Hypertension Flashcards
1
Q
What’s the most common SE caused by diuretics?
A
Increase urination
2
Q
What’s the most common SE caused by ACE-I?
A
Cough
3
Q
What’s the most common SE caused by CCB, esp if high doses are used?
A
Edema
4
Q
What’s normal BP according to classification of BP in adults according to JNC 7?
A
< 120/80 mmHg
5
Q
What’s pre-HTN according to classification of BP in adults according to JNC 7?
A
120-139/80-89
6
Q
What’s stage 1 HTN according to classification of BP in adults according to JNC 7?
A
140-159/90-99
7
Q
What’s stage 2 HTN according to classification of BP in adults according to JNC 7?
A
> = 160/100
8
Q
What’s the compelling tx for HTN pt with HF?
A
ACE-I, ARB, BB, Diuretic, Aldosterone antagonist
9
Q
What’s the compelling tx for HTN pt with S/P MI?
A
ACE-I, BB, Aldosterone antagonist
10
Q
What’s the compelling tx for HTN pt with High risk of CAD?
A
ACE-I, BB, Diuretic, CCB
11
Q
What’s the compelling tx for HTN pt with DM?
A
ACE-I, ARB, BB, Diuretic, CCB
12
Q
What’s the compelling tx for HTN pt with CKD?
A
ACE-I, ARB
13
Q
What’s the compelling tx for HTN pt with recurrent stroke prevention?
A
ACE-I, Diuretic
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)
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
16
Q
According to JNC 8, whats the BP goal in general population (w/o DM or CKD) >= 60 yrs?
A
< 150/90mmHg
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
18
Q
What’s the recommended initiation drug for blacks (all ages, DM present)?
A
Thiazides or CCB
Alone or in combo
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
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%
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
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
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
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
25
What's the BP goal for STEMI based on AHA guidelines? Drug of choice?
< 130/80
BB (if pt is hemodynamically stable) and ACE-I or ARB
26
What's the BP goal for LVD based on AHA guidelines? Drug of choice?
< 120/80
ACE-I or ARB and BB and Aldosterone Antagonist and Thiazide or loop diuretic and hydralazine/Isosorbide dinitrate (black pts)
27
Should lifestyle modifications be encouraged if needed?
Yes!
28
Lifestyle modifications wrt WEIGHT that should be encouraged in HTN?
Maintain normal BMI and waist circumference
29
Lifestyle modifications wrt EATING that should be encouraged in HTN?
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
30
Lifestyle modifications wrt SODIUM INTAKE that should be encouraged in HTN?
Limit Na to =< 2.4 gm/day
Lower may be beneficial
31
Lifestyle modifications wrt PHYSICAL ACTIVITY that should be encouraged in HTN?
Engage in regular aerobic physical activity such as brisk walking (at least 30 min per day, most days of the week)
32
Lifestyle modifications wrt ALCOHOL consumption that should be encouraged in HTN?
Women - 1 drink/day
Men - 2 drinks/day
33
Lifestyle modifications wrt SMOKING that should be encouraged in HTN?
Smoking cessation
34
What should be controlled in HTN pts to reduce cardiovascular dx risk?
Control BG and Lipids
35
When's Furosemide (loop diuretic) mostly used?
Heart failure
36
What may happen if Furosemide (loop) is used long-term? Supplement to use while on furosemide?
They can lower bone density
K supplements
37
Where do thiazides work on nephron?
Distal convoluted tubule of nephron (inhibit Na reabsorption)
38
Where do loops work on nephron?
Ascending loop by blocking Na reabsorption
39
List agents under Thiazdes?
Chlorothiazide (Diuril)
Chlorthalidone (Thalitone)
Hydrochlorothiaze (Microzide - capsule; Oretic - tablet)
Indapamide
Metolazone (Zaroxolyn)
Methylclothiazide
40
What's the brand name of Chlorthalidone (Thiazide diuretic)?
