Hypertension Flashcards
1
Q
normal BP
A
<80
2
Q
pre hypertension
A
120-139/80-89
3
Q
stage I HTN
A
140-159/90-99
4
Q
stage II HTN
A
> 160/>100
5
Q
which drugs can cause secondary HTN
A
corticosteroids, anorexiants/decongestants, thyroid hormone excess, OCPs, NSAIDs/COX-2, occasionally TCA’s and venlafaxine, excessive licorice
6
Q
goal BP- no diabetes, no kidney diseases
A
<140/90
7
Q
goal BP- diabetes or kidney disease
A
<130/80
8
Q
first choice patient with stage I HTN without compelling indications
A
Thiazide
9
Q
first choice for patient with stage II HTN without compelling indications
A
2 drug combo: ACEI, ARB, BB, or CCB
10
Q
first choice HTN tx pt has heart failure
A
ACEI plus BB
11
Q
first choice HTN tx pt has CAD
A
ACEI plus BB
12
Q
first choice HTN tx pt has diabetes
A
ACEI or ARB
13
Q
first choice HTN tx pt has CKD
A
ACEI or ARB
14
Q
first choice HTN tx pt has recurrent stroke
A
ACEI plus thiazide
15
Q
first choice HTN tx pt has isolated systolic HTN
A
thiazide
16
Q
what does excessive body sodium do in the body
A
increases vascular resistance (increases vessel rigidity, fluid retention, and epi and norepi release
17
Q
this diuretic has a potent diuretic effect but low hypertensive effect
A
furosemide
18
Q
this class inhibits luminal NaCl transport in the distal tubule of the kidney
A
thiazide
19
Q
short term effects: sodium and water excretion (decreases plasma volume)
A
HCTZ
20
Q
long term effects: decrease peripheral vascular resistance
A
HCTZ
21
Q
this class loses efficacy as renal function declines, not generally used if creat clearance is <30 mL/min
A
thiazide diuretics
22
Q
can use this class for HTN, CHF, nephrogenic diabetes insipidus, and to prevent kidney stones due to hypercalciuria
A
thiazide diuretics
23
Q
Adverse effects: HYPOkalemia, hyperuricemia, hypomagnesemia, impaired carb tolerance, and HYPERglycemia
A
thiazide
24
Q
this class changes urine ionic content: increases the loss of Na, K, and water
A
thiazide
25
adverse effects: hyperlipidemia, hyponatremia (our goal), allergies, weakness, fatigue, parasthesias, impotence, photosensitivity
thiazide
26
this drug is usually combined with loop diuretics for patients with HF who are refractory to loop diuretics alone (given 30 min before lasix)
metolazone
27
this drug requires close monitoring, can cause volume depletion and hypokalemia
metolazone
28
this class acts on the ascending LOH at the chloride pump (can potentially cause a 25-30% reduction in Na content of urine)
loops
29
this class is the most potent diuretic. can be used on pts with renal insufficiency that have failed thiazide
loops
30
this class can increase renal blood flow. Can relieve pulmonary congestion, decrease LV filling pressures before diuresis occurs
loops
31
class causes changes in urine ionic content: increases loss of Na, K ,water, and calcium
loops
32
this class is used for edema (heart failure), hypercalcemia, hyperkalemia, and acute renal failure
loops
33
adverse effects include: hyperuricemia, hyperglycemia, hypovolemia, hypotension, potassium and magnesium depletion, allergic reactions, and ototoxicity
loops
34
this drug is a synthetic steroid antagonist of aldosterone. It inhibits Na resorption and K secretion in collecting tubules
spironolactone
35
this drug is effective as an antiHTN, but limited use due to hyperkalemia
spironolactone
36
Can be used to treat primary and secondary aldosteronism. Also, it can blunt the potassium wasting tendencies of other diuretics
spironolactone
37
Adverse effects include gynocomastia, menstrual irregularities, hyperkalemia, and hyperchloremic metabolic acidosis
spironolactone
38
this drug directly inhibits sodium flux through the ion channels of the collecting tubule
triamterene
39
