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Hypertension Flashcards

1
Q

What’s the most common SE caused by diuretics?

A

Increase urination

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2
Q

What’s the most common SE caused by ACE-I?

A

Cough

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3
Q

What’s the most common SE caused by CCB, esp if high doses are used?

A

Edema

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4
Q

What’s normal BP according to classification of BP in adults according to JNC 7?

A

< 120/80 mmHg

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5
Q

What’s pre-HTN according to classification of BP in adults according to JNC 7?

A

120-139/80-89

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6
Q

What’s stage 1 HTN according to classification of BP in adults according to JNC 7?

A

140-159/90-99

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7
Q

What’s stage 2 HTN according to classification of BP in adults according to JNC 7?

A

> = 160/100

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8
Q

What’s the compelling tx for HTN pt with HF?

A

ACE-I, ARB, BB, Diuretic, Aldosterone antagonist

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9
Q

What’s the compelling tx for HTN pt with S/P MI?

A

ACE-I, BB, Aldosterone antagonist

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10
Q

What’s the compelling tx for HTN pt with High risk of CAD?

A

ACE-I, BB, Diuretic, CCB

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11
Q

What’s the compelling tx for HTN pt with DM?

A

ACE-I, ARB, BB, Diuretic, CCB

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12
Q

What’s the compelling tx for HTN pt with CKD?

A

ACE-I, ARB

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13
Q

What’s the compelling tx for HTN pt with recurrent stroke prevention?

A

ACE-I, Diuretic

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14
Q

Drugs that can cause/ worsen HTN?

A

ACTH, Alcohol (excessive), Amphetamines, Appetite suppressants

Caffeine, Calcineurin antagonists (Cyclosporine), Corticosteroids

Decongestants (e.g Pseudoephedrine)

Erythropoietin Stimulating Agents, Estrogen

Herbals (bitter orange, ephedra (ma-huang), ginseng, Guarana, SJW)

Mirabegron (Myrbetriq)

NSAIDs

Oncology drugs (Bevacizumab (Avastin), Sorafenib (Nexavar))

SNRIs (Duloxetine and Venlafaxine - at higher doses)

Thyroid hormone (if given too much)

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15
Q

According to JNC 8, whats the BP goal in general population (w/o DM or CKD) < 60 yrs? All ages, DM present? All ages, CKD present?

A

< 140/90mmHg

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16
Q

According to JNC 8, whats the BP goal in general population (w/o DM or CKD) >= 60 yrs?

A

< 150/90mmHg

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17
Q

What’s the recommended initiation drug for non-black (all ages, DM present)?

A

Thiazides or ACE-I or ARB or CCB

Alone or in combo

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18
Q

What’s the recommended initiation drug for blacks (all ages, DM present)?

A

Thiazides or CCB

Alone or in combo

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19
Q

What’s the recommended initiation for ALL ages, all races, with CKD present?

A

ACE-I or ARB

Alone or in combo with other drug class

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20
Q

What’s defined as high risk in HTN pts?

A

DM

CKD

Known CAD or CAD equivalent (carotid artery dx, PAD, abdominal aortic aneurysm)

10yr Framingham risk score > 10%

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21
Q

What’s the BP goal for general CAD prevention based on AHA guidelines? Drug of choice?

A

< 140/90

Any drug or combo

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22
Q

What’s the BP goal for high CAD risk based on AHA guidelines? Drug of choice?

A

< 130/80

ACE-I or ARB or CCB or Thiazide diuretic or combo

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23
Q

What’s the BP goal for stable angina based on AHA guidelines? Drug of choice?

A

< 130/80

BB and ACE-I or ARB

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24
Q

What’s the BP goal for unstable angina/NSTEMI based on AHA guidelines? Drug of choice?

A

< 130/80

BB (if pt is hemodynamically stable) and ACE-I or ARB

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25
Q

What’s the BP goal for STEMI based on AHA guidelines? Drug of choice?

A

< 130/80

BB (if pt is hemodynamically stable) and ACE-I or ARB

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26
Q

What’s the BP goal for LVD based on AHA guidelines? Drug of choice?

A

< 120/80

ACE-I or ARB and BB and Aldosterone Antagonist and Thiazide or loop diuretic and hydralazine/Isosorbide dinitrate (black pts)

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27
Q

Should lifestyle modifications be encouraged if needed?

