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PHARM exam 3 NURP 422 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

ARBs are best for which type of patient

A

heart failure, post MI, diabetes, chronic kidney disease

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2
Q

MOA of adrenergic antagonists

A

Inhibit sympathetic system by depleting norepinephrine stores in the CNS this results in a decrease in peripheral vascular resistance and a reduction in BP

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3
Q

side effects of thiazides

A

hypokalemia, hypomagnesemia, hypercalcemia, hyperuricemia, hyperglycemia

tinnitus, paresthesia, and cramps, N/V/D, muscle cramps, weakness, sexual dysfunction

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4
Q

1st line treatment for African Americans with or without DM

A

CCB or thiazide

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5
Q

How can you recognize an ACE inhibitor medication?

A
  • pril ending

ie. lisinopril, captopril

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6
Q

MOA of beta blockers. (-olol) drugs

A

Beta-1 receptors are located in the heart, as well as kidneys, and involved in coardiac contractility, rate, and renin release.

Beta blockers bond to beta-1 receptors and are termed cardio selective because they do not interfere or have a major impact on beta-2 receptors

Beta blockers reduce BP by blocking central and peripheral beta receptors which results in decreased cardiac output and sympathetic outflow

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7
Q

central alpha receptor agonists MOA

A

Stimulates the alpha 2 adrenergic receptors in the brain, they block sympathetic activity by binding and activating alpha 2 adenoreceptors, this reduces sympathetic outflow to the heart, thereby decreasing cardiac output and decreasing heart rate and contractility

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8
Q

When should electrolyte labs be re-evaluated after initiation of diuretic treatment?

A

4 weeks into treatment

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9
Q

Calcium Channel Blockers MOA

A

inhibit the movement of calcium ions across the cell membrane, they relax and vasodilator the cardiovascular system

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10
Q

True/False: Over time baroreceptors can adapt to high BP and their responsiveness decreases

A

TRUE

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11
Q

contraindications for direct vasodilators

A

Use with caution in pts with CAD or mitral valve rheumatic heart disease
Hydralazine is associated with lupus like syndrome in high doses, dermatitis, drug fever, peripheral neuropathy

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12
Q

Steps of the Renin-Angiotensin-Aldosterone System

A
  1. Renin released by kidneys
  2. Converts angiotensinogen to angiotensin 1
  3. ACE converts angiotensin 1 to angiotensin 2
  4. Angiotensin 2 stimulates aldosterone release from adrenal gland
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13
Q

How should beta blocker therapy be discontinued?

A

NOT abruptly. tapered gradually over 14 days to prevent withdrawal symptoms which included unstable agina, MI, or even death. patients without CAD could experience tachycardia, palpitations, increased sweating and fatigue

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14
Q

MOA of ACE inhibitors

A

dilate arteries and veins by blocking angiotensin II formation and inhibiting bradykinin metabolism. vasodilation will reduce arterial pressure and affect both preload and afterload of the heart.

it promotes renal excretion of sodium and water by blocking the effects of angiotensin II on the kidney and blocks angiotensin II stimulation of the aldosterone secretion. ultimately it reduces blood volume, venous pressure and arterial pressure.

it inhibits cardiac and vascular remodeling thats associated with chronic hypertension, heart failure, and MI

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15
Q

What are the two major determinants of BP?

A
  1. Cardiac output
  2. Total Peripheral resistance
    CO plus TPR = BP
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16
Q

Which Antihypertensives are considered 1st line for white pts >18yrs with HTN?

A

ACE, ARB, Thiazide, or CCB alone or in combo with another med.

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17
Q

How can you recognize ARBs?

A

-sartan ending

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18
Q

What are some risk factors for Primary HTN?

A 
Obesity
Sedentary
Increased Na intake
Age
Stress
Family history
Smoking
Diabetes
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19
Q

Drawbacks of Potassium sparing diuretics

A

Less diuresis than the others
Hyperkalemia
Hirsuitism, gynecomastia, menstrual irregularities

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20
Q

The JNC 8 goal for DM pts regardless of race is less than

A

140/90

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21
Q

MOA of nondihydropyridines CCBs

  • verapamil
    diltiazem (Cardizem)
A

decrease heart rate and slow cardiac conduction at the AV node

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22
Q

What are the common side effects of antihypertensives?