Thalitone
41
What's the brand name of Hydrochlorothiazide capsule and tablet (Thiazide diuretic)?
Capsule - Microzide
Tablet - Oretic
42
What's the point at which not much clinical benefit is seen in both Chlorthalidone (Thalitone) and Hydrochlorothiaze (Microzide - capsule; Oretic - tablet)?
> 25-50mg/ day
Though, max is 100mg/d
43
SEs of Thiazides?
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
44
Which Thiazide is effective in pts with reduced renal fxn?
Metolazone
45
List loop diuretics agents (used mainly in HF)
Furosemide (LASIX) PO, IV
Bumetanide PO, IV
Torsemide (Demadex) PO, IV
Ethacrynic acid (Edecrin) PO, IV
46
What's the brand name of Furosemide PO, IV (loop diuretics)?
Lasix
47
What's the oral loop dose equivalency of Furosemide (Lasix)?
40mg
48
What's the oral loop dose equivalency of Bumetanide?
1mg
49
What's the oral loop dose equivalency of Torsemide (Demadex)?
20mg
50
What's the oral loop dose equivalency of Ethacrynic (Edecrin)?
50mg
51
What's the warning associated with loop diuretics?
Sulfa allergy
Doesn't apply to Ethacrynic acid (Edecrin)
52
Which loop diuretics does the sulfa allergy not apply to?
Ethacrynic acid (Edecrin)
53
SEs of loop diuretics?
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
54
What's the difference btw effect of Thiazide and loop on Ca?
Thiazide => hypercalcemia
Loop=> hypocalcemia
55
Which loop causes the most Ototoxicity?
Ethacrynic acid (Edecrin)
56
List potassium-sparing diuretics
Amiloride (Midamor)
Triamterene (Dyrenium)
Spironolactone (Aldactone)
Eplerenone (Inspra)
57
What's the brand name of Triamterene + HCTZ?
Maxzide
Maxzide-25
Dyazide
58
What's the brand name of Eplerenone?
Inspra
59
CI to potassium-sparing diuretics?
Renal impairment (CrCl < 30ml/min)
Hyperkalemia
Eplerenone concomitant use of strong 3A4 inhibitors
60
SEs to potassium-sparing diuretics?
Hyperkalemia
Increased serum creatinine
61
SEs specific to Spironolactone (Aldactone)?
Gynecomastia
Breast tenderness
62
Monitoring of potassium-sparing diuretics?
Check K before starting and frequently thereafter
BP
SCr/BUN
63
In what class of people is angioedema for the use RAAS inhibitors most common?
Black pts
64
T/F? If a person has had angioedema with any 1 of these agents, ACE-I, ARB or Aliskiren, then all others are CI?
T
Bcuz angioedema can get fatal very quickly
Counsel to report any swelling of lips, mouth, tongue, face or neck immediately
65
Are RAAS inh (ACE-I, ARB or Aliskiren) CI in pregnancy?
Yes
D/c drugs as soon as pregnancy is detected
66
List ACE-I agents
Benazepril (Lotensin)
Captopril (Capoten)
Enalapril, Enalaprilat IV injection (Vasotec)
Fosinopril
Lisinopril (Prinivil, Zestrin)
Moexipril (Univasc)
Perindopril (Aceon)
Quinapril (Accupril)
Ramipril (Altace)
Trandolapril (Mavik$
67
What's the brand name of Benazepril (ACE-I)?
Lotensin
68
What's the brand name of Enalapril, Enalaprilat IV injection (ACE-I)?
Vasotec
69
What's the brand name of Lisinopril (ACE-I)?
Prinivil
Zestril
70
What's the brand name of Quinapril (ACE-I)?
Accupril
71
What's the brand name of Ramipril (ACE-I)?
Altace
72
Howz Captopril (Capoten) taken?
1 hr before meals
73
How's Moexipril (Univasc) taken?
On an empty stomach
74
Black box warning of ACE-I/ ARB/ Aliskiren (direct renin inh)?