therapeutic uses: blunt K wasting tendencies of other diuretics, HTN. It is a weak diuretic alone, and is usually combined with thiazides
triamterene
40
adverse effects include hyperkalemia, hyperchloremic metabolic acidosis, and kidney stones
triamterene
41
all diuretics interact with this class of drug
NSAIDs
42
cholestyramine and sucralfate decrease the absorption of this diuretic
furosemide (loop)
43
Drug interactions include ACE I, digoxin, and diabetic medications
loop and thiazide diuretics
44
potassium sparing diuretics interact with this drug class
ACEI
45
this class blocks the conversion of angiotensin I to angiotensin II, resulting in vasodilation of vascular smooth muscle
ACEI
46
this class reduces PVR without a reflexive increase in CO, HR, or contractility
ACEI
47
this class stimulates the synthesis of vasodilatory prostaglandins. It decreases aldosterone, H20, and Na retention. Inhibits breakdown of bradykinin
ACEI
48
DO NOT USE in pregnancy or renovascular HTN
ACEI
49
Adverse effects: dry cough, altered taste, rashes, fever, hyperkalemia, elevations in SCr and BUN, hypotension and first dose syncope, and angioedema
ACEI
50
this class blocks the angiotensin II receptors competitively inhibiting angiotensin II binding to AT1 receptors. Blocks pressor and aldosterone-releasing effects causing vasodilation and decreased PVR
Angiotensin II antagonists
51
this class inhibits angiotensin II generated from all pathways, but DO NOT stimulate the synthesis of vasodilatory compounds
ARBs
52
This class is indicated for HTN and CHF. It is renal protective in patients with DM and may be considered first line
ARBs
53
DO not use in pregnancy or renal artery stenosis
ARBs
54
ADRs: rash, altered taste, hyperkalemia, elevated SCr BUN
ARB
55
this ARB reduces uric acid
losartan
56
this class causes reduction in HR, contractility, BP, and suppresses sympathetic nervous system activity
Beta blockers
57
therapeutic uses include ischemic heart disease, heart failure, dysrhythmias, and HTN
BB
58
this class of BB shows partial agonist activity- less reduction in resting HR, CO, and BP
intrinsic sympathomimetic activity (ISA)
59
contraindications include severe asthma, severe bradycardia, heart block, and overt HF
BB
60
Adverse effects include fatigue, lethargy, insomnia, depression, bronchoconstriction, cold extremities, sexual dysfunction, decrease HDL increase LDL, bradycardia. Abrupt withdrawal may precipitate MI
BB
61
block the inward movement of Ca by binding to L-type calcium, resulting in smooth muscle relaxation and arteriolar dilation
CCB
62
Therapeutic effects include coronary and peripheral vasodilation, negative inotropic and chronotropic effects. Alleviate coronary vasospasm
CCB
63
Used in HTN, ischemic heart disease, and dysrhythmias
CCB (dysrhythmias are non-dihydropyridinies only)
64
this drug is indicated for angina, HTN, supraventricular tachyarrhythmias, and migraines. Effects both cardiac and vascular smooth muscle
verapamil
65
this CCB effects cardiac and vascular smooth muscle but has less negative inotropic effects than verapamil, so fewer SEs
diltiazem
66
these CCBs have a great affinity for vascular cells IN THE PERIPHERY and does not effect cardiac contractility
dihydropyridines
67
these CCBs are beneficial for decreasing PVR but may induce reflex tachycardia
dihydropyridines
68
second generation dyhydropyridines- very effective and widely used
amlodipine and felodipine
69
this class of CCB can cause hypotension, dizziness and peripheral edema
dihydropyridines
70
this class of CCB can cause hypotension, dizziness, constipation, bradycardia, and exacerbation of HF
non-dihydropyridines
71
these drugs have no effect on blood sugar or lipids
CCB
72
this class is contraindicated in hypotension and immediate release in CV indications in adult pts due to cardiac ischemia
