Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Therapeutics 2 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What classifies normal blood pressure?

A

<120mmHg/<80mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What classifies elevated blood pressure?

A

120-129mmHg/<80mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the classification of stage 1 hypertension?

A

130-139mmHg/80-89mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the classification of stage 2 hypertension?

A

140+ mmHg/ 90+ mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is Isolated Systolic Hypertension (ISH)?

A

a condition in which SBP is 130+ mmHg, but DBP is < 80 mmHg that is associated with increased risk of cardiovascular events, stroke, and kidney disease progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the relationship between blood pressure and CV morbidity/mortality?

A

there is a strong correlation between BP and CV morbidity and mortality
-the risk of negative outcomes is lowest at a BP of 115/75mmHg
-above 115/75mmHg, with each increment of 20mmHg SBP or 10 mmHg DBP, the risk of CV DOUBLES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is primary hypertension?

A

aka essential HTN and accounts for 95% of cases, linked to: genetics, environmental factors, and aging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are causes of secondary HTN?

A

-chronic kidney disease
-renovascular disease
-primary aldosteronism
-obstructive sleep apnea
-pheochromocytoma
-cushing’s syndrome
-hyper/hypothyroididm
-coarctation of the aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What substance/drugs may elevate blood pressure?

A

-alcohol
-antidepressants
-caffeine
-calcineurin inhibitors
-cocaine, amphetamines, other illicit drugs
-corticosteroids
-dietary supplements
-erythropoietin
-hormones
-NSAIDs, COX inhibitors
-oral decongestants
-stimulants
-vascular endothelial growth factor inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the complications associated with hypertension?

A

-heart disease
-stroke or transient ischemic attack (TIA)
-nephropathy/chronic kidney disease (CKD)
-retinopathy
-peripheral arterial disease (PAD)
-carotid artery disease (CAD)
-aortic aneurysm (AA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are modifiable risk factors for hypertension?

A

-current cigarette smoking and/or secondhand smoke exposure
-diabetes mellitus (DM)
-dyslipidemia
-overweight/obesity
-physical inactivity
-unhealthy diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the relatively fixed risk factors for hypertension?

A

-CKD
-family history
-increased age
-low socioeconomic/educational status
-male sex
-obstructive sleep apnea
-psychosocial stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is blood pressure diagnosed?

A

use proper blood pressure technique and obtain 2 readings obtained on 2 or more occasions to estimate and classify BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the optimal BP for someone with hypertension and <65 yo?

A

<130/80 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the target BP for someone with DM?

A

<130/80 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the target BP for someone with Kidney Disease?

A

SBP < 120 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the optimal BP for someone with hypertension and >65 yo?

A

140/90 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is treatment for a pt with stage 1 HTN and ASCVD risk < 10%?

A

nonpharm therapy only and reassess in 3-6 months and initiate drug therapy if not at goal by 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is treatment for a pt with stage 1 HTN and ASCVD risk > 10% OR pt has DM or CKD?

A

initiate drug therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is treatment for a pt with stage 2 HTN?

A

initiate drug therapy with at least 2 medications from different drug classes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the treatment for secondary prevention of HTN?

A

initiate drug therapy (typically at 130/80) where the number and type of drugs are influenced by co-morbid conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What drugs are Thiazides and Thiazide-like Diuretics?

A

-cholorothiazide
-hydrochlorothiazide
-chlorothalidone
-indapamide
-metolazone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the mechanism of action of Thiazide Diuretics?

A

blocks sodium (Na+) reabsorption in the distal tubule -> increased Na+/H2O excretion, K+ excretion, and decreased blood volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the adverse effects of Thiazide Diuretics?

A

-hyperuricemia (elevated uric acid)
-hyperglycemia (high blood sugar)
-hypercholesterolemia (high cholesterol)
- hypertriglyceridemia (high triglycerides)
-hypokalemia (low potassium) THIS IS DOSE DEPENDENT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What labs must be monitored when taking Thiazide Diuretics?