A

HA
Dizziness, syncope
Hypotension

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23
Q

Which pts would benefit from potassium sparing diuretics

A

Pts with heart failure is its true benefit but can be used for HTN

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24
Q

potential treatment for patients with heart failure and/or post MI

A

ACE inhibitors

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25
Q

which class of HTN can cause depression that may result from decreased catecholamine and serotonin levels in CNS

A

Adrenergic antagonists

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26
Q

CCBs are indicated for which patients?

A

Indicated for diabetic patients as well as those with coronary artery disease

Effective for HTN in African American population

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27
Q

JNC8 recommend treatment in elderly 60 and older for BP less than

A

150/90

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28
Q

Which drugs shouldn’t be given with ACE inhibitors?

A

Diuretics (spironolactone)
Lithium; causes lithium toxicity
NSAIDS; causes HTN to worsen

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29
Q

contraindications for central alpha receptor agonists

A

Use cautiously in pts with severe coronary insufficiency, conduction disturbances, recent MI, cerebrovascular disease, renal failure

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30
Q

List some factors that affect BP besides CO and TPR

A 
Blood viscosity
Heart rhythm, rate and contractility
Blood vessel elasticity, diameter, thickness
PNS and SNS
Vasopressin/Antidiuretic hormone
Baroreceptors
Renin-Angiotensin-aldosterone system 
(**Mean Arterial Pressure does not affect BP)
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31
Q

MOA of ARBs (angiotensin II receptor blockers)

A

they block the vasoconstriction and aldosterone-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the receptor

they dilate arteries and veins and reduce artierla pressure, effective on preload and afterload. down regulates sympathetic andrenergic activity by blocking the effects of angiotensin II on the sympathetic nerve release and reuptake of norepinephrine
promotes renal excretion of sodium and water by blocking the effects of angiotensin II in the kidney and blocking angiotensin II stimulation of aldosterone secretion

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32
Q

Which HTN med can cause a uric acid retention and should be cautioned in patients with gout?

A

Thiazides

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33
Q

What is an additional use for Nondihydropyridine CCBs other than HTN?

diltiazem, verapamil

A

Because of negative inotropic effects:
A.fib (antiarrhythmic effects)
Angina
SVT

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34
Q

Side effects for CCbs

A

Flushing, headache, excessive hypotension, edema, reflex tachycardia- most commonly seen in the dihydropyridines

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35
Q

What labs should you do before starting an antihypertensive?

A

Baseline BP, Basic metabolic panel (BUN, creatinine, glucose)

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36
Q

MOA of thiazide diuretics

A

increase the urinary excretion of sodium and chloride in equal amounts. inhibit reabsorption of sodium and chloride in the ascending loop of Henle and distal tubules

The resulting diuresis with thiazides yields a decreased plasma volume. it affects stroke volume as well as CO, long term, the reduction in peripheral vascular resistance.

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37
Q

contraindications of loop diuretics

A

high doses are contraindicated in pts with hyperlipidemia, gout, diabetes
pts who are anuric, those who are hypersensitive to these or sulfonylureas, pts with hepatic coma or states of severe electrolyte depletion
Ethacrynic acid is contraindicated in infants

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38
Q

which HTN med is first line treatment in pregnancy

A

labetalol

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39
Q

Where are the two angiotensin 2 receptor sites?

A
  1. vessel walls (vasoconstriction purposes)

2. adrenal cortex (aldosterone release purposes)

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40
Q

Which Antihypertensive is best to avoid in diabetes? Why?

A

Beta blockers; mask the early signs of hypoglycemia

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41
Q

Contraindications for thiazide diuretics

A

in patients with a creatinine clearance of less than 30 ml/min or those who have renal decompensation or hypersensitive to thiazides or sulfonamides

42
Q

1st line HTN med for CKD

A

ACE or ARB

43
Q

MOA for alpha blockers - doxazosin, prazosin, terazosin

A

Block the effect of the sympathetic nerves on blood vessels by binding to alpha adrenergic located receptors on smooth muscles. Act as a competitive agonist by boinding to norepinephrine that is released by sympathetic nerves

44
Q

What are common causes of secondary HTN?

A 
Oral contraceptives
Hypothyroidism
Cocaine/other stimulants
CKD
Sleep apnea
Pheochromocytoma
45
Q

MOA of potassium sparing diuretics

A

they interfere with sodium reabsorption at the distal tubules in the kidney, and reduce potassium excretion

46
Q

Which antihypertensive class is considered the GOLD STANDARD?

