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NAPLEX Review > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Causes of primary HTN

A

Unknown but usually a combo of obesity, sedentary lifestyle, excessive salt intake, smoking, family history, diabetes, dyslipidemia

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2
Q

Causes of secondary HTN

A

renal disease, adrenal disease, obstructive sleep apnea, or drugs

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3
Q

What are the ACC/AHA categories for HTN?

A

Normal: <120/<80
Elevated: 120-129/<80
Stage 1 HTN: 130-139 systolic OR 80-89 diastolic
Stage 2 HTN: >140 systolic OR >90 diastolic

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4
Q

What should sodium intake be reduced to in someone with HTN to help lower BP?

A

<1500mg daily

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5
Q

What medications can increase BP?

A 
Amphetamine and ADHD drugs
Cocaine
Decongestants
Erythropoiesis-stimulating agents (ESA)
Immunosuppressants
NSAIDs
Systemic steroids
Oral contraceptives
Some oncology meds
Antidepressants
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6
Q

What medications are not recommended by the guidelines but have some evidence for lowering BP?

A

fish oil, coenzyme Q10, L-arginine, garlic, fiber, potassium

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7
Q

What medications are preferred first line treatment for HTN?

A

ACEi
ARBs
CCBs
Thiazide diuretics

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8
Q

When should you start HTN treatment?

A

Stage 2 HTN

Stage 1 HTN with Clinical ASCVD or 10 year ASCVD >10%

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9
Q 
What is initial drug selection for treatment of HTN in patients who are 
Non-black
Black
CKD (all races)
Diabetes with albuminuria (all races)
Stage 2 HTN
A 
Non-black: TZD, CCB, ACEi, ARB
Black: TZD, CCB
CKD: ACEi, ARB
DM+A: ACEi, ARB
Stage 2: 2 first line drugs
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10
Q

What medications can be used in pregnancy for HTN?

A

labetalol and nifedipine (first line) and methyldopa

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11
Q

What medications have BBW for fetal toxicity in pregnancy?

A

ACEi, ARB, aliskiren

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12
Q

What is the goal BP for someone with HTN during pregnancy and at what point would you treat them for HTN?

A

Goal: 120-160/80-110

Treat if >160/>105

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13
Q

Brand name for

lisinopril/HCTZ

A

Zestoretic

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14
Q

Brand name for

losartan/HCTZ

A

Hyzaar

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15
Q

Brand name for

Olmesartan/HCTZ

A

Benicar HCT

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16
Q

Brand name for

Valsartan/HCTZ

A

Diovan HCT

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17
Q

Brand name for

Benazepril/Amlodipine

A

Lotrel

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18
Q

Brand name for

Valsartan/Amlodipine

A

Exforge

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19
Q

Brand name for

atenolol/chlorthalidone

A

Tenoretic

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20
Q

Brand name for

bisoprolol/HCTZ

A

Ziac

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21
Q

Brand name for

Triamterene/HCTZ

A

Maxzide, Diazide

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22
Q

Thiazide diuretic MOA

A

inhibit sodium reabsorption in the distal convoluted tubule causing an increased excretion of sodium, chloride, water, and potassium

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23
Q

What drugs are thiazide diuretics

A

Chlorthalidone, HCTZ, Chlorothiazide, Indapamide, Metolazone

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24
Q

thiazide diuretic contraindications, Side effects

A

CI: Sulfonamide-derived drug allergy (not likely to cross-react); anuria

SE: Decreased K, Mg, Na; Increased Ca, UA, LDL, TG BG

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25
Q

Which diuretic is effective when CrCl < 30?

A

Loop

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26
Q

What is the only thiazide diuretic that is available IV

A

Chlorothiazide

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27
Q

Thiazide drug interactions

A

Lithium - decreased lithium clearance and increased risk of toxicity

Increases dofetilide serum concentration and increases risk of QT prolongation

28
Q

Examples of dihydropyridine CCBS

A

Amlodipine, nicardipine, nifedipine

-pine

29
Q

Examples of non-dhydropyridine CCBs

A

Diltiazem, verapamil

30
Q

DHP CCB MOA

A

inhibit calcium ions from entering vascular smooth muscle causing peripheral arterial vasodilation

31
Q

CCB Side effects and clinical notes

A

SE: peripheral edema, HA, flushing, palpitations, reflex tachycardia, gingival hyperplasia

Amlodipine is safest in HF

32
Q

Which CCB is drug of choice in pregnancy?

A

Nifedipine ER

33
Q

Which CCB is CI if allergy to soybeans, soy, or eggs?

A

clevidipine

34
Q

Which CCB IV formulation contains lipid emulsion and how many kcal of fat per mL?

