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Cardio > Hypertension Therapy > Flashcards

Hypertension Therapy Flashcards

1
Q

When should non-pharmacological treatment for HTN be used?

A

It should be started in all patients, but only some can use it alone for treatment

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2
Q

What is the non-pharmacological approach to treating HTN?

A
  1. Weight loss
  2. Diet
  3. Exercise (150 min/week)
  4. Alcohol consumption (2 drinks - men/1 drink -women)
  5. Smoking cessation
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3
Q

What are the three classes of diuretics?

A
  1. Thiazide
  2. Loop
  3. Potassium sparing
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4
Q

What is the site of action for thiazides?

A

The luminal side of the distal convoluted tubule?

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5
Q

What is the MOA for thiazides?

A

They compete for Cl binding site on the Na/Cl cotransporter. This leads to the excretion of Na, Cl, K, and H2O.

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6
Q

What is the starting dose for thiazide diuretics?

A

12.5 mg/day

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7
Q

What is the max dose for thiazide diuretics?

A

25 mg/day

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8
Q

In what patient population should you take caution when using thiazide diuretics?

A

Elderly patients due to the potential for hyponatremia and hypokalemia

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9
Q

What time of day should you avoid taking thiazide diuretics?

A

At bedtime

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10
Q

What lab value would you check before starting a thiazide diuretic?

A

CrCL NEEDS to be greater than 40 ml/min

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11
Q

What is the frequency of dosing for thiazide diuretics?

A

once daily

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12
Q

What are the adverse effects of thiazide diuretics?

A
  1. Electrolyte disturbance
  2. Orthostasis
  3. Dizziness
  4. Hyperuricemia
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13
Q

What are the monitoring parameters for thiazide diuretics?

A
  1. BUN/SCr

2. Electrolytes

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14
Q

What are the common loop diuretics (brand/generic)?

A
  1. Bumex/Bumetanide
  2. Lasix/Furosemide
  3. Demadex/Torsemide
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15
Q

What is the site of action for the loop diuretics?

A

The luminal side of the thick ascending loop of Henle

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16
Q

What is the MOA for loop diuretics?

A

Compete for the Cl binding site on the Na, K, 2Cl symporter causing excretion of Na, Cl, H2O, K, Ca, and Mg

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17
Q

What is the dosing range for Furosemide?

A

20 - 80 mg/day up to twice daily

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18
Q

What are the adverse effects of loop diuretics?

A
  1. Orthostasis
  2. Dizziness
  3. Electrolyte disturbance
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19
Q

What are the monitoring parameters for loop diuretics?

A
  1. BUN/SCr
  2. Electrolytes
  3. Serum bicarbonate
  4. CBC, Plt, and LFT’s
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20
Q

What are the two sub-classes of K+ sparing diuretics?

A
  1. Na channel blockers

2. Aldosterone inhibitors

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21
Q

What is the site of action for Na channel blockers?

A

The late distal convoluted tubule and collecting duct

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22
Q

What is the site of action for aldosterone inhibitors?

A

Mineralocorticoid receptors in the late distal convoluted tubule and collecting duct

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23
Q

Name one aldosterone inhibitor? (Brand/generic)

A
  1. Aldactone/Spironolactone
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24
Q

What is the dosing range and frequency of Spironolactone?

A

50 - 100 mg 1 to 2 times daily

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25
Q

What is the mechanism of action for the aldosterone inhibitors?

A

They antagonize aldosterone receptors in the distal convoluted tubule and block sodium movement from the lumen to the interstitial space

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26
Q

What are the adverse effects of aldosterone inhibitors?

A

Hyperkalemia, GI, and gynecomastia

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27
Q

What are the monitoring parameters for aldosterone inhibitors?

A
  1. BUN/SCr (closely follow)

2. electrolytes (closely follow K+)

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28
Q

What is the mechanism of action for ACE inhibitors?

A

They inhibit the conversion of angiotensin 1 to angiotensin 2 which decreases total peripheral resistance and increases the excretion of water and Na. They also inhibits the inactivation of bradykinin which increases vasodilation and Na excretion.

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29
Q

In which patient population are ACE inhibitors less likely to be effective?

A

African Americans

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30
Q

What are the adverse effects of ACE inhibitors?

A
  1. ACE-induced cough
  2. Angioedema (More likely in African Americans)
  3. Hyperkalemia
  4. Renal impairment
  5. Hypotension
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31
Q

Why do you see a “bump” in SCr and K+ levels when a patient begins an ACE inhibitor?

