Lab 3 - Hypertension Flashcards

1
Q

Hydrochlorothiazide - MoA

A

Thiazide diuretic. Inhibit Na+, Cl- symporter and increase sodium excretion

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2
Q

Hydrochlorothiazide - Dose and route

A

12,5 mg orally

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3
Q

Hydrochlorothiazide - Adverse effects

A
Hyponatremia
Hypokalemia and metabolic alkalosis
Hypomagnesemia
Hypercalcemia
Hyperuricemia
Hypertrigyceridemia
Hyperglycemia
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4
Q

Hydrochlorothiazide - Contraindications

A
Liver and kidney failure
Diabetes
Gout
Allergy to sulfonamides
Obs in pts with urinary issues (overactive bladder, BPH, especially in elderly)
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5
Q

Hydrochlorothiazide - Interactions

A
  • ACE inhibitors have opposite effect on potassium
  • Increase serum levels of lithium by increasing reabsorption
  • Hypotensive effect decreased by NSAIDs and augumented by ACE inhibitors
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6
Q

Captopril - Dose and route

A

12,5 mg X 2 PO

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7
Q

Propanolol - Dose and route

A

40 mg orally. Increase dose to not more than 160mg x 2

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8
Q

Amlodipine - MoA

A

Dihydropyridine calcium channel blocker. Arteriolar vasodilation

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9
Q

Amlodipine - Dose and route

A

5 mg orally

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10
Q

Amlodipine - Adverse effects

A
Hypotension and reflex tachycardia
Dizziness
Flushing
Headache
Peripheral edema
Gingival hyperplasia
Constipation
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11
Q

Amlodipine - Contraindications

A

Severe hypotension
Cardiogenic shock
Acute MI
Aortastenosis

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12
Q

Amlodipine - Interactions

A

Serum levels increased by azole antifungal agents and cimetidine

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13
Q

Methyldopa - MoA

A

alpha 2 agonist. converted to methylnorepinephrine which activated a2

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14
Q

Methyldopa - Dose and route

A

125mg x 2 orally

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15
Q

Methyldopa - Adverse effects

A

Sedation
Orthostatic hypotension
Dry mouth
Headache

Immunologic effects including;
coombs positive hemolytic anemia, autoimmune hepatitis, other organ dysfunction.
Lupus-like syndrome

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16
Q

Methyldopa - Contraindications

A
Sick sinus syndrome
Acute hepatitis
Cirrhosis
Pheochromocytoma
MAO inhibitors
17
Q

Methyldopa - Interactions

A
  • Hypotensive effect decreased with tricyclic antidepressants
  • Hypotensive effect increased with levodopa
  • Sedative effect increased by CNS depressants
  • Can cause hypertensive crisis with MAO inhibitors
18
Q

Nitroprusside - MoA

A

Release nitric oxide and causes vasodilation

19
Q

Nitroprusside - Dose and route

A

0.3 mcg/kg/min IV infusion

20
Q

Nitroprusside - Adverse effects

A
Hypotension
Dizziness
Headache
Increased intracranial pressure
Methemoglobinemia
Thiocyanate and cyanide toxicity
21
Q

Nitroprusside - Contraindications

A

Vitamin B12 deficiency
Anemia
Severe renal disease
Hypovolaemia

22
Q

Nitroprusside - Interactions

A

Increased hypotensive effect with other hypotensive drugs

23
Q

HTN - Diagnosis

A

1) Staging BP
2) Cardiovascular risk (DM, LV hypertrophy, chronic renal disease)
3) Secondary causes of HTN + identify cardiovascular consequences)
Physical Exam: retinal arteriolar changes (narrowing), left ventricular lift, A2, S4, abdominal bruit, delayed femoral pulse etc.
Lab:
- Renal: urinalysis, albumin excretion, BUN, creatinine
- Endocrine: Na, K, Ca, TSH
- Metabolic: fasting blood glucose, total cholesterol, triglycerides
Other: Hb (anemia, polycythemia), CBC, Gamma- glutamyltransferase (chronic alcoholism), CXR (identification of distal aortic arch in coarctation of aorta), ECG/Echo

Renal artery stenosis - MR angiography
Cushing syndrome: dexamethasone suppression test, Adrenal CT
Pheochromocytoma: 24-h urine collection of catecholamines, plasma metanephrine + Adrenal CT
Primary hyperaldosteronism: depressed plasma renin + hyper secretion of aldosterone

24
Q

Metoprolol - Dose and Route

Preferred in what kind of pts?

A

50 mg PO
Young ptw with hyperkinetic circulation
DM with CAD

25
Q

Bilateral adrenal hyperplasia - treatment + dose

A

Aldosterone antagonist- Eplerenone: 50 mg PO

26
Q

HTN in black pt (stage 1)

A

CCB or thiazide –> if needed combine them or add ACE-inh

27
Q

HTN <60 y old (stage 1)

A

ACE - inh –> CCB or thiazide –> combine all

28
Q

HTN >60 y old (stage 1)

A

CCB or thiazide –> ACE-inh –> combine all

29
Q

Stage 2 HTN

A

start with 2 drugs; ACE-inh + CCB/thiazide

30
Q

HTN with HF

A

ACE-inh + Thiazide + Beta- blocker

31
Q

HTN and DM (+ CAD)

A

ACE- inh

DM + CAD: Beta-blockers

32
Q

DOC for chronic HTN in pregnancy and preeclampsia

A

chronic HTN in pregnancy: Methyldopa

preeclampsia: Hydralazine

33
Q

Hydralazine - Dose and route

A

12,5 mg bid

34
Q

BP Goal

Clinic, Ambulatory, CM, Proteinuria/renal failure, elderly

A
Clinic: <140/90
Ambulatory: <130/80
DM: <140/80
Proteinuria/renal failure<130
Elderly<150/90
35
Q

BP in hypertensive emergency and urgency

A

Emergency: >220/140

Urgency >180/120