A

Yes!

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28
Q

Lifestyle modifications wrt WEIGHT that should be encouraged in HTN?

A

Maintain normal BMI and waist circumference

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29
Q

Lifestyle modifications wrt EATING that should be encouraged in HTN?

A

Recommend DASH (dietary approaches to stop HTN) eating plan

Which is high in fruits and vegetables and recommended low-fat dairy products with reduced saturated and total fat

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30
Q

Lifestyle modifications wrt SODIUM INTAKE that should be encouraged in HTN?

A

Limit Na to =< 2.4 gm/day

Lower may be beneficial

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31
Q

Lifestyle modifications wrt PHYSICAL ACTIVITY that should be encouraged in HTN?

A

Engage in regular aerobic physical activity such as brisk walking (at least 30 min per day, most days of the week)

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32
Q

Lifestyle modifications wrt ALCOHOL consumption that should be encouraged in HTN?

A

Women - 1 drink/day

Men - 2 drinks/day

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33
Q

Lifestyle modifications wrt SMOKING that should be encouraged in HTN?

A

Smoking cessation

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34
Q

What should be controlled in HTN pts to reduce cardiovascular dx risk?

A

Control BG and Lipids

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35
Q

When’s Furosemide (loop diuretic) mostly used?

A

Heart failure

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36
Q

What may happen if Furosemide (loop) is used long-term? Supplement to use while on furosemide?

A

They can lower bone density

K supplements

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37
Q

Where do thiazides work on nephron?

A

Distal convoluted tubule of nephron (inhibit Na reabsorption)

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38
Q

Where do loops work on nephron?

A

Ascending loop by blocking Na reabsorption

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39
Q

List agents under Thiazdes?

A

Chlorothiazide (Diuril)

Chlorthalidone (Thalitone)

Hydrochlorothiaze (Microzide - capsule; Oretic - tablet)

Indapamide

Metolazone (Zaroxolyn)

Methylclothiazide

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40
Q

What’s the brand name of Chlorthalidone (Thiazide diuretic)?

A

Thalitone

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41
Q

What’s the brand name of Hydrochlorothiazide capsule and tablet (Thiazide diuretic)?

A

Capsule - Microzide

Tablet - Oretic

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42
Q

What’s the point at which not much clinical benefit is seen in both Chlorthalidone (Thalitone) and Hydrochlorothiaze (Microzide - capsule; Oretic - tablet)?

A

> 25-50mg/ day

Though, max is 100mg/d

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43
Q

SEs of Thiazides?

A

Hypokalemia (can be avoided by regular intake of K rich foods)

Hyponatremia, Hypomagnesemia

Hyperuricemia (increase UA)

Elevated lipids (increase CH and TG)

Hyperglycemia

Hypercalcemia

Dizziness

Photosensitivity

Rash

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44
Q

Which Thiazide is effective in pts with reduced renal fxn?

A

Metolazone

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45
Q

List loop diuretics agents (used mainly in HF)

A

Furosemide (LASIX) PO, IV

Bumetanide PO, IV

Torsemide (Demadex) PO, IV

Ethacrynic acid (Edecrin) PO, IV

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46
Q

What’s the brand name of Furosemide PO, IV (loop diuretics)?

A

Lasix

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47
Q

What’s the oral loop dose equivalency of Furosemide (Lasix)?

A

40mg

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48
Q

What’s the oral loop dose equivalency of Bumetanide?

A

1mg

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49
Q

What’s the oral loop dose equivalency of Torsemide (Demadex)?

A

20mg

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50
Q

What’s the oral loop dose equivalency of Ethacrynic (Edecrin)?

A

50mg

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51
Q

What’s the warning associated with loop diuretics?

A

Sulfa allergy

Doesn’t apply to Ethacrynic acid (Edecrin)

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52
Q

Which loop diuretics does the sulfa allergy not apply to?

A

Ethacrynic acid (Edecrin)

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53
Q

SEs of loop diuretics?

