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Naplex 2025 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What are the 2 types of Hypertension?

A
  • Primary [Unknown of the cause but many risks]
  • Secondary [caused by underlying issues; renal disease, sleep apnea, adreanel issues]
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2
Q

What is important to know about the neurohormonal pathways?

A
  • SNS & RAAS when activated will increase the BP
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3
Q

Wha

What are some drugs that can increase blood pressure [sympathomimetic]?

A
  • ADHD Drugs [amphetamines…]
  • Decogestatnts [Pseudophedrine…]
  • Recreatinla substances [Cocaine, Caffiene…]
  • Antidepressants [TCAs, SNRIs, MAOi]
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4
Q

What are some drugs that increase blood pressure by increasing Na+ and H20 Retention?

A
  • NSAIDs, Immunosuppressives, Systemic Steroids
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5
Q

What are the four catergories of BP fromt he ACC/AHA?

A
  • Normal: < 120 / < 80 mmHg
  • Elevated: 120 - 129 / < 80 mmHg
  • Stage 1 HTN: 130 - 139 OR 80 - 89 mmHg
  • Stage 2: >140 OR > 90
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6
Q

What is the MOA of the Thiazide Diuretucs?

A
  • Inhibits Na reabsorption in the distal tubule, causing increase excretion of Na, Cl, H20, K
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7
Q

What are the 2 thiazides that are used?>

A
  • Chlorthalidone 12.5-25mg daily
  • Hydrochlorothiazide 12.5-50mg daily
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8
Q

What are the contraindications for the Thiazides>

A
  • Hypersensitivity to sulfonamides
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9
Q

What are the Side effects to thiazides?

A
  • Decrease in K, Mg, Na
  • Increase in Ca, UA, LDL, TG, BG
  • Photosensitivity, Impotence
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10
Q

What is the monitoring for the Thiazides>?

A
  • Electrolytes, Renal function
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11
Q

What are some important notes about the Thiazides?

A
  • Decreased effect when CrCl < 30
  • Take in AM to not pee at night
  • Cholorthiazide is IV
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12
Q

What are the 2 types of Calcium Channel Blockers and what do they effect?

A
  • DHP [Selective for vascular smooth muscle that causes vasodilation = decrease BP]
  • Non-DHP [Selective for Myocardium; causing (-) inotropic and choronotrpic effects = decreased contraction and HR]
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13
Q

What are the DHPs used for?

A
  • HTN
  • Angina
  • Raynauds Phenomenon
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14
Q

What are the DHPs that are used?

“-pine”

Brand/Generic

A
  • Amlodipine [Norvasc]
  • Nicardipine [Cardene IV]
  • Nifedipine [Procardia XL]
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15
Q

What are the warnings for the DHP CCBs?

A
  • Hypotension
  • Worsening angina and/or MI, Hepatic impairment
  • Nifedipine IR should NOT be used for chronic HTN in NON-pregnant adults = better in pregnancy
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16
Q

What are the side effects of DHP CCBs?

A
  • Perihperal Edema, Headache, Flushing, Palputations, Reflex Tachycardia, Gingival Hyperpalsia
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17
Q

What are some important notes for the DHP CCBs?

A
  • Amlodipine is safe in HFrEF
  • Nifedipine ER is DOC in Pregnancy
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18
Q

What is the MOA for the Non-DHP CCBs?

A
  • Help control the Myocardium; causing negative inotropic activity [decrease contraction] and chronotropic activity [decrease HR]
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19
Q

What are the Non-DHP CCBs?

Brand/Generic

A
  • Verapimil [Calan SR]
  • Diltiazem [Cardazem, Tiazac]
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20
Q

What are the warnings for Non-DHP CCBs?

A
  • Heart Failure may worsen, bradycardia
  • Hypotension, liver injury
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21
Q

What are the side effects for Non-DHP CCBs?

A
  • Constipation [V], Gingival Hyperplasia
  • Edema [D], Headache, Dizziness
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22
Q

What are some of the drug interactions for both DHP and Non-DHP CCBs?

A
  • Non-DHP: caution with Beta-blockers, digoxin, clonidine, amiodarone [decrease HR]
  • CCBs: 3A4 interactions –> NO grapefruits
  • Non-DHP: P-gp & 3A4 can increase conc. of other drug [like statins; taking sim or lova should have lower doses[
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23
Q

Is are the 3 classes of Renin-Angiotensin-Aldosterone System Inhibitors?

A
  • ACEi
  • ARBs
  • Aliskiren
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24
Q

What are some other disease states that ACEi/ARBs could be used in?

A
  • Chronic Kidney Disease [slows progression by blocking vasoconstriction of effernet arteriole]
  • Heart Faliure [protect myocardium from remodeling due to Ang II and improces survival]
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25
What is the MOA of the ACEi?
- Block the conversion of Ang I --> Ang II; decrease vasoconstriction and aldosterone - Also blocks bradykinin
26
What are the ACEi that are more commonly used? ## Footnote Brand/Generic
- Benazepril [Lotensin] - Enalapril [Vasotec] - Lisinopril [Zestril] - Quinapril [Accupril] - Ramipril [Altace]
27
What are the Boxed Warnings for the ACEi and ARBs?
- Injury or death to fetus; DC ASAP when pregnant
28
What are the contraindications for the ACEi and ARBs?
- DO NOT use if Hx of Angioedema - DO NOT use with 36 h of Entresto [ACE to ARNI] - DO NOT use with aliskern w/ diabetes
29
What are some of the warnings for ACEi and ARBs?
- Angioedema, Hypotension, Hyperkalemia, Renal Impairment - Olmensartan: severe diarrhea with wieght loss
30
What is one of the main side effects with ACEi and ARBs?
- Cough [because of the blocking of bradykinin]
31
What is the Direct Renin Inhibitor that is used>
- Aliskiren
32
What is the MOA for Aliskiren?
- Directly inhibits Renin, preventing Ang I from being made = NO Ang II
33
# MOA What are some of the drug interactions for the RAAS? ## Footnote -
- ALL: Risk of Hyperkalemia - DO NOT use more than one together - NSAIDS: use with caution with RAAS [Renal issues] - Switching to entresto; 36 h wash out for ACEi - ACE/ARB decrease lithium clearance [increase toxicity]
34
What are the potassium sparing diuretics that are used?
- Triamterene and Amiloride [Driectly block Na Channels in Distal tubule and Collecting duct; increasing Na and H20 Reabsorption] - **Spironolactone** and Eplereone [Directly inhibits Aldosterone]
35
When are Triamterene and Amiloride most common used?
- When the patient is taking a Thiazide [helps conserve the potassium]
36
What are some of disease that Spironolactone and Eplerenone used in?
- Resistant Hypertension [DHP + Thiazide + ACE/ARB not working] - Heart Failure [1st line] ## Footnote Spiro [non-selective & blocks androgen] Epler [selective]
37
What is the Boxed Warning for the Potassium-Sparing Diuretics?
- HYPERKALEMIA [more with Triamterne & Amiloride]
38
What are the contraindications for Potassium-Sparing Diuretics? ## Footnote -
- Hyperkalemia, renal impairment, Addison's Disease [Spiro]
39
What are the side effects for the Potassium-Sparing Diuretics?
- Hyperkalemia, Increased Scr, Dizziness - Spiro: Gynecomastia,Breast Tenderness, Impotence
40
What are some monitoring for Potassium-Sparing Diuretics?
- BP - K - Renal Function - Fluid Status
41
What are the MOA of Beta-Blockers?
- Competivitly inhibit Beta 1 [Heart: decrease in HR and contractility = decrease BP] and/or Beta 2 [Lung: causing bronchospasms (not used in those with COPD or astham]
42
What is important to know about the beta blockers with Intrinsic sympathmimetic activity and which drugs have this?
- Acebutolol, Pindolol - Partially stimulate Beta at rest and blocking catecholamines [good for those with braydcardia but NOT for those post-MI
43
When should Beta-Blockers be used in HTN?
- NOT FIRST LINE; really only used when other comorbidity are present [post-MI, Angina, HF] - Bisoprolol, Carvediol, Metoprolol S are best in HFrEF
44
What are the Beta-1 Selectives that are used? ## Footnote Brand/Generic
- Atenolol [Tenormin] - Esmolol [Brevibloc] - Metoprolol Tartrate [Lopressor] & Metoprolol Succinate [Tropol XL]
45
What are the Boxed Warning for Beta 1 selectives, Beta 1 & 2 Selective and Non-Selective?
- AVOID STOPPING ABRUPTLY
46
What is the contraindication for the Beta 1 Selectives, Beta 1 & 2 and non-selectives?
- Severe bradycardia - Asthma in Non-selectives
47
What are the warnings for Beta 1 selectives, Beta 1 & 2 and Non-selectives?
- Caution in Diabetes [Masks Hypoglycemia], COPD/Asthma, Raynauds
48
What are the side effects of Beta-1 Selectives, Beta 1 & 2 and Non-selectives?
- Bradycardia, Hypotension, CNS effects [fatigue, dizziness, depression] impotence
49
What are some inportant notes about the Beta-1 selectives?
- Metoprolol T & S should be taken with food - Metoprolol T IV =/= to PO [1:2.5] - Metoprolol S can be cut in have but NOT chewed or crushed
50
What is the 1 Beta 1 selective blocker with nitric oxide
- Nebivolol [Bystolic]
51
What are the Beta 1 & 2 blockers that are used? ## Footnote Brand/Generic
- Propranolol [Indreal LA & XL] - Nadolol [Corgard]
52
What are some other important things to note about the Beta 1 & 2 Blockers?
- Propranolol is highly lipid soluble making it useful in non cardio things - Non-selectives can prevent hemorrhage in those with portal HTN
53
What are the 2 Non-Selective Beta Blokcers and Alpha-1 Blockers that are used? ## Footnote Brand/Generic
- Carvedilol [Coreg] - Labetalol
54
What is important to know about Labetalol?
- Drug of choice in Pregnany
55
What are some of the drug interactions for the Beta Blockers?
- Caution when giving with Non-DHP, Digoxin, clonidine, Amiodarione [DECREASE HR] - Beta Blockers can mask hypoglycemic episodes
56
What are the Centrally-acting Alpha 2 adrenergic agonist that are used? ## Footnote Brand/Generic
- Clonidine [Patch = Catapres-TTS; ADHD = Kapvay] - Gaunfacine ER [Intuniv = ADHD] - Methyldopa
57
What are the Warnings for the a2 agonist?
- DO NOT stop abruptly; could cuase rebound tachycardia - Methyldopa: Risk of Hemolytic anemia
58
What are the side effects for the a2 agonist?
- Clonidine/Guanfacine: Dry mouth, somnolence, dizziness, fatigue, constipation, decrease HR, hypotension, impotence - Methyldopa: DILE [Drug induced lupus]
59
What are some important notes about the a2 agonst?
- Clonidine Patch: apply weekly and take it off before MRIs - Methlydopa: Good in pregnancy
60
What is the MOA for the Direct vasodilators>
- Causes direct vasodilation on arterioles; decreasing BP and HR
61
What are the Direct Vasodilatior that are used>
- Hydralazine - Minoxidil
62
What are the Warnings for Hydralazine?
- DILE [Drug induced Lupus]
63
What are the side effects for Hydralazine>
- Perupheral Edema - Headache - Flushing - Palpitations - Reflex Tachycardia
64
What is the Boxed warning for Minoxidil?
- POTENT vasodilator
65
What are the side effects of Minoxidil? ## Footnote -
- Hair Growth - Tachycardia - Fluid Retention

Naplex 2025 (57 decks)

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