dihydropyridines
73
this class is contraindicated in severe bradycardia, hypotension, heart block, or overt HF. Careful in patients taking beta blockers (can cause AV block or heart failure)
non-dihydropyridines
74
this drug increases plasma digoxin levels
verapamil
75
this class lowers MAP by causing relaxation of both arterial and venous smooth muscle. Causes minimal changes in CO, renal blood flow, and GFR
alpha 1 receptor antagonists
76
this class is primarily used for BPH. Not used much for HTN (inferior to diuretics, postural hypotension, and first dose syncope)
alpha 1 receptor antagonists
77
caution in pts with poorly controlled angina w/o beta blocker and incontinence
alpha 1 receptor antagonists
78
ADRs: first dose syncope, dizziness, HA, postural hypotension, weakness, nausea, palpitations
alpha 1 receptor antagonists
79
alpha 2 agonist- causes inhibition of NE causing vasodilation. reduce activity of vasomotor center in the brian (reduced symp activity, vasodilation)
clonidine
80
this drug does not decrease renal BF or GFR- agent of choice for pts with chronic renal disease
clonidine
81
Indicated in HTN, drug withdrawl, and side effects associated with neuroleptics
clonidine
82
ADRs: dry mouth, sedation, depression, hypotension, sexual dysfunction, urinary retention, constipation, and dizziness. ABRUPT withdrawal can cause severe HTN
clonidine
83
analogue of levodopa- gets converted to methylnorepinepherine centrally decreases adrenergic outflow from the CNS. (acts as an alpha 2 agonist to decrease symp outflow)
methyldopa
84
agent of choice in HTN pts with chronic renal disease and pregnancy
methyldopa
85
this class directly acts on vascular smooth muscle, primary arterioles to decrease tone. Involves a decrease in calcium entry and mobilization of intracellular calcium stores
hydralazine
86
this is used for moderate to severe HTN- needs to be given with diuretic acid and a sympatholytic drug
hydralazine
87
ADRs include HA, nausea, anorexia, palpitations. Higher doses produce high incidence of symptoms that resemble lupus erythematosus
hydralazine
88
this class can be used as monotherapy or combo with diuretics or ARBs
aliskiren
89
this class inhibits generation of angiotensin I- preventing the formation of angiotensin II and reducing activation of all AT receptors
aliskiren
90
this drug does not inhibit bradykinin breakdown like ACEI
aliskiren
91
contraindicated in pregnancy- risk of fetal death or injury. DC ASAP (cat C in first trimester, D in second and third)
aliskiren
92
ADRs include angioedema, diarrhea, HA, cough, and an increase in SrCr
aliskiren
93
competitive inhibitor of CYP3A4. Interacts with atorvastatin and ketoconazole. Decreased efficacy of furosemide
aliskiren
94
DOC for HTN in pregnancy
methyldopa or labetalol (hydralazine if IV)
95
isolated systolic HTN
SBP > 140, DBP <90
96
goal treatment of iso systolic HTN
SBP< 140
97
DOC iso systolic HTN
thiazide diuretic
98
severely elevated BP without end organ damage
hypertensive urgency
99
severely elevated BP associated with acute and ongoing organ damage in the brain, kidneys, heart, eyes, or vascular system. (end organ damage; DBP usually >/= 130)
hypertensive emergency
100
Treat hypertensive urgency
(hours to days) clonidine, captopril, labetolol
101
treat hypertensive emergency
(minutes to hours) IV nitroprusside
102
this is a prodrug that decompensates to NO, causing vasodilation. Dilates both arteries AND veins (reduced TPR and venous return)
nitroprusside
103
this drug has an immediate onset of action (1-2 minutes). Can cause HA, dizziness, nausea, and palpitations
nitroprusside
104
metab of this drug results in cyanide production. Can administer thiosulfate to counteract
nitroprusside