A

Orthostatic hypotension

Hypokalemia, reduced Na, Mg, Cl, Ca

Metabolic acidosis

Hyperuricemia

Elevated lipids (increase CH and TG)

Hyperglycemia

Photosensitivity

Ototoxicity, including hearing loss, tinnitus and vertigo

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54
Q

What’s the difference btw effect of Thiazide and loop on Ca?

A

Thiazide => hypercalcemia

Loop=> hypocalcemia

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55
Q

Which loop causes the most Ototoxicity?

A

Ethacrynic acid (Edecrin)

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56
Q

List potassium-sparing diuretics

A

Amiloride (Midamor)

Triamterene (Dyrenium)

Spironolactone (Aldactone)

Eplerenone (Inspra)

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57
Q

What’s the brand name of Triamterene + HCTZ?

A

Maxzide

Maxzide-25

Dyazide

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58
Q

What’s the brand name of Eplerenone?

A

Inspra

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59
Q

CI to potassium-sparing diuretics?

A

Renal impairment (CrCl < 30ml/min)

Hyperkalemia

Eplerenone concomitant use of strong 3A4 inhibitors

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60
Q

SEs to potassium-sparing diuretics?

A

Hyperkalemia

Increased serum creatinine

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61
Q

SEs specific to Spironolactone (Aldactone)?

A

Gynecomastia

Breast tenderness

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62
Q

Monitoring of potassium-sparing diuretics?

A

Check K before starting and frequently thereafter

BP

SCr/BUN

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63
Q

In what class of people is angioedema for the use RAAS inhibitors most common?

A

Black pts

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64
Q

T/F? If a person has had angioedema with any 1 of these agents, ACE-I, ARB or Aliskiren, then all others are CI?

A

T

Bcuz angioedema can get fatal very quickly

Counsel to report any swelling of lips, mouth, tongue, face or neck immediately

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65
Q

Are RAAS inh (ACE-I, ARB or Aliskiren) CI in pregnancy?

A

Yes

D/c drugs as soon as pregnancy is detected

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66
Q

List ACE-I agents

A

Benazepril (Lotensin)

Captopril (Capoten)

Enalapril, Enalaprilat IV injection (Vasotec)

Fosinopril

Lisinopril (Prinivil, Zestrin)

Moexipril (Univasc)

Perindopril (Aceon)

Quinapril (Accupril)

Ramipril (Altace)

Trandolapril (Mavik$

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67
Q

What’s the brand name of Benazepril (ACE-I)?

A

Lotensin

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68
Q

What’s the brand name of Enalapril, Enalaprilat IV injection (ACE-I)?

A

Vasotec

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69
Q

What’s the brand name of Lisinopril (ACE-I)?

A

Prinivil

Zestril

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70
Q

What’s the brand name of Quinapril (ACE-I)?

A

Accupril

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71
Q

What’s the brand name of Ramipril (ACE-I)?

A

Altace

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72
Q

Howz Captopril (Capoten) taken?

A

1 hr before meals

73
Q

How’s Moexipril (Univasc) taken?

A

On an empty stomach

74
Q

Black box warning of ACE-I/ ARB/ Aliskiren (direct renin inh)?

A

D/c as soon as pregnancy is detected

75
Q

CI of ACE-I/ ARB?

A

Angioedema

Bilateral renal artery stenosis

Can’t used concurrently with Aliskiren in pts with DM

76
Q

In what grp of pts can’t ACE-I/ARB be used concurrently with Aliskiren?

A

Pts with DM

77
Q

SEs of ACE-I/ ARB/ Aliskiren (direct renin inh)?

A

Cough

Hyperkalemia

Angioedema (d/c drug if it occurs)

Hypotension

78
Q

Which SEs are specific to Captopril (Capoten) use - ACE-I?

A

Taste perversion

Rash

79
Q

Monitoring of ACE-I/ ARB/ Aliskiren (direct renin inh)?

A

BP

K

Renal fxn

80
Q

Pregnancy cat of ACE-I/ ARB/ Aliskiren (direct renin inh)?

81
Q

List ARB agents

A

Valsartan (Diovan)

Losartan (Cozaar)

Irbesartan (Avapro)

Candesartan (Atacand)

Olmersartan (Benicar)

Telmisartan (Micardis)

Eprosartan (Teveten)

Azilsartan (Edarbi)

82
Q

What’s the brand name of Valsartan? ARB

83
Q

What’s the brand name of Losartan? ARB

84
Q

What’s the brand name of Olmesartan? ARB

85
Q

MOA of direct renin inhibitor?