A

ACE inhibitors

47
Q

T/F Most patients with primary HTN have increased peripheral resistance and normal CO

A

TRUE

48
Q

What population does CCB medications work especially well on?

A

Blacks

49
Q

Which labs should be taken before use of Diuretics?

A 
BUN
Creatinine
Electrolytes
Uric acid
Glucose
50
Q

side effects of direct vasodilators

A 
Reflex tachycardia (use concurrent betablocker, headache, fluid retention (use concurrent diuretic), hypertension
-Hydralazine is associated with lupus like syndrome in high doses, dermatitis, drug fever, peripheral neuropathy
51
Q

Beta blockers should be reserved for which patients

A

post MI or CHF patients, not considered first line therapy for HTN

52
Q

Which Antihypertensives are best for patients with diabetes/CKD? Why?

A

ACE inhibitors and ARBs; renal protective

53
Q

are loop diuretics safe in pregnancy? lactation?

A

safe in pregnancy but lactation safety has yet to be established

54
Q

What physiological changes happen with high BP?

A

Baroreceptors cause vasodilation
SNS inhibited and PNS increased
Decreased HR, contractility

55
Q

treatment of alpha blockers is good for which patient

A

Pts with benign prostatic hypertrophy, usually not prescribed for solely HTN tx

56
Q

side effects of central alpha receptor agonists

A

Fluid retention or sedation, potential bradycardia, dry mouth, abrupt cessation can cause elevated BP

First dose can cause dizziness and syncope

57
Q

Which Antihypertensives are considered 1st line for pts >18yrs with CKD and diabetes?

A

ACE or ARB alone or in combo. with another med

*pt’s with diabetes with no CKD are the same as the rest of the population >18 with HTN

58
Q

1st line HTN med for pediatrics if lifestyle modification has failed

A

ACE inhibitors

59
Q

side effects of loop diuretics

A

concerned about electrolytes, monitor for low potassium, magnesium and hyperglycemia, as well as low calcium

60
Q

1st line HTN med for DM

A

ACE or ARB considered cornerstone therapy

61
Q

Which Antihypertensives are considered 1st line for black pts >18yrs with HTN?

A

Thiazide or CCB alone or in combo with another med

62
Q

side effects of ARBs

A

hypotension, fatigue, dizziness, upper respiratory infections and viral infections, can develop a cough, sinusitis and pharyngitis *lower rate of cough and lower risk of angioedema compared to ACEI

63
Q

Which antihypertensives are best to use in pt’s with heart failure?

A

ACE/ARB + BB + Diuretic + spironolactone

64
Q

____ are the treatment of choice in patients with heart failure, post MI, clinical coronary artery disease, diabetes, chronic kidney disease, as well as recurrent stroke prevention

A

ACE inhibitors

65
Q

Which type of pts would benefit from loop diuretics

A

indicated in the presence of edema associated with CHF, hepatic cirrhosis, renal disease. This class is useful when greater diuresis is desired compared to thiazides.

Should be reserved for HTN pts with renal insufficiency or need more diuresis, have a Crcl less than 30

66
Q

What 2 alterations to therapy can you make if goal BP is not met?

A
  1. Max out single dose of single drug
  2. Add 2nd drug
    * If BP is very high initially can start with 2 drugs and choose one to modify
67
Q

Which population is most likely to have isolated systolic HTN?

A

Elderly; indicates atherosclerosis

68
Q

Side effects of potassium sparing diuretics

A

hyperkalemia, hyponatremia menstrual irregularities, gynecomastia

69
Q

Beta blockers in pregnancy?

A

Avoid in early pregnancy d/t risk of fetal growth retardation, avoid atenolol in lactation

70
Q

Hypertension in >60 years

A

150/90 or higher

71
Q

side effects of ACE inhibitors

A

dry cough, dizziness, risk of angioedema (African americans), hyperkalemia, hypotension

72
Q

What is considered first line management for hypertension

A 
maintain appropriate body weight
DASH diet (low fat, low sodium)
restriction of sodium
120minutes/week acitivity
reduce alcohol consumption
73
Q

Side effects of beta blockers

A

fatigue, drowsiness, bradycardia, AV conduction abnormalities, development of CHF.
*masking of hypoglycemic symptoms- important for diabetic pts to know

74
Q

Which drugs should NOT be given in conjunction with Nondihydropyridines?

A

Drugs that further decrease HR (digoxin, beta blockers)

75
Q

adult patients with HTN and DM, pharmacologic treatment should be started after BP is ____ regardless of age

A

140/90

76
Q

Which CCB is most often used for HTN and why?