A

Vasodilation occurs which decreases the pressure in the glomerular. Because of the decreased pressure there is decreased filtration; therefore, SCr will in increase in the blood until there is compensation for the pressure. Then Scr will decrease again. Potassium increases because ACE inhibitors decrease the levels of aldosterone which is responsible for excreting potassium.

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32
Q

What is a positive aspect of using ACE inhibitors in diabetic patients?

A

renal protection

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33
Q

What is the dosing range and frequency of lisinopril?

A

10 - 40 mg once daily

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34
Q

What is the dosing range and frequency of benazepril?

A

10 - 40 mg once or twice daily

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35
Q

What are the monitoring parameters for ACE inhibitors?

A
  1. BUN/SCr

2. Electrolytes

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36
Q

What is the mechanism of action for ARBs?

A

It inhibits the effects of angiotensin 2 at various sites in the body (same MOA as ACE inhibitors)

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37
Q

What is an acceptable rise in SCr when taking an ACE or ARB?

A

30%

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38
Q

List 3 ARBs (generic/brand)

A
  1. Olmesartan (Benicar)
  2. Irbesartan (Avapro)
  3. Losartan (Cozaar)
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39
Q

What is the dosing range and frequency of olmesartan?

A

20 - 40 mg once daily

40
Q

What is the dosing range and frequency of losartan?

A

25 - 100 mg one to two times daily

41
Q

What are the adverse effects of ARBs?

A
  1. Hyperkalemia
  2. Angioedema
  3. Hypotension
  4. Renal impairment
42
Q

What are the monitoring parameters for ARBs?

A
  1. BUN/SCr

2. Electrolytes

43
Q

What is the mechanism of action for direct renin inhibitors?

A

Inhibits the conversion of angiotensinogen to angiotensin 1 by inhibiting renin

44
Q

Why can’t direct renin inhibitors be used in first line treatment?

A

Because they are too new and don’t have mortality data

45
Q

Why are direct renin inhibitors contraindicated in combination with an ACE-I or ARB?

A

Because a study found that it increased the rates of stroke and kidney impairment when the two were used together

46
Q

What is the brand and generic name of the one direct renin inhibitor?

A

Aliskerin (Tekturna)

47
Q

What is the dosing range and frequency of aliskerin?

A

150 - 300 mg once daily

48
Q

What are the adverse reactions for direct renin inhibitors?

A
  1. Angioedema
  2. Hypotension
  3. Hyperkalemia
  4. GERD
  5. Renal impairment
49
Q

What are the monitoring parameters for direct renin inhibitors?

A
  1. BUN/SCr

2. Electrolytes

50
Q

What is the mechanism of action for calcium channel blockers?

A

It prevents calcium influx and maintains relaxation in smooth muscle which decreases mean arterial pressure

51
Q

What is the difference between dihydropyridine and non-dihydropyridine CCBs?

A

Dihydropyridine is more selective for vascular smooth muscle?

52
Q

Which type of CCB is more likely to have a more depressant effect on the heart?

A

Non-dihydropyridine CCBs

53
Q

When should Non-DHP CCBs be avoided?

A

In heart failure and in combination with beta-blockers

54
Q

What are the two Non-DHP CCBs?

A

Verapamil and Diltiazem

55
Q

What are the brand names of Diltiazem?

A

Cardiazem CD, Dilacor XR, Tiazac, and Cardiazem LA

56
Q

What are the brand names of Verapamil IR?

A

Calan and Isoptin

57
Q

What are the brand names of Verapamil LA?

A

Calan SR and Isoptin SR

58
Q

What are the brand names of Verapamil Coer?

A

Covera HS and Verelan PM

59
Q

What is the dosing range and frequency of Calan/Isoptin?

A

80 - 320 mg twice daily

60
Q

What is the dosing range and frequency of Calan SR/Isoptin SR?

A

120 - 360 mg one to two times daily

61
Q

What is the dosing range and frequency of Covera HS/Verelan PM?

A

120 - 360 mg once daily

62
Q

What is the dosing range and frequency of Cardiazem LA?

A

120 - 540 mg once daily

63
Q

What is the dosing range and frequency of Cardiazem CD/Dilacor XR/Tiazac?

A

180 - 420 once daily

64
Q

What are the adverse effects of Non-DHP CCBs?