D/c as soon as pregnancy is detected
75
CI of ACE-I/ ARB?
Angioedema
Bilateral renal artery stenosis
Can't used concurrently with Aliskiren in pts with DM
76
In what grp of pts can't ACE-I/ARB be used concurrently with Aliskiren?
Pts with DM
77
SEs of ACE-I/ ARB/ Aliskiren (direct renin inh)?
Cough
Hyperkalemia
Angioedema (d/c drug if it occurs)
Hypotension
78
Which SEs are specific to Captopril (Capoten) use - ACE-I?
Taste perversion
Rash
79
Monitoring of ACE-I/ ARB/ Aliskiren (direct renin inh)?
BP
K
Renal fxn
80
Pregnancy cat of ACE-I/ ARB/ Aliskiren (direct renin inh)?
D
81
List ARB agents
Valsartan (Diovan)
Losartan (Cozaar)
Irbesartan (Avapro)
Candesartan (Atacand)
Olmersartan (Benicar)
Telmisartan (Micardis)
Eprosartan (Teveten)
Azilsartan (Edarbi)
82
What's the brand name of Valsartan? ARB
Diovan
83
What's the brand name of Losartan? ARB
Cozaar
84
What's the brand name of Olmesartan? ARB
Benicar
85
MOA of direct renin inhibitor?
Directly inhibits renin, which is responsible for conversion of angiotensin to angiotensin I, a potent vasoconstrictor, thereby reducing BP
86
List agent under direct renin inhibitor
Aliskiren (Tektuma)
87
CI to Aliskiren (direct renin inh) use?
Don't use concurrently with ACE-I or ARBS in pts with diabetes
Angioedema
Bilateral renal artery stenosis
88
Effect of all RAAS inh on K?
All increase risk of HYPERkalemia
89
Which BB indicated for HTN only?
Nebivolol
90
BB with intrinsic sympathomimetic activity (ISA)?
CAPP
Carteolol
Acebutolol
Penbutolol
Pindolol
91
Place in therapy for BB with intrinsic sympathomimetic activity (ISA) - CAPP?
Pts with excessive bradycardia who need BB therapy
Don't reduce HR as much as other beta-blockers
92
List Beta-1 selective agents
AMEBBA
Atenolol
Metoprolol
Esmolol
Bisoprolol
Betaxolol
Acebutolol
93
Which BB has more CNS SEs? Why?
Propranolol
Has high lipid solubility (lipophilic) and crosses BBB
94
Which BB should be with food?
Carvedilol, even CR version
95
Is Carvedilol CR same as Carvedilol IR?
CR is less bioavailable than IR
96
What's the 1st line tx for HTN in pregnancy?
Labetalol
Nifedipine
Methyldopa
97
Whys Propranolol used in stage fright?
Can cover up sx of shakiness, palpitations and anxiety (with hyperglycemia)
Occurs mostly in non-selective bb
98
List bb selective agents?
AMEBBA
Acebutolol (Sectral)
Atenolol (Tenormin)
Betaxolol
Bisoprolol (Zebeta)
Metoprolol tartate (Lopressor)
Metoprolol Succinate ext-release (Toprol XL)
99
What's the brand name of Atenolol? (Beta1-selective blockers)?
Tenormin
100
What's the brand name of Metoprolol tartrate? (Beta1-selective blockers)?
Lopressor
101
What's the brand name of Metoprolol succinate ext-release? (Beta1-selective blockers)?
Toprol XL
102
Most common SE of Beta1-selective blockers?
Reduced HR
Hypotension
Fatigue
Dizziness
103
Monitoring of Beta1-selective blockers?
HR
BP
104
How should bb be stopped?
Must taper
105
Which metoprolol is taken with food?
Metoprolol tartrate (Lopressor)
106
Are IV doses of Beta1-selective blockers equivalent to PO doses?
No
107
Which bb is both B-1 selective blocker and Nitric Oxide-Dependent vasodilation?
Nebivolol (Bystolic)
108
What's the brand name of Nebivolol? (B-1 selective blocker and Nitric Oxide-Dependent vasodilation)
Bystolic
109
SEs of Nebivolol (Bystolic)? (B-1 selective blocker and Nitric Oxide-Dependent vasodilation)
Headaches
Fatigue
110
List non-selective bb (B1 & B2)
Carteolol
Nadolol (Corgard)
Penbutolol (Levatol)
Pindolol
Propranolol (Inderal LA, InnoPran XL)
Timolol
111
What's the brand name of Propranolol? (Non-selective bb)
Inderal LA
InnoPran XL
112
List bb that are non-selective alpha- and beta-blocker
Carvedilol (Coreg, Coreg CR)
Labetalol (Trandate)
113
Brand name of Carvedilol (non-selective alpha- and beta-blocker)?
Coreg
Coreg CR
114
Brand name of Labetalol (non-selective alpha- and beta-blocker)?
Trandate
115
How should all forms of Carvedilol be taken?
With food
116
Types of CCBs?
Dihydropyridines
Non-dihydropyridines
117
Where does dihydropyridine work?
Periphery
118
List dihydropyridine CCBs
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
Brand name of Amlodipine (dihydropyridine CCBs)?
Norvasc
120
Brand name of Nifedipine ER (dihydropyridine CCBs)?
Adalat CC
Procardia XL
Afeditab CR
121
Brand name of Nicardipine IV (dihydropyridine CCBs)?
Cardene
122
SEs of Dihydropyridine CCBs?
Peripheral edema
Headache
Flushing
Tachycardia/reflex
Gingival hyperplasia
123
Monitoring of Dihydropyridine CCBs?
Peripheral edema
124
Which Dihydropyridine CCBs is used in inpatient acute care?
Clevidipine (Cleviprex)
125
Non-Dihydropyridine CCBs?
Inhibit Ca2+ ions from entering the "slow" channels or voltage-sensitive areas of vascular smooth muscle and myocardium = VD
126
List Non-Dihydropyridine CCBs agents
Diltiazem
Verapamil
127
SEs of Non-Dihydropyridine CCBs?
Edema
Headache
AV block
Bradycardia
Hypotension
Arrhythmias
HF
Constipation (more verapamil)
Gingival hyperplasia
128
Uses of Clonidine?
Most commonly used for resistant HTN and in pts who can't swallow
129
List agents under Centrally-Acting Alpha2 Agonist
Clonidine (Catapres; Catapres-TTS patch$
Guanabenz
Guanfacine (Tenex)
Methyldopa
130
Brand name of Clonidine (Centrally-Acting Alpha2 Agonist)?
Catapres
Catapres-TTS patch
131
SEs of Centrally-Acting Alpha2 Agonist?
Bradycardia
Dry mouth
Drowsiness
Sedation
Lethargy
Hypotension
Depression
Psychotic rxns
Nasal stuffiness
Sexual dysfxn
132
How often is Clonidine patch (Catapress-TTS) applied?
Weekly
133
List direct vasodilators agents
Hydralazine
Minoxidil
134
SEs of direct vasodilators (Hydralazine and Minoxidil)?
Headache
Reflex tachycardia
Palpitations
Anorexia
Rare - lupus-like syndrome
135
List alpha blockers agents
Prazosin (Minipress)
Terazosin (Hytrin)
Doxazosin (Cardura, Cardura XL)
136
What's the brand name of Terazosin (Alpha blockers)?
Hytrin
137
What's the brand name of Doxazosin (Alpha blockers)?
Cardura
Cardura XL
138
What's the brand name of Amlodipine + Benazepril? Classes?
Lotrel
ACE-I and CCB
139
What's the brand name of Lisinopril + HCTZ? Classes?
Prinzide
Zestoretic
ACE-I and Diuretic
140
What's the brand name of Losartan + HCTZ? Classes?
Hyzaar
ARB and diuretic
141
What's the brand name of Valsartan + HCTZ? Classes?
Diovan HCT
ARB and diuretic
142
What's the brand name of Olmesartan + HCTZ? Classes?
Benicar
ARB and diuretic
143
What's the brand name of Bisoprolol + HCTZ? Classes?
Ziac
BB and diuretic
144
What's the brand name of Triamterene + HCTZ? Classes?
Dyazide, Maxzide
Diuretic and diuretic
145
What's HTN urgency?
BP (gen >= 180/110-120) w/o acute target organ damage
146
Tx of HTN urgency?
Oral med with onset of action of 15-30 mins
Reduce BP gradually over 24-48 hr
147
What's HTN emergency?
BP (gen >= 180/110-120) + acute target organ damage (such as encephalopathy, MI, unstable angina, pulmonary edema, eclampsia, stroke, aortic dissection)
148
Tx of HTN emergency?
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
List drugs used in HTN urgencies
Captopril (Capoten)
Clonidine (Catapres)
Labetalol (Trandate)
150
What's the dose of Captopril (Capoten) and SEs used in HTN urgencies?
Captopril (Capoten) 25mg, repeat in 1-2 hrs PRN
Hypotension, high K, angioedema
151
What's the dose of Clonidine (Catapres) and SEs used in HTN urgencies?
Clonidine (Catapres) 0.1-0.2mg, repeat in 1-2 hrs PRN
Hypotension, drowsiness, sedation, dry mouth etc
152
What's the dose of Labetalol (Trandate) and SEs used in HTN urgencies?
Labetalol (Trandate) 100-400mg, repeat in 2-3 hrs PRN
Hypotension, heart block, bronchoconstriction
153
Drugs used in HTN emergencies?
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
Look at pt counseling on pg 573 and 574
Look!
155
What's in the drug Exforge?
Amlodipine + Valsartan
156
What BP med is C/I with Sodium Polystyrene Sulfonate (Kayexalate)? Why?
ACE-I, ARBs and DRI
These meds increase potassium (cause hyperkalemia)... SPS (Kayexalate) is used to treat hyperkalemia
157
MOA of Clonidine?
Alpha-2 AGONIST => reduces norepinephrine release
158
List BP meds not used with grapefruit/ grapefruit juice?
Cardizem LA (Diltazem)
Calan SR (Verapamil)
Dilt-XR (Diltazem hydrochloride extended release)
159
SE of Clonidine?
Can worsen Constipation, Depression, Fatigue
160
Effect of Diltazem and Verapamil on hepatic metabolism of other drugs?
CYP 3A4 inhibitor
161
How should BP be lowered in HTN emergency?
10-15% in next hr
162
What's the new SE of Olmesartan (added in 2013, in addition to ARB SE)?
Sprue-like enteropathy
163
Which SE is unique to Verapamil?
Constipation
164
Is cough a common SE of ARBs?
No!
Cough is ACE-I
165
What makes up Lotrel?
Amlodipine and Benazepril
166
What makes up Exforge?
Amlodipine and Valsartan
167
What makes up Lotensin HCT?
Benazepril and HCTZ
168
What makes up Prinzide (also called Zestoretic)?
Lisinopril and HCTZ
169
What makes up Hyzaar?
Losartan and HCTZ
170
What makes up Micardis HCT?
Telmisartan and HCTZ
171
What makes up Diovan HCT?
Valsartan and HCTZ
172
What makes up Benicar HCT?
Olmesartan and HCTZ
173
What makes up Ziac?
Bisoprolol and HCTZ
174
What makes up Dyazide (also called Maxzide)?
Triamterene and HCTZ
175
What's the conversion of Carvedilol IR to Carvedilol CR?
3.125mg BID (Coreg) = 10mg daily (Coreg CR)
176
Which BP med is considered safe in pregnancy?
HCTZ
177
What BP med is the drug of choice for HTN patient with aortic dissection?
Beta-blocker
178
What's the most common SE caused by BB?
Fatigue (and sometimes sexual problems)