A

Directly inhibits renin, which is responsible for conversion of angiotensin to angiotensin I, a potent vasoconstrictor, thereby reducing BP

86
Q

List agent under direct renin inhibitor

A

Aliskiren (Tektuma)

87
Q

CI to Aliskiren (direct renin inh) use?

A

Don’t use concurrently with ACE-I or ARBS in pts with diabetes

Angioedema

Bilateral renal artery stenosis

88
Q

Effect of all RAAS inh on K?

A

All increase risk of HYPERkalemia

89
Q

Which BB indicated for HTN only?

90
Q

BB with intrinsic sympathomimetic activity (ISA)?

A

CAPP

Carteolol

Acebutolol

Penbutolol

Pindolol

91
Q

Place in therapy for BB with intrinsic sympathomimetic activity (ISA) - CAPP?

A

Pts with excessive bradycardia who need BB therapy

Don’t reduce HR as much as other beta-blockers

92
Q

List Beta-1 selective agents

A

AMEBBA

Atenolol

Metoprolol

Esmolol

Bisoprolol

Betaxolol

Acebutolol

93
Q

Which BB has more CNS SEs? Why?

A

Propranolol

Has high lipid solubility (lipophilic) and crosses BBB

94
Q

Which BB should be with food?

A

Carvedilol, even CR version

95
Q

Is Carvedilol CR same as Carvedilol IR?

A

CR is less bioavailable than IR

96
Q

What’s the 1st line tx for HTN in pregnancy?

A

Labetalol

Nifedipine

Methyldopa

97
Q

Whys Propranolol used in stage fright?

A

Can cover up sx of shakiness, palpitations and anxiety (with hyperglycemia)

Occurs mostly in non-selective bb

98
Q

List bb selective agents?

A

AMEBBA

Acebutolol (Sectral)

Atenolol (Tenormin)

Betaxolol

Bisoprolol (Zebeta)

Metoprolol tartate (Lopressor)

Metoprolol Succinate ext-release (Toprol XL)

99
Q

What’s the brand name of Atenolol? (Beta1-selective blockers)?

100
Q

What’s the brand name of Metoprolol tartrate? (Beta1-selective blockers)?

101
Q

What’s the brand name of Metoprolol succinate ext-release? (Beta1-selective blockers)?

102
Q

Most common SE of Beta1-selective blockers?

A

Reduced HR

Hypotension

Fatigue

Dizziness

103
Q

Monitoring of Beta1-selective blockers?

104
Q

How should bb be stopped?

A

Must taper

105
Q

Which metoprolol is taken with food?

A

Metoprolol tartrate (Lopressor)

106
Q

Are IV doses of Beta1-selective blockers equivalent to PO doses?

107
Q

Which bb is both B-1 selective blocker and Nitric Oxide-Dependent vasodilation?

A

Nebivolol (Bystolic)

108
Q

What’s the brand name of Nebivolol? (B-1 selective blocker and Nitric Oxide-Dependent vasodilation)

109
Q

SEs of Nebivolol (Bystolic)? (B-1 selective blocker and Nitric Oxide-Dependent vasodilation)

A

Headaches

Fatigue

110
Q

List non-selective bb (B1 & B2)

A

Carteolol

Nadolol (Corgard)

Penbutolol (Levatol)

Pindolol

Propranolol (Inderal LA, InnoPran XL)

Timolol

111
Q

What’s the brand name of Propranolol? (Non-selective bb)

A

Inderal LA

InnoPran XL

112
Q

List bb that are non-selective alpha- and beta-blocker

A

Carvedilol (Coreg, Coreg CR)

Labetalol (Trandate)

113
Q

Brand name of Carvedilol (non-selective alpha- and beta-blocker)?

A

Coreg

Coreg CR

114
Q

Brand name of Labetalol (non-selective alpha- and beta-blocker)?

115
Q

How should all forms of Carvedilol be taken?

116
Q

Types of CCBs?

A

Dihydropyridines

Non-dihydropyridines

117
Q

Where does dihydropyridine work?