A

potassium (K+)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Thiazides + ___________ have been shown to reduce the incidence of recurrent stroke.

A

ACE inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What diuretic may be preferred on the basis of it’s long half-life and proven CVD risk reduction?

A

chlorothalidone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Thiazides are generally ineffective in patients with a eGFR ________.

A

< 30 mL/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Thiazide Diuretics must be used in caution with what disease state?

A

gout, if not on uric acid lowering therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the drug interactions of Thiazide Diuretics?

A

NSAIDs can weaken BP-lowering effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What drugs are Loop Diuretics?

A

-bumetanide
-ethacrynic acid
-furosemide
-torsemide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the mechanism of action of Loop Diuretics?

A

block sodium (Na+) reabsorption in the ascending loop of Henle -> increased Na+/H2O excretion, K+ excretion, and decreased blood volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the adverse effects of Loop Diuretics?

A

-hyperuricemia (high uric acid)
-hyperglycemia (high blood sugar)
-hypercholesterolemia (high cholesterol)
-hypertriglyceridemia (high TG)
-hypokalemia (low potassium) THIS IS DOSE DEPENDENT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What labs must be monitored while taking Loop Diuretics?

A

potassium (K+)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

__________ is preferred for symptomatic relief in patients with heart failure or those at risk for fluid overload.

A

Loop Diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the drug interactions of Loop Diuretics?

A

NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What drugs are Potassium-sparing Diuretics?

A

amiloride and triamterene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What drugs are Aldosterone Antagonists?

A

spironolactone and eplerenone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is the MOA of Potassium-sparing Diuretics?

A

interferes with the potassium sodium exchange in the distal tubule/collecting duct, excretes Na+ and H2O while retaining potassium (K+)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the adverse effects of Potassium-sparing Diuretics?

A

-hyperkalemia (high potassium)
-gynecomastia
-rash
-GI disturbances

41
Q

What disease states should Potassium-sparing Diuretics not be used in?

A

renal dysfunction or pt at risk for hyperkalemia

42
Q

What are the drug interactions of Potassium-sparing Diuretics?

A

-K+ supplements or other K+ sparing diuretics
-ACE inhibitors
-angiotensin II receptor blockers (ARBs)
-direct renin inhibitors

43
Q

Spironolactone is especially useful as __________________________.

A

add-on therapy for patients with treatment resistant HTN

44
Q

What drugs Angiotensin Converting Enzyme Inhibitor (ACEI)?

A

-pril’s
-benazepril
-lisinopril
-ramipril

45
Q

What is the mechanism of action of angiotensin converting enzyme inhibitors (ACEIs)?

A

inhibit angiotensin converting enzyme (ACE), blocking the conversion of Angiotensin I to Angiotensin II which causes increased vasoconstriction, Na+/H2O retention, and increased aldosterone

46
Q

What are the adverse effects Angiotensin Converting Enzyme Inhibitors (ACEIs)?

A

-hyperkalemia
-cough (kinin-mediated)
-angioedema
-acute renal failure in patients with bilateral RAS
-increased fetal mortality

47
Q

What are the monitoring parameters for Angiotensin Converting Enzyme Inhibitors (ACEIs)?

A

-potassium (K+)
-serum creatine

48
Q

What pt may benefit from ACEIs?

A

-pt in the remodeling phase post MI
-high coronary risk pts
-can reduce proteinuria and retard the progression of kidney disease in both diabetic and nondiabetic nephropathy

49
Q

What are the contraindications of ACEIs?

A

-pregnancy and breastfeeding
-bilateral RAS
-history of angioedema secondary to prior ACEI use

50
Q

What are the drug interactions of ACEIs?

A

-K+ supplements
-K+ sparing diuretics
-angiotensin II receptor blockers (ARBs)
-direct renin inhibitors (DRIs)

51
Q

What drugs are Angiotensin II Receptor Blockers (ARBs)?

A

-sartan
-irbesartan
-losartan
-olmesartan
-valsartan

52
Q

What are the contraindications of ARBs?

