Hypertension Therapy Flashcards
(97 cards)
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
2
Q
What is the non-pharmacological approach to treating HTN?
A
- Weight loss
- Diet
- Exercise (150 min/week)
- Alcohol consumption (2 drinks - men/1 drink -women)
- Smoking cessation
3
Q
What are the three classes of diuretics?
A
- Thiazide
- Loop
- Potassium sparing
4
Q
What is the site of action for thiazides?
A
The luminal side of the distal convoluted tubule?
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.
6
Q
What is the starting dose for thiazide diuretics?
A
12.5 mg/day
7
Q
What is the max dose for thiazide diuretics?
A
25 mg/day
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
9
Q
What time of day should you avoid taking thiazide diuretics?
A
At bedtime
10
Q
What lab value would you check before starting a thiazide diuretic?
A
CrCL NEEDS to be greater than 40 ml/min
11
Q
What is the frequency of dosing for thiazide diuretics?
A
once daily
12
Q
What are the adverse effects of thiazide diuretics?
A
- Electrolyte disturbance
- Orthostasis
- Dizziness
- Hyperuricemia
13
Q
What are the monitoring parameters for thiazide diuretics?
A
- BUN/SCr
2. Electrolytes
14
Q
What are the common loop diuretics (brand/generic)?
A
- Bumex/Bumetanide
- Lasix/Furosemide
- Demadex/Torsemide
15
Q
What is the site of action for the loop diuretics?
A
The luminal side of the thick ascending loop of Henle
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
17
Q
What is the dosing range for Furosemide?
A
20 - 80 mg/day up to twice daily
18
Q
What are the adverse effects of loop diuretics?
A
- Orthostasis
- Dizziness
- Electrolyte disturbance
19
Q
What are the monitoring parameters for loop diuretics?
A
- BUN/SCr
- Electrolytes
- Serum bicarbonate
- CBC, Plt, and LFT’s
20
Q
What are the two sub-classes of K+ sparing diuretics?
A
- Na channel blockers
2. Aldosterone inhibitors
21
Q
What is the site of action for Na channel blockers?
A
The late distal convoluted tubule and collecting duct
22
Q
What is the site of action for aldosterone inhibitors?
A
Mineralocorticoid receptors in the late distal convoluted tubule and collecting duct
23
Q
Name one aldosterone inhibitor? (Brand/generic)
A
- Aldactone/Spironolactone
24
Q
What is the dosing range and frequency of Spironolactone?
A
50 - 100 mg 1 to 2 times daily
25
What is the mechanism of action for the aldosterone inhibitors?
They antagonize aldosterone receptors in the distal convoluted tubule and block sodium movement from the lumen to the interstitial space
26
What are the adverse effects of aldosterone inhibitors?
Hyperkalemia, GI, and gynecomastia
27
What are the monitoring parameters for aldosterone inhibitors?
1. BUN/SCr (closely follow)
| 2. electrolytes (closely follow K+)
28
What is the mechanism of action for ACE inhibitors?
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.
29
In which patient population are ACE inhibitors less likely to be effective?
African Americans
30
What are the adverse effects of ACE inhibitors?
1. ACE-induced cough
2. Angioedema (More likely in African Americans)
3. Hyperkalemia
4. Renal impairment
5. Hypotension
31
Why do you see a "bump" in SCr and K+ levels when a patient begins an ACE inhibitor?
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.
32
What is a positive aspect of using ACE inhibitors in diabetic patients?
renal protection
33
What is the dosing range and frequency of lisinopril?
10 - 40 mg once daily
34
What is the dosing range and frequency of benazepril?
10 - 40 mg once or twice daily
35
What are the monitoring parameters for ACE inhibitors?
1. BUN/SCr
| 2. Electrolytes
36
What is the mechanism of action for ARBs?
It inhibits the effects of angiotensin 2 at various sites in the body (same MOA as ACE inhibitors)
37
What is an acceptable rise in SCr when taking an ACE or ARB?
30%
38
List 3 ARBs (generic/brand)
1. Olmesartan (Benicar)
2. Irbesartan (Avapro)
3. Losartan (Cozaar)
39
What is the dosing range and frequency of olmesartan?
20 - 40 mg once daily
40
What is the dosing range and frequency of losartan?
25 - 100 mg one to two times daily
41
What are the adverse effects of ARBs?
1. Hyperkalemia
2. Angioedema
3. Hypotension
4. Renal impairment
42
What are the monitoring parameters for ARBs?
1. BUN/SCr
| 2. Electrolytes
43
What is the mechanism of action for direct renin inhibitors?
Inhibits the conversion of angiotensinogen to angiotensin 1 by inhibiting renin
44
Why can't direct renin inhibitors be used in first line treatment?
Because they are too new and don't have mortality data
45
Why are direct renin inhibitors contraindicated in combination with an ACE-I or ARB?
Because a study found that it increased the rates of stroke and kidney impairment when the two were used together
46
What is the brand and generic name of the one direct renin inhibitor?
Aliskerin (Tekturna)
47
What is the dosing range and frequency of aliskerin?
150 - 300 mg once daily
48
What are the adverse reactions for direct renin inhibitors?
1. Angioedema
2. Hypotension
3. Hyperkalemia
4. GERD
5. Renal impairment
49
What are the monitoring parameters for direct renin inhibitors?