118
Q

List dihydropyridine CCBs

A

Amlodipine (Norvasc)

Felodipine (Plendil)

Isradipine ER (daily) and IR (BID)

Nisoldipine ER (Sular)

Nisoldipine ER

Nicardipine ER (Cardene SR)
Nicardipine IR (Cardene) TID
Nicardipine IV (Cardene)
119
Q

Brand name of Amlodipine (dihydropyridine CCBs)?

120
Q

Brand name of Nifedipine ER (dihydropyridine CCBs)?

A

Adalat CC

Procardia XL

Afeditab CR

121
Q

Brand name of Nicardipine IV (dihydropyridine CCBs)?

122
Q

SEs of Dihydropyridine CCBs?

A

Peripheral edema

Headache

Flushing

Tachycardia/reflex

Gingival hyperplasia

123
Q

Monitoring of Dihydropyridine CCBs?

A

Peripheral edema

124
Q

Which Dihydropyridine CCBs is used in inpatient acute care?

A

Clevidipine (Cleviprex)

125
Q

Non-Dihydropyridine CCBs?

A

Inhibit Ca2+ ions from entering the “slow” channels or voltage-sensitive areas of vascular smooth muscle and myocardium = VD

126
Q

List Non-Dihydropyridine CCBs agents

A

Diltiazem

Verapamil

127
Q

SEs of Non-Dihydropyridine CCBs?

A

Edema

Headache

AV block

Bradycardia

Hypotension

Arrhythmias

HF

Constipation (more verapamil)

Gingival hyperplasia

128
Q

Uses of Clonidine?

A

Most commonly used for resistant HTN and in pts who can’t swallow

129
Q

List agents under Centrally-Acting Alpha2 Agonist

A

Clonidine (Catapres; Catapres-TTS patch$

Guanabenz

Guanfacine (Tenex)

Methyldopa

130
Q

Brand name of Clonidine (Centrally-Acting Alpha2 Agonist)?

A

Catapres

Catapres-TTS patch

131
Q

SEs of Centrally-Acting Alpha2 Agonist?

A

Bradycardia

Dry mouth

Drowsiness

Sedation

Lethargy

Hypotension

Depression

Psychotic rxns

Nasal stuffiness

Sexual dysfxn

132
Q

How often is Clonidine patch (Catapress-TTS) applied?

133
Q

List direct vasodilators agents

A

Hydralazine

Minoxidil

134
Q

SEs of direct vasodilators (Hydralazine and Minoxidil)?

A

Headache

Reflex tachycardia

Palpitations

Anorexia

Rare - lupus-like syndrome

135
Q

List alpha blockers agents

A

Prazosin (Minipress)

Terazosin (Hytrin)

Doxazosin (Cardura, Cardura XL)

136
Q

What’s the brand name of Terazosin (Alpha blockers)?

137
Q

What’s the brand name of Doxazosin (Alpha blockers)?

A

Cardura

Cardura XL

138
Q

What’s the brand name of Amlodipine + Benazepril? Classes?

A

Lotrel

ACE-I and CCB

139
Q

What’s the brand name of Lisinopril + HCTZ? Classes?

A

Prinzide

Zestoretic

ACE-I and Diuretic

140
Q

What’s the brand name of Losartan + HCTZ? Classes?

A

Hyzaar

ARB and diuretic

141
Q

What’s the brand name of Valsartan + HCTZ? Classes?

A

Diovan HCT

ARB and diuretic

142
Q

What’s the brand name of Olmesartan + HCTZ? Classes?

A

Benicar

ARB and diuretic

143
Q

What’s the brand name of Bisoprolol + HCTZ? Classes?

A

Ziac

BB and diuretic

144
Q

What’s the brand name of Triamterene + HCTZ? Classes?

A

Dyazide, Maxzide

Diuretic and diuretic

145
Q

What’s HTN urgency?

A

BP (gen >= 180/110-120) w/o acute target organ damage

146
Q

Tx of HTN urgency?

A

Oral med with onset of action of 15-30 mins

Reduce BP gradually over 24-48 hr

147
Q

What’s HTN emergency?

A

BP (gen >= 180/110-120) + acute target organ damage (such as encephalopathy, MI, unstable angina, pulmonary edema, eclampsia, stroke, aortic dissection)

148
Q

Tx of HTN emergency?

A

Reduce MAP by no more than 25% (within mins to 1 hr)

If stable, to 160/100-110 mmHg within the next 2-6 hrs

Use IV meds

149
Q

List drugs used in HTN urgencies

A

Captopril (Capoten)

Clonidine (Catapres)

Labetalol (Trandate)

150
Q

What’s the dose of Captopril (Capoten) and SEs used in HTN urgencies?

A

Captopril (Capoten) 25mg, repeat in 1-2 hrs PRN

Hypotension, high K, angioedema

151
Q

What’s the dose of Clonidine (Catapres) and SEs used in HTN urgencies?

A

Clonidine (Catapres) 0.1-0.2mg, repeat in 1-2 hrs PRN

Hypotension, drowsiness, sedation, dry mouth etc

152
Q

What’s the dose of Labetalol (Trandate) and SEs used in HTN urgencies?

A

Labetalol (Trandate) 100-400mg, repeat in 2-3 hrs PRN

Hypotension, heart block, bronchoconstriction

153
Q

Drugs used in HTN emergencies?

A

Clevidipine (Cleviprex) - DHP-CCB

Sodium Nitroprusside (Nitropress) - Arteriole & Venous VD

Nicardipine (Cardene) - DHP-CCB

Fenolodopam (Corlopam) - Dopamine-1 receptor agonist

NTG - venous vasodilator

Enalaprilat (Vasotec IV) - ACE-I

Hydralazine - Arteriole vasodilator

Labetalol (Trandate) - Alpha&beta blocker

Esmolol (Brevibloc) - bb

154
Q

Look at pt counseling on pg 573 and 574

155
Q

What’s in the drug Exforge?

A

Amlodipine + Valsartan

156
Q

What BP med is C/I with Sodium Polystyrene Sulfonate (Kayexalate)? Why?

A

ACE-I, ARBs and DRI

These meds increase potassium (cause hyperkalemia)… SPS (Kayexalate) is used to treat hyperkalemia

157
Q

MOA of Clonidine?

A

Alpha-2 AGONIST => reduces norepinephrine release

158
Q

List BP meds not used with grapefruit/ grapefruit juice?

A

Cardizem LA (Diltazem)

Calan SR (Verapamil)

Dilt-XR (Diltazem hydrochloride extended release)

159
Q

SE of Clonidine?

A

Can worsen Constipation, Depression, Fatigue

160
Q

Effect of Diltazem and Verapamil on hepatic metabolism of other drugs?

A

CYP 3A4 inhibitor

161
Q

How should BP be lowered in HTN emergency?

A

10-15% in next hr

162
Q

What’s the new SE of Olmesartan (added in 2013, in addition to ARB SE)?

A

Sprue-like enteropathy

163
Q

Which SE is unique to Verapamil?

A

Constipation

164
Q

Is cough a common SE of ARBs?

A

No!

Cough is ACE-I

165
Q

What makes up Lotrel?

A

Amlodipine and Benazepril

166
Q

What makes up Exforge?

A

Amlodipine and Valsartan

167
Q

What makes up Lotensin HCT?

A

Benazepril and HCTZ

168
Q

What makes up Prinzide (also called Zestoretic)?

A

Lisinopril and HCTZ

169
Q

What makes up Hyzaar?

A

Losartan and HCTZ

170
Q

What makes up Micardis HCT?

A

Telmisartan and HCTZ

171
Q

What makes up Diovan HCT?

A

Valsartan and HCTZ

172
Q

What makes up Benicar HCT?

A

Olmesartan and HCTZ

173
Q

What makes up Ziac?

A

Bisoprolol and HCTZ

174
Q

What makes up Dyazide (also called Maxzide)?

A

Triamterene and HCTZ

175
Q

What’s the conversion of Carvedilol IR to Carvedilol CR?

A

3.125mg BID (Coreg) = 10mg daily (Coreg CR)

176
Q

Which BP med is considered safe in pregnancy?

177
Q

What BP med is the drug of choice for HTN patient with aortic dissection?

A

Beta-blocker

178
Q

What’s the most common SE caused by BB?

A

Fatigue (and sometimes sexual problems)

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