A

-pt with bilateral RAS
-pregnancy and breastfeeding

53
Q

What is the mechanism of action of Angiotensin II Receptor Blocker (ARBs?

A

directly antagonize angiotensin II receptors, sparing angiotensin converting enzyme (ACE)

54
Q

What are the adverse effects of Angiotensin Receptor Blockers (ARBs)

A

-hyperkalemia (high potassium)
-angioedema
-acute renal failure in patients with bilateral RAS
-increased fetal mortality

55
Q

What are the indications of Angiotensin II Receptor Blocker (ARBs)?

A

-delayed the progression of kidney disease in type 2 DM
-high coronary risk pt, but not demonstrated superiority over ACEIs
-pt who are intolerant to ACEIs due to cough, but NOT angioedema!

56
Q

What are the drug interactions of ARBs?

A

-K+ supplements
-K+ sparing diuretics
-direct renin inhibitors (DRIs)

57
Q

What drugs are Beta Blockers (BBs)?

A

-olol
-atenolol
-metoprolol tartate/succinate
-propranolol

58
Q

What is the mechanism of action of Beta Blockers?

A

directly block adrenergic stimulation of beta receptors resulting in decreased chronotropy and intropy

59
Q

What are the adverse effects of Beta Blockers?

A

-bradycardia
-fatigue
-depression
-decreased exercise tolerance
-bronchospasm
-mask signs and symptoms of hypoglycemia
-insomnia
-impotence
-hypertriglyceridemia
-worsening HF

60
Q

What are the monitoring parameters for ARBs?

A

-potassium (K+)
-serum creatine

61
Q

What are the monitoring parameters for Beta Blockers?

A

heart rate

62
Q

What disease states are Beta Blockers contraindicated in or should be used with caution?

A

-relatively contraindicated in asthma and COPD
-contraindicated in pt with 2nd and 3rd degree heart block
-caution with DM

63
Q

What are the indications of Beta Blockers?

A

no longer recommended as initial therapy for hypertension in the absence of certain co-morbid conditions!
-prevent re-infarction in post-MI pts
-angina
-tachycardia
-Afib
-pt who also have migraines

64
Q

What drugs are Calcium Channel Blockers (CCBs)?

A

-non-DHPs: diltiazem and verapamil
-DPHs: -ipine; amlodipine, nifedipine

65
Q

What is the mechanism of action of Calcium Channel Blockers (CCBs)?

A

impair the transport of calcium through voltage-sensitive calcium channels- NON-DHPs work directly on the myocardium and DHPs work on the peripheral vasculature

66
Q

What are the adverse effects of Calcium Channel Blockers (CCBs)?

A

-peripheral edema (DHP, dose related and more common in women)
-constipation (verapamil is the worst offender)
-bradycardia (non-DHP)
-reflex tachycardia (DPH)

67
Q

What are the monitoring parameters for Calcium Channel Blockers (CCBs)?

A

heart rate

68
Q

What are the indications of Calcium Channel Blockers (CCBs)?

A

effective at lowering BP in all racial/ethnic groups!
-long-acting DHPs reduce CV events and stroke in pt with HTN
-non-DHP may be useful in pt with tachycardia and Afib, but are contraindicated in HFrEF but could be used in HFpEF
-non-DHP reduce proteinuria and can be used if pt are intolerant to ACEI or ARB
-improve GFR and kidney survival following renal transplant

69
Q

What drugs are Alpha1 Blockers?

A

-azosin
-doxazosin
-prazosin
-terazosin

70
Q

What is the mechanism of action of Alpha1 Blockers?

A

inhibit adrenergic stimulation on peripheral alpha1 receptors resulting in reduced peripheral vascular resistance and vasodilation

71
Q

What are the adverse effects of Alpha1 Blockers?

A

-syncope/orthostatic hypotension
-dizziness
-headache
-drowsiness
-reflex tachycardia

72
Q

What drug should Alpha1 Blockers be combined with to be maximally effective?

