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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
Which diuretic is effective when CrCl < 30?
Loop
26
What is the only thiazide diuretic that is available IV
Chlorothiazide
27
Thiazide drug interactions
Lithium - decreased lithium clearance and increased risk of toxicity Increases dofetilide serum concentration and increases risk of QT prolongation
28
Examples of dihydropyridine CCBS
Amlodipine, nicardipine, nifedipine | -pine
29
Examples of non-dhydropyridine CCBs
Diltiazem, verapamil
30
DHP CCB MOA
inhibit calcium ions from entering vascular smooth muscle causing peripheral arterial vasodilation
31
CCB Side effects and clinical notes
SE: peripheral edema, HA, flushing, palpitations, reflex tachycardia, gingival hyperplasia Amlodipine is safest in HF
32
Which CCB is drug of choice in pregnancy?
Nifedipine ER
33
Which CCB is CI if allergy to soybeans, soy, or eggs?
clevidipine
34
Which CCB IV formulation contains lipid emulsion and how many kcal of fat per mL?
Clevidipine | 2 kcal/mL
35
Non DPH CCB Warnings and SE
Warnings: HF, bradycardia SE: edema, constipation (verapamil), gingival hyperplasia
36
CCB drug interadtions
Use with caution with Beta blockers, digoxin, clonidine, amiodarone and precidex CCB are CYP3A4 substrates (no grapefruit juice)
37
ACEi MOA
prevent conversion of angiotensin I to angiotensin II, resulting in decreased vasoconstriction and decreased aldosterone secretion
38
ACEi BBW ,CI, warnings, and SE
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
ARB MOA
block angiotensin II from binding to the angiotensin II type 1 receptor on vascular smooth muscle, preventing vasoconstriction
40
ACE vs ARB | Which have less cough, less angioedema, and no washout period between Entresto use?
ARB
41
What drug is a direct renal inhibitor?
Aliskiren
42
Aliskiren contrindications
do not use with ACE inhibitors or ARBs in patients with diabetes
43
What electrolyte abnormality do all RAAS inhibitors cause?
hyperkalemia
44
Why should you only use one RAAS inhibitor at a time?
increased risk of renal impairment, hypotension, and hyperkalemia
45
How long is the washout period between Entresto and an ACE and an ARB
ACE: 36 hours ARB: no washout required
46
Which aldosterone antagonist is selective and which is non selective?
Selective: eplerenone | Non-selective: spironolactone (also blocks androgen)
47
Potassium-spring diuretics BBW, CI, and SE
BBW: hyperkalemia (K>5.5) CI: hyperkalemia, severe renal impairment, addison's disease SE: hyperkalemia, increased SCr, dizziness (spironolactone: gynecomastia, breast tenderness, impotence)
48
Which potassium sparing diuretic is a major substrate of CYP3A4
eplerenone
49
Which disease states are beta blockers recommended first line?
post-MI, stable ischemic heart disease, HF
50
Beta blocker BBW, Warnings, SE
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
What is the IV to PO ratio of metoprolol tartrate?
IV:PO 1:2.5
52
Which BB crosses the BBB and has more CNS effects?
propranolol (migraine prophylaxis)
53
What is the BB of choice for pregnancy?
Labetalol
54
What are beta 1 selective blockers?
``` Atenolol Exmolol Metoprolol Acebutolol Betaxolol Bisoprolol ```
55
What are beta 1 selective blockers with nitric oxide-dependent vasodilation
Nebivolol
56
Beta 1 and beta 2 blocker (non-selective)
Propranolol, nadolol, pindalol, timolol
57
Non-selective beta-blockers and alpha-1 blockers
Carvedilol and labetalol
58
What beta blockers are a CYP substrate and what CYP do they act on?
Carvedilol, propranolol, metoprolol, nebivolol | CYP2D6 substrate
59
What drugs are alpha 2 adrenergic agonists?
Clonidine, guanfacine, methyldopa
60
Alpha 2 adrenergic agonist warnings, SE, notes
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
Methyldopa contrindication
concurrent use with MAO inhibitors
62
What drugs are direct vasodilators?
Hydralazine and minoxidil
63
Warnings and SE for hydralazine
Warning: drug-induced lupus erythematosus SE: peripheral edema, HA, flushing, palpitations, reflex tachycardia
64
CI and SE for minoxidil
Boxed warning: potent antihypertensive | SE: fluid retention, tachycardia, hair growth
65
HTN emergency vs urgency
Emergency: acute target organ damage Urgency: no target organ damage
66
HTN emergency treatment
IV medications | Decrease BP by 25% within the first hour then decrease to 160/100 mmHg over next 2-6 hours
67
HTN urgency treatment
Oral medications | Decrease BP over 24 to 48 hours

NAPLEX Review (79 decks)

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