70
ADRs of ACEI
Dry cough, altered taste, rashes, fever
Hyperkalemia
angioedema (face, neck, laryngeal swelling)
71
ADRs of ACEI in kidney
elevations of SrCr and BUN
72
Problem with ACEI if respond too well
hypotension and first-dose syncope
| greater if hypovolemia or on diuretics
73
what is the prototype of ARB
Losartan
74
What does ARB stand for?
Angiotensin Receptor Blockers
75
what do ARBs drug names end in?
-sartan
76
MOA of ARBs
Block the angiotensin II receptors competitively inhibiting angiotensin II binding to AT1 receptors. Blocks pressor and aldosterone-releasing effects causing vasodilation and decreased PVR
77
Do ARBs 100% cut off aldosterone?
no, there are other pathways
78
Difference b/w ARBs and ACEIs?
Unlike ACEI do not stimulate synthesis of vasodilatory compounds
79
What can ARBs be 1st line for?
DM (due to effects of BUN/ CrCl with ACEI)
80
Contraindications with ARBs
Pregnancy
| renal artery stenosis
81
ADRs with ARBd
altered taste
hyperkalemia
elevations in SRCr, BUN
82
What ADR does losartan do?
reduces uric acid
83
Effects of Beta Blockers
reduction in HR
reduction in contractility
Reduction in BP
Suppression sympathetic nervous system activity
84
therapeutic uses for beta blockers
ischemic heart dz
heart failure
dysrhythmias
hypertension
85
What are Beta-1 selective BBs?
Atenolol
Metoprolol
Acebutolol
Bisoprolol
86
What are Beta 1 and Beta 2 blockers?
```
Propranolol
Sotolol
Timolol
Nadalol
Pindolol
Carvidelol
Labetaolol
```
87
what is Intrinsinsic Sympathomimetic Activity (ISA)?
Partial agonist activity, less reduction in resting HR, Co, and BP
88
What BBs are intrinsic sympathomimetic activity (ISA)?
acebutolol
pindolol
carteolol
89
why can partial agonists (ISAs) be beneficial?
Doesn't reduce HR as much, could be good for people who have a huge effect to BBs
90
What BBs have alpha-1 blocking activity which adds vasodilatory properties.
Carvidelol
| Labetaolol
91
Contraindications of BBs
Severe asthma
| severe bradycardia, heart block, over HF
92
What conditions should you use caution with BBs with?
Asthma/ COPD
peripheral vascular dz
DM
dyslipidemia
93
ADRs of BBs
fatigue, lethargy, insomnia, depression
bronchoconstriction, cold extremities
decreased libido and impotence
94
what can abrupt withdrawal of BB lead to?
may precipitate MI
95
How do BB affect lipids
decrease HDL, increase LDL
96
what should you monitor with BBs
BP, HR
symptoms of HF, difficulty breathing
CNS disturbances
97
MOA of CCBs
block inward movement of Ca by binding to L-type calcium channels. Lead to smooth muscle relaxation and arteriolar dilation.
98
Therapeutic uses of CCBs
HTN
ischemic heart dz
dysrhythmias (non-dihydropyrididines only)
99
what are 2 non-dihydropyridines CCBs?
Verapamil
| Diltiazem
100
What are dihydropyridines CCBs?
Nifedipine (prototype)
felodipine
amlodipine
isradapine
101
what type of CCBs have more affinity for the periphery?
dihydropyridines
102
problem of decreased PVR through greater peripheral vasodilation.
Body may repond with reflex tachycardia
103
What are 2 second generations CCB that are widely used for HTN.
amlodipine
| felodipine
104
ADRs of dihydropyridines CCB
hypotension
dizziness
peripheral edema- through cap dilation
105
ADRs of non-dihydropyridines
HPOTN
dizziness
bradycardia
exacerbation of HF
106
if a patient has trouble with blood sugars or lipids what should you give them probably?
CCB
107
what CCB can cause constipation and you should prescribe doucsate at the same time.
Verapamil
108
what does verapamil increase the plasma levels of?
Digoxin
109
When should immediate release CCB be avoided?
CV indications due to potential cardiac ischemia
110
Non-dihydropyridines shoudl be given with caution in patients taking what due to possibility of AV block or heart failure?
BBs
111
What are alpha 1 blocking agents?
Prazosin
Doxazosin
Terazosin
112
MOA of alpha 1 blockers
Lows MAP by causing relaxation of both arterial and venous smooth muscle
minimal changes in CO, renal blood flow and GFR
113
Primary use for alpha 1 blockers
BPH
114
why are alpha 1 blockers not often used for HTN?
body will respond with increasing CO (increase HR in response) and high incidence of postural HTN.
115
ADRs of alpha 1 blockers?
first dose syncope
dizziness, HA, fatigue
postural HPOTN
palpitations
116
what is a centrally acting alpha 2 agonist?
clonidine
117
MOA of clonidine?
inhibition of NE release causing vasodilation.
118
Indications for clonidine?
HTN
drug withdrawal
side effects w/ neuroletpcis
119
what can abrupt d/c of clonidine cause?
severe hypertension
120
ADRs with clonidine
```
dry mouth
sedation
depression
HPOTN
sexual dysufnction
urinary retention
```
121
what is an analogue of L-Dop that acts an an alpha 2 agonists.
Methyldopa
122
when is methyldopa an agent of choice?
Patients with chronic renal dz and pregnancy
123
ADRs of methyldopa
Sedation, depression, dry mouth
hyperprolactinemia
nightmares
124
ADRs of hydralazine
HA, palpitations
angina or ischemic arrhythmias due to reflex tachycardia
high doses can present with lupus like symptoms
125
MOA of hydralazine
acts on smooth muscle, primarily arterioles, to decrease tone
126
What is a renin inhibitor?
Aliskiren
127
Does aliskiren inhibit bradykinin breakdown like ACEI?
No
128
ADRs with aliskiren
angioedema, cough, increase SrCr
129
Contradincitionas with aliskiren
pregnancy
130
Metabolism of aliskiren
CYP3A4
131
drug-drug interactions with aliskiren
competitive inhibition of aliskiren metabolism by atorvastatin and ketoconazole
decreased efficacy of furosemide with cocurrent admin
132
DOC for pregnant patients with HTN
Methyldopa or labetalol
133
If IV therapy is needed for pregnancy HTN what is prefered
hydralazine
134
what is isolated systolic HTN?
SBP >140 with DBP <90
135
who does isolated systolic HTN usually occur in?
elderly patients
136
what is preferred therapy for isolated systolic HTN?
thiazide diuretics
137
If you lower BP too fast with isolated systolic HTN what can happen?
hyperprofusion
138
Severely elevated BP without acute end organ damage
HTN urgency
139
Severely elevated BP associated with acute and ongoing organ damage in the kidneys, brain, heart, eyes, or vascular system
HTN Emergency
140
End organ damage is usually associated with DBP > than what?
130 mm Hg
141
tx for HTN urgency
Captopril, clonidine, labetolol
142
how fast should BP be lowered with HTN urgency?
hours to days
143
how fast should BP be lowered with HTN emergency?
minutes to hours to minimize end-organ damage
144
Drugs for HTN emergencies
Nitoprusside (SNP) IV
145
MOA of nitroprusside
prodrug that decomposes to NO causing vasodilation
146
does nitroprusside work well in patients with cardiac failure?
No
147
what type toxicity can long duration nitroprusside metabolism cause?
cyanide toxicity
148
what can be administered to to reduce cyanide toxicity associated with long term nitroprusside?
thiosulfate (produced thiocyanate a less toxic form)