A
  1. Bradycardia
  2. AV block
  3. Arrhythmia
  4. Hypotension
  5. Heart failure
  6. Edema
  7. Constipation
65
Q

What are the monitoring parameters for Non-DHP CCBs?

A
  1. BUN/SCr
  2. LFTs
  3. HR
66
Q

What is the brand name of amlodipine?

A

Norvasc

67
Q

What is the dosing range and frequency of amlodipine?

A

2.5 - 10 mg once daily

68
Q

What are the adverse effect associated with DHP CCBs?

A
  1. Angina
  2. Edema
  3. Fatigue
  4. Dizziness
69
Q

What is the MOA of beta blockers?

A

They decrease NE binding to beta 1 receptors which decreases heart rate and cardiac output. They also decreases renin release due to beta 1 blockade in the kidneys

70
Q

In what patient population should you administer beta blockers with caution?

A

Patients with heart failure

71
Q

In what patient population are beta blockers avoided or used with extreme caution?

A

Asthma and COPD due to action on beta 2 receptors

72
Q

What is important about the end of therapy on a beta-blocker?

A

Avoid abrupt discontinuation

73
Q

What are the selective beta-blockers (Generic/brand)?

A
  1. Atenolol (Tenormin)
  2. Bisoprolol (Zebeta)
  3. Metoprolol Tartrate (Lopressor)
  4. Metoprolol Succinate (Toprol XL)
  5. Nebivolol (Bystolic)
74
Q

What is the dosing range and frequency of Atenolol?

A

25 - 100 mg once daily

75
Q

What is the dosing range and frequency of Metoprolol Tartrate?

A

50 - 100 mg twice daily

76
Q

What is the dosing range and frequency of Metoprolol Succinate?

A

50 - 100 mg once daily

77
Q

What are the adverse effects associated with all beta-blockers?

A
  1. heart failure
  2. heart block
  3. depression
  4. bradycardia
  5. dyspnea
  6. dizziness
  7. fatigue
  8. erectile dysfunction
78
Q

What are the two non-selective beta-blockers (Generic/brand)?

A
  1. Carvedilol (Coreg)

2. Labetalol (Trandate)

79
Q

What is the dosing range and frequency of carvedilol?

A

12.5 - 50 mg twice daily

80
Q

What are the monitoring parameters for beta-blockers?

A
  1. BUN/SCr

2. Heart rate

81
Q

What is the MOA of alpha 2 agonists?

A

It decreases cardiac output by decreasing heart rate and mean arterial pressure through decreases sympathetic activity

82
Q

Why should you avoid abrupt discontinuation with alpha 2 agonists?

A

rebound hypertension

83
Q

What is the brand name of Clonidine?

A

Catapres

84
Q

What is the brand name of the Clonidine patch?

A

Catapres TTS

85
Q

What is the brand name of methyldopa?

A

Aldomet

86
Q

What is the dosing range and frequency of clonidine?

A

0.1 - 0.8 mg twice daily

87
Q

What is the dosing range and frequency of clonidine patch?

A

0.1 - 0.3 mg weekly

88
Q

What is the dosing range and frequency of methyldopa?

A

250 - 1000 mg twice daily

89
Q

What are the adverse effects associated with alpha 2 agonists?

A
  1. orthostatic hypotension
  2. bradycardia
  3. sedation
  4. constipation
  5. rebound HTN
90
Q

What are the monitoring parameters for alpha 2 agonists?

A
  1. BUN/Scr

2. Heart rate

91
Q

What is the MOA of alpha 1 blockers?

A

They block postsynaptic alpha 1 receptors resulting in vasodilation and decreased mean arterial pressure

92
Q

Why should you take alpha 1 antagonists at bedtime when first starting?

A

It often causes orthostatic hypotension

93
Q

What symptoms do alpha 1 antagonists improve?

A

Symptoms related to benign prostatic hypertrophy

94
Q

What are the three alpha 1 antagonists (Generic/brand)?

A
  1. Doxazosin (Cardura)
  2. Terazosin (Hytrin)
  3. Prazosin (Minipress)
95
Q

What is the dosing range and frequency of doxazosin?

A

1 - 16 mg once daily

96
Q

What are the adverse effects associated with alpha 1 antagonists?

A
  1. orthostatic hypotension
  2. drowsiness
  3. dizziness
97
Q

What is the monitoring parameter for alpha 1 antagonists?

A

Heart rate

Cardio (11 decks)

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