A

diuretics

73
Q

Alpha1 Blockers may be especially useful if pts have concomitant ________ or in ________ HTN.

A

BPH, treatment resistant

74
Q

What drugs are Alpha-Beta Blockers?

A

-carvedilol
-labetalol

75
Q

What are the adverse effects of Alpha-Beta Blocker?

A

-bradycardia
-orthostatic hypotension
-dizziness
-headache

76
Q

Labetalol, given IV, is used for ____________.

A

hypertensive emergencies

77
Q

What drugs are centrally acting Alpha2 Agonists?

A

clonidine

78
Q

What are the adverse effects of centrally acting Alpha2 Agonists?

A

-drowsiness
-sedation
-fatigue
-depression
-dry mouth
-orthostasis
-bradycardia
-heart block
-rebound hypertension

79
Q

Clonidine, given orally, is used in _____________.

A

hypertensive urgencies

80
Q

What drugs are direct vasodilators?

A

-hydralazine
-minoxidil

81
Q

What are the adverse effects of direct vasodilators?

A

-reflex tachycardia
-headache
-dizziness
-lupus-like symptoms (at high doses)
-edema

82
Q

What is the black box warning associated with Minoxidil?

A

concomitant antihypertensive use needed to prevent tachycardia and edema

83
Q

What drugs are direct renin inhibitors?

A

aliskiren

84
Q

What are the side effects of direct renin inhibitors?

A

-diarrhea
-abdominal pain/dyspepsia
-cough
-angioedema
-rash
-hyperkalemia

85
Q

For black patients, initial treatment for HTN should include __________.

A

thiazide diuretic or calcium channel blocker

86
Q

What drug classes indicated for HTN should be avoided in pregnancy?

A

ACEIs, ARBs, aliskiren

87
Q

What drug classes indicated for HTN should be avoided in pt with recent MI?

A

beta blockers with ISA, atenolol, and DHP calcium channel blockers

88
Q

Define: Hypertensive Urgency

A

BP > 180/120 mmHg and not associated with acute or immediately progressing target organ injury

89
Q

What short acting oral antihypertensives can be given acutely for hypertensive urgencies?

A

-captopril 25-50mg po every 1-2h
-clonidine 0.2mg po every hour
-labetalol 200-400 mg po every 2-3h

90
Q

Define: Hypertensive Emergency

A

BP > 180/120 mmHg and is associated with acute or immediately progressing target organ injury

91
Q

Indication for parenteral drug for hypertensive emergency, clovidipine:

A

calcium channel blocker
-acute pulmonary edema
-perioperative HTN
-acute renal failure

92
Q

Indication for parenteral drug for hypertensive emergency, enalaprilat:

A

ACEI
-acute left ventricular failure
-high plasma renin activity

93
Q

Indication for parenteral drug for hypertensive emergency, esmolol:

A

beta blocker
-aortic dissection
-perioperative
-acute coronary syndrome

94
Q

Indication for parenteral drug for hypertensive emergency, hydralazine:

A

vasodilator
-eclampsia
-preeclampsia

95
Q

Indication for parenteral drug for hypertensive emergency, labetalol:

A

alpha/beta blocker
-acute coronary syndrome
-aortic dissection
-eclampsia
-preeclampsia

96
Q

Indication for parenteral drug for hypertensive emergency, nicardipine:

A

calcium channel blocker
-acute renal failure
-eclampsia
-preeclampsia
-perioperative
-acute sympathetic dischange

97
Q

Indication for parenteral drug for hypertensive emergency, nitroglycerine:

A

vasodilator
-coronary ischemia
-pulmonary edema
-perioperative

98
Q

Indication for parenteral drug for hypertensive emergency, phentoamine:

A

alpha blocker
-acute sympathetic discharge (drug overdoses or clonidine withdrawal)

99
Q

Indication for parenteral drug for hypertensive emergency, sodium nitroprusside:

A

vasodilator
DRUG OF CHOICE
-pulmonary edema

Therapeutics 2 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions