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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 12.5-50mg 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
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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”

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
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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?

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
Q

What is the MOA of the ACEi?

A
  • Block the conversion of Ang I –> Ang II; decrease vasoconstriction and aldosterone
  • Also blocks bradykinin
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26
Q

What are the ACEi that are more commonly used?

A
  • Benazepril [Lotensin]
  • Enalapril [Vasotec]
  • Lisinopril [Zestril]
  • Quinapril [Accupril]
  • Ramipril [Altace]
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27
Q

What are the Boxed Warnings for the ACEi and ARBs?

A
  • Injury or death to fetus; DC ASAP when pregnant
28
Q

What are the contraindications for the ACEi and ARBs?

A
  • DO NOT use if Hx of Angioedema
  • DO NOT use with 36 h of Entresto
  • DO NOT use with aliskern & diabetes
29
Q

What are some of the warnings for ACEi and ARBs?

A
  • Angioedema, Hypotension, Hyperkalemia, Renal Impairment
  • Olmensartan: severe diarrhea with wieght loss
30
Q

What is one of the main side effects with ACEi and ARBs?

A
  • Cough [because of the blocking of bradykinin]
31
Q

What is the Direct Renin Inhibitor that is used>

A
  • Aliskiren
32
Q

What is the MOA for Aliskiren?

A
  • Directly inhibits Renin, preventing Ang I from being made = NO Ang II
33
Q

MOA

What are some of the drug interactions for the RAAS?

-

A
  • 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
Q

What are the potassium sparing diuretics that are used?

A
  • 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
Q

When are Triamterene and Amiloride most common used?

A
  • When the patient is taking a Thiazide [helps conserve the potassium]
36
Q

What are some of disease that Spironolactone and Eplerenone used in?

A
  • Resistant Hypertension [DHP + Thiazide + ACE/ARB not working]
  • Heart Failure [1st line]

Spiro [non-selective & blocks androgen]
Epler [selective]

37
Q

What is the Boxed Warning for the Potassium-Sparing Diuretics?

A
  • Amiloride & Triamterene: HYPERKALEMIA
38
Q

What are the contraindications for Potassium-Sparing Diuretics?

-

A
  • Hyperkalemia, renal impairment, Addison’s Disease [Spiro]
39
Q

What are the side effects for the Potassium-Sparing Diuretics?

A
  • Hyperkalemia, Increased Scr, Dizziness
  • Spiro: Gynecomastia,Breast Tenderness, Impotence
40
Q

What are some monitoring for Potassium-Sparing Diuretics?

A
  • BP
  • K
  • Renal Function
  • Fluid Status
41
Q

What are the MOA of Beta-Blockers?

A
  • 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
Q

What is important to know about the beta blockers with Intrinsic sympathmimetic activity and which drugs have this?

A
  • Acebutolol, Pindolol
  • Partially stimulate Beta at rest and blocking catecholamines [good for those with braydcardia but NOT for those post-MI
43
Q

When should Beta-Blockers be used in HTN?

A
  • NOT FIRST LINE; really only used when other comorbidity are present [post-MI, Angina, HF]
  • Bisoprolol, Carvediol, Metoprolol S are best in HFrEF
44
Q

What are the Beta-1 Selectives that are used?

A
  • Atenolol [Tenormin]
  • Esmolol [Brevibloc]
  • Metoprolol Tartrate [Lopressor] & Metoprolol Succinate [Tropol XL]
45
Q

What are the Boxed Warning for Beta 1 selectives, Beta 1 & 2 Selective and Non-Selective?

A
  • AVOID STOPPING ABRUPTLY
46
Q

What is the contraindication for the Beta 1 Selectives, Beta 1 & 2 and non-selectives?

A
  • Severe bradycardia
  • Asthma in Non-selectives
47
Q

What are the warnings for Beta 1 selectives, Beta 1 & 2 and Non-selectives?

A
  • Caution in Diabetes [Masks Hypoglycemia], COPD/Asthma, Raynauds
48
Q

What are the side effects of Beta-1 Selectives, Beta 1 & 2 and Non-selectives?

A
  • Bradycardia, Hypotension, CNS effects [fatigue, dizziness, depression] impotence
49
Q

What are some inportant notes about the Beta-1 selectives?

A
  • 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
Q

What is the 1 Beta 1 selective blocker with nitric oxide

A
  • Nebivolol [Bystolic]
51
Q

What are the Beta 1 & 2 blockers that are used?

A
  • Propranolol [Indreal]
  • Nadolol [Corgard]
52
Q

What are some other important things to note about the Beta 1 & 2 Blockers?

A
  • Propranolol is highly lipid soluble making it useful in non cardio things
  • Non-selectives have prevent hemorrhage in those wiht portal HTN
53
Q

What are the 2 Non-Selective Beta Blokcers and Alpha-1 Blockers that are used?

A
  • Carvedilol [Coreg]
  • Labetalol
54
Q

What is important to know about Labetalol?

A
  • Drug of choice in Pregnany
55
Q

What are some of the drug interactions for the Beta Blockers?

A
  • Caution when giving with Non-DHP, Digoxin, clonidine, Amiodarione [DECREASE HR]
  • Beta Blockers can mask hypoglycemic episodes
56
Q
A
57
Q

What are the Centrally-acting Alpha 2 adrenergic agonist that are used?

A
  • Clonidine [Patch = Catapres-TTS; ADHD = Kapvay]
  • Gaunfacine ER [Intuniv = ADHD]
  • Methyldopa
58
Q

What are the Warnings for the a2 agonist?

A
  • DO NOT stop abruptly; could cuase rebound tachycardia
  • Methyldopa: Hemolytic anemia
59
Q

What are the side effects for the a2 agonist?

A
  • Clonidine/Guanfacine: Dry mouth, somnolence, dizziness, fatigue, constipation, decrease HR, hypotension, impotence
  • Methyldopa: DILE [Drug induced lupus]
60
Q

What are some important notes about the a2 agonst?

A
  • Clonidine Patch: apply weekly and take it off before MRIs
  • Methlydopa: Good in pregnancy
61
Q

What is the MOA for the Direct vasodilators>

A
  • Causes direct vasodilation on arterioles; decreasing BP and HR
62
Q

What are the Direct Vasodilatior that are used>

A
  • Hydralazine
  • Minoxidil
63
Q

What are the Warnings for Hydralazine?

A
  • DILE [Drug induced Lupus]
64
Q

What are the side effects for Hydralazine>

A
  • Perupheral Edema
  • Headache
  • Flushing
  • Palpitations
  • Reflex Tachycardia
65
Q

What is the Boxed warning for Minoxidil?

A
  • POTENT vasodilator
66
Q

What are the side effects of Minoxidil?

-

A
  • Hair Growth
  • Tachycardia
  • Fluid Retention

Naplex 2025 (10 decks)

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