A

Clevidipine

2 kcal/mL

35
Q

Non DPH CCB Warnings and SE

A

Warnings: HF, bradycardia
SE: edema, constipation (verapamil), gingival hyperplasia

36
Q

CCB drug interadtions

A

Use with caution with Beta blockers, digoxin, clonidine, amiodarone and precidex

CCB are CYP3A4 substrates (no grapefruit juice)

37
Q

ACEi MOA

A

prevent conversion of angiotensin I to angiotensin II, resulting in decreased vasoconstriction and decreased aldosterone secretion

38
Q

ACEi BBW ,CI, warnings, and SE

A

BBW: injury and death to the developing fetus when used in 2nd and 3rd trimesters
CI: hx of angioedema, use within 36 hours of Entresto
Warnings: angioedema, hyperkalemia, hypotension, renal impairment, bilateral renal artery stenosis
SE: cough, hyperkalemia, increased SCr, hypotension

39
Q

ARB MOA

A

block angiotensin II from binding to the angiotensin II type 1 receptor on vascular smooth muscle, preventing vasoconstriction

40
Q

ACE vs ARB

Which have less cough, less angioedema, and no washout period between Entresto use?

A

ARB

41
Q

What drug is a direct renal inhibitor?

A

Aliskiren

42
Q

Aliskiren contrindications

A

do not use with ACE inhibitors or ARBs in patients with diabetes

43
Q

What electrolyte abnormality do all RAAS inhibitors cause?

A

hyperkalemia

44
Q

Why should you only use one RAAS inhibitor at a time?

A

increased risk of renal impairment, hypotension, and hyperkalemia

45
Q

How long is the washout period between Entresto and an ACE and an ARB

A

ACE: 36 hours
ARB: no washout required

46
Q

Which aldosterone antagonist is selective and which is non selective?

A

Selective: eplerenone

Non-selective: spironolactone (also blocks androgen)

47
Q

Potassium-spring diuretics BBW, CI, and SE

A

BBW: hyperkalemia (K>5.5)
CI: hyperkalemia, severe renal impairment, addison’s disease
SE: hyperkalemia, increased SCr, dizziness (spironolactone: gynecomastia, breast tenderness, impotence)

48
Q

Which potassium sparing diuretic is a major substrate of CYP3A4

A

eplerenone

49
Q

Which disease states are beta blockers recommended first line?

A

post-MI, stable ischemic heart disease, HF

50
Q

Beta blocker BBW, Warnings, SE

A

BBW: do not d/c abruptly
Warnings: caution in patients with diabetes (can mask hypoglycemia), use with caution in bronchospastic disease
SE: bradycardia, fatigue, hypotension, dizziness, depression, impotence

51
Q

What is the IV to PO ratio of metoprolol tartrate?

A

IV:PO
1:2.5

52
Q

Which BB crosses the BBB and has more CNS effects?

A

propranolol (migraine prophylaxis)

53
Q

What is the BB of choice for pregnancy?

A

Labetalol

54
Q

What are beta 1 selective blockers?

A 
Atenolol
Exmolol
Metoprolol
Acebutolol
Betaxolol
Bisoprolol
55
Q

What are beta 1 selective blockers with nitric oxide-dependent vasodilation

A

Nebivolol

56
Q

Beta 1 and beta 2 blocker (non-selective)

A

Propranolol, nadolol, pindalol, timolol

57
Q

Non-selective beta-blockers and alpha-1 blockers

A

Carvedilol and labetalol

58
Q

What beta blockers are a CYP substrate and what CYP do they act on?

A

Carvedilol, propranolol, metoprolol, nebivolol

CYP2D6 substrate

59
Q

What drugs are alpha 2 adrenergic agonists?

A

Clonidine, guanfacine, methyldopa

60
Q

Alpha 2 adrenergic agonist warnings, SE, notes

A

Warnings: do not d/c abruptly, hemolytic anemia (methyldopa)
SE: dry mouth, somnolence, fatigue, dizziness, constipation, decreased HR, hypotension; skin rash/pruritus/erhythmia (clonidine patch)

61
Q

Methyldopa contrindication

A

concurrent use with MAO inhibitors

62
Q

What drugs are direct vasodilators?

A

Hydralazine and minoxidil

63
Q

Warnings and SE for hydralazine

A

Warning: drug-induced lupus erythematosus
SE: peripheral edema, HA, flushing, palpitations, reflex tachycardia

64
Q

CI and SE for minoxidil

A

Boxed warning: potent antihypertensive

SE: fluid retention, tachycardia, hair growth

65
Q

HTN emergency vs urgency

A

Emergency: acute target organ damage
Urgency: no target organ damage

66
Q

HTN emergency treatment

A

IV medications

Decrease BP by 25% within the first hour then decrease to 160/100 mmHg over next 2-6 hours

67
Q

HTN urgency treatment

A

Oral medications

Decrease BP over 24 to 48 hours

NAPLEX Review (79 decks)

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