A

Amlodipine; few side effects

77
Q

MOA of direct vasodilators
-hydralazine
minoxidil

A

Causes arterial smooth muscle relaxation resulting in a lowered BP

78
Q

MOA of loop diuretics

A

Inhibit the reabsorption of sodium and chloride but not only in proximal and distal tubules but also in the loop of henele.

79
Q

Which Antihypertensive is best for patients with migraines or anxiety?

A

Beta blockers (decrease SNS)

80
Q

pts who should avoid potassium sparing diuretics

A

pts with potassium levels of more than 5 mEq/L, have renal insufficiency or diabetes and in patients receiving concurrent treatment with ACE inhibitor, NSAIDS, or potassium supplements

81
Q

Which other HTN medication can Dihydropyridine CCBs be safely used in combo therapy with?

A

Beta Blockers

82
Q

alpha blockers are contraindicated in which patients

A

Avoid in patients with cardiovascular disease due to increases in mortality

83
Q

dihydropyridines MOA of CCB

A

potent vasodilators, all the -pines

84
Q

which central alpha receptor agonist can result in severe rebound HTN if abruptly discontinued, can cause potential cognitive changes in older adults

A

clonidine

85
Q

hypertension in <60 years

A

140/90 or higher

86
Q

T/F: CCBs should not be given to patients with heart failure due to their inotropic effect

A

TRUE; except amlodipine (more for nondyhidropyridines)

87
Q

CCBs, especially verapamil and diltiazem are contraindicated in which patients?

A

Avoid in patients with heart failure, left ventricular systolic dysfunction why? Bc EF < 45%, bradycardia

88
Q

_____ is recommended for women diagnosed with HTN during pregnancy

A

methyldopa

89
Q

types of hypertension

A

primary (essential)- 95% have this- causes is unknown, environment and genetic components
secondary (idiopathic)- CKD, renovascular, hypothyroidism, hyperparathyroidism, primary aldosteronism, medications can increase BP such as birth control, nicotine, steroids, appetite suppressants, andidepressants, nasal decongestants

90
Q

Which diuretic has the greatest diuresis effect and is specifically indicated for heart failure, cirrhosis and renal disease?

A

Loop Diuretics

*K sparing also used for these but to a lesser degree

91
Q

Are ACE inhibitors acceptable during pregnancy?

A

NO. they’re considered teratogenic

92
Q

Which Antihypertensives are best for patients who have had past MIs?

A

ACE in./ARB or Beta blockers

93
Q

Which component of the renin-angiotensin-aldosterone system acts as a potent vasoconstrictor?

A

Angiotensin 2

94
Q

side effects of alpha blockers include

A

Dizziness, orthostatic hypertension, d/t loss of reflex and vasoconstriction upon standing
Nasal congestion, headache, reflex tachycardia, fluid retention- use diuretic in conjunction
vivid dreams, depression

95
Q

what is the goal of antihypertensive therapy?

A

to manage hypertension and reduce cardiovascular disease (including lipid disorders, glucose intolerance or diabetes, obesity, and smoking ) and renal disease

96
Q

After when is HTN diagnosed

A

after 3 confirmed readings at least 1 week apart. BP should be obtained after the patient has had time to relax for at least 5 minutes, chair feet on floor uncrossed, not driving caffeine an hour prior. diagnosis should be confirmed at an additional patient visit 1-4 weeks after first measurement

97
Q

Why would you use an ARB over an ACE? Why would you choose an ACE over an ARB?

A

ARBs used when pt can’t tolerate ACE in.

ARBs are more expensive than ACE inhibitors

98
Q

contraindications of ACE inhibitors

A

pts with bilateral renal artery stenosis, or unilateral b/c of risk of acute renal failure.

Not recommended in combination with ARBs

pts with hx of angioedema

99
Q

Contraindications for betablockers

A

avoid in pts with sinus bradycardia, asthma, COPD, heart blocks, or every cardiac failure

Use cautiously in patients with PVD, claudication, systolic CHF, diabetes, depression or reactive airway disease

100
Q

contraindications for ARBs

A

pregnancy due to concerns of fetus, don’t use in combination with ace inhibitors or renin inhibitors.

101
Q

T/F: ACE inhibitors are prodrugs converted to active form in the liver and intestines

A

TRUE (captopril and lisinopril are safe in liver disease)

PHARM exam 3 NURP 422 (5 decks)

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