1. BUN/SCr
| 2. Electrolytes
50
What is the mechanism of action for calcium channel blockers?
It prevents calcium influx and maintains relaxation in smooth muscle which decreases mean arterial pressure
51
What is the difference between dihydropyridine and non-dihydropyridine CCBs?
Dihydropyridine is more selective for vascular smooth muscle?
52
Which type of CCB is more likely to have a more depressant effect on the heart?
Non-dihydropyridine CCBs
53
When should Non-DHP CCBs be avoided?
In heart failure and in combination with beta-blockers
54
What are the two Non-DHP CCBs?
Verapamil and Diltiazem
55
What are the brand names of Diltiazem?
Cardiazem CD, Dilacor XR, Tiazac, and Cardiazem LA
56
What are the brand names of Verapamil IR?
Calan and Isoptin
57
What are the brand names of Verapamil LA?
Calan SR and Isoptin SR
58
What are the brand names of Verapamil Coer?
Covera HS and Verelan PM
59
What is the dosing range and frequency of Calan/Isoptin?
80 - 320 mg twice daily
60
What is the dosing range and frequency of Calan SR/Isoptin SR?
120 - 360 mg one to two times daily
61
What is the dosing range and frequency of Covera HS/Verelan PM?
120 - 360 mg once daily
62
What is the dosing range and frequency of Cardiazem LA?
120 - 540 mg once daily
63
What is the dosing range and frequency of Cardiazem CD/Dilacor XR/Tiazac?
180 - 420 once daily
64
What are the adverse effects of Non-DHP CCBs?
1. Bradycardia
2. AV block
3. Arrhythmia
4. Hypotension
5. Heart failure
6. Edema
7. Constipation
65
What are the monitoring parameters for Non-DHP CCBs?
1. BUN/SCr
2. LFTs
3. HR
66
What is the brand name of amlodipine?
Norvasc
67
What is the dosing range and frequency of amlodipine?
2.5 - 10 mg once daily
68
What are the adverse effect associated with DHP CCBs?
1. Angina
2. Edema
3. Fatigue
4. Dizziness
69
What is the MOA of beta blockers?
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
In what patient population should you administer beta blockers with caution?
Patients with heart failure
71
In what patient population are beta blockers avoided or used with extreme caution?
Asthma and COPD due to action on beta 2 receptors
72
What is important about the end of therapy on a beta-blocker?
Avoid abrupt discontinuation
73
What are the selective beta-blockers (Generic/brand)?
1. Atenolol (Tenormin)
2. Bisoprolol (Zebeta)
3. Metoprolol Tartrate (Lopressor)
4. Metoprolol Succinate (Toprol XL)
5. Nebivolol (Bystolic)
74
What is the dosing range and frequency of Atenolol?
25 - 100 mg once daily
75
What is the dosing range and frequency of Metoprolol Tartrate?
50 - 100 mg twice daily
76
What is the dosing range and frequency of Metoprolol Succinate?
50 - 100 mg once daily
77
What are the adverse effects associated with all beta-blockers?
1. heart failure
2. heart block
3. depression
4. bradycardia
5. dyspnea
6. dizziness
7. fatigue
8. erectile dysfunction
78
What are the two non-selective beta-blockers (Generic/brand)?
1. Carvedilol (Coreg)
| 2. Labetalol (Trandate)
79
What is the dosing range and frequency of carvedilol?
12.5 - 50 mg twice daily
80
What are the monitoring parameters for beta-blockers?
1. BUN/SCr
| 2. Heart rate
81
What is the MOA of alpha 2 agonists?
It decreases cardiac output by decreasing heart rate and mean arterial pressure through decreases sympathetic activity
82
Why should you avoid abrupt discontinuation with alpha 2 agonists?
rebound hypertension
83
What is the brand name of Clonidine?
Catapres
84
What is the brand name of the Clonidine patch?
Catapres TTS
85
What is the brand name of methyldopa?
Aldomet
86
What is the dosing range and frequency of clonidine?
0.1 - 0.8 mg twice daily
87
What is the dosing range and frequency of clonidine patch?
0.1 - 0.3 mg weekly
88
What is the dosing range and frequency of methyldopa?
250 - 1000 mg twice daily
89
What are the adverse effects associated with alpha 2 agonists?
1. orthostatic hypotension
2. bradycardia
3. sedation
4. constipation
5. rebound HTN
90
What are the monitoring parameters for alpha 2 agonists?
1. BUN/Scr
| 2. Heart rate
91
What is the MOA of alpha 1 blockers?
They block postsynaptic alpha 1 receptors resulting in vasodilation and decreased mean arterial pressure
92
Why should you take alpha 1 antagonists at bedtime when first starting?
It often causes orthostatic hypotension
93
What symptoms do alpha 1 antagonists improve?
Symptoms related to benign prostatic hypertrophy
94
What are the three alpha 1 antagonists (Generic/brand)?
1. Doxazosin (Cardura)
2. Terazosin (Hytrin)
3. Prazosin (Minipress)
95
What is the dosing range and frequency of doxazosin?
1 - 16 mg once daily
96
What are the adverse effects associated with alpha 1 antagonists?
1. orthostatic hypotension
2. drowsiness
3. dizziness
97
What is the monitoring parameter for alpha 1 antagonists?
Heart rate
