Lecture Flashcards by Kellie Wheeler

What is a NORMAL BP

120/80

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What is pre-HTN?

120-139 systolic

80-89 diastolic

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What is stage I HTN?

140-159 systolic

90-99 diastolic

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What is stage II HTN?

Greater than 160 systolic

Greater than 100 diastolic

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What classifies a blood pressure as a hypertensive emergency?

DBP greater than 120mmHg

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What are the 4 types of diuretics?

Thiazide
Thiazide-like
K+ sparing
“Loop diuretics”

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What is the site of action of diuretics?

Renal nephron

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Increases urinary Na+ and H2O excretion, decreases extracellular fluid and/or plasma volume which causes a decrease in TPR

Method of action of diuretics

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What is the most commonly used medication for mild to moderate hypertension?

Diuretics

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How do you dose diuretics?

Start with low potency, monitor for tolerance

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What kind of diet do you recommend to a person on diuretics?

Low in Na+, high in K+

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What should you warn your patient about when they take a diuretic?

Hypokalemia
Hypovalemia - low blood plasma
Dehydration

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What do beta blockers do?

Decrease heart rate, decrease stroke volume, decrease TPR via decreasing renin and angiotensin II

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What is the site of action of beta blockers?

Heart and kidney

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Who should you caution use of beta blockers in?

Patients with pulmonary disease

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What is the benefit of beta blockers post MI?

Cardio protective

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What are some other uses for beta blockers?

Stage fright
Anxiety
Headache prevention/treatment
PTSD
Panic disorders

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What should you monitor in a patient with renal insufficiency if they are taking an ACEI?

Monitor creatinine closely

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If your patient is receiving hemodialysis and you want to start them on an ACEI, what should you do?

Communicate with nephrologist because increased incidence of negative effects

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If your patient on an ACEI experiences edema, what should you do?

Take them off medication and do not try again! Once experienced they are always at risk and it can be life threatening

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What vitamin should you keep an eye on if your patient is taking an ACEI?

K+

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What is the site of action for an ACEI?

Renal (Renin-angiotensin system)

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What do ACEIs do?

Inhibit conversion of Angiotensin I to angiotensin II

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ACEIs _____ arteriolar resistance, _____ venous capacity, _____ cardiac output, and _______ vascular volume, and ______ renovascular resistance

Lower

Increase

Lower

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Site of action of ARBs?

Smooth muscle of blood vessels

What do ARBs do?

Block angiotensin from binding to angiotensin receptors Relaxes and dilates blood vessels

Site of action of direct renin inhibitor?

Renal

What do direct renin inhibitors do?

Inhibit renin which diminishes production of angiotensin Dilates vessels, lowers TPR, lowers BP

Site of action of DCCB and NDCCB?

Vascular smooth muscle, SA and AV nodal conduction, myocardium

What may cause a positive ANA and a direct Coombs test?

Nifedipine

Why should a patient not take a CCB with grapefruit juice or grapefruit?

Could increase serum concentration of CCB

What type of health maintenance should you include in your patient education when your patient is on a beta blocker?

Dental - gingival hypertrophy and inflammation may occur

Site of action of Hydralazine?

Vascular smooth muscle

What drug can cause Lupus?

Hydralazine

Which drug may caused increased hair production?

Hydralazine

What is the drug of choice for treatment of a hypertensive emergency in women?

Hydralazine

What is the site of action of alpha blockers?

Peripheral arterioles, veins, and smooth muscle

What drug should patients taking an alpha blocker avoid?

Cialis - hypotension

What is the site of action of a centrally acting A2 agonist?

CNS/Brain

What does prolonged use of a centrally acting A2 agonist cause?

H2O retention

What can occur to BP in response to starting a patient on a centrally acting A2 agonist?

Rebound increase in BP

What is commonly used in detox protocols for ETOH withdrawal?

Centrally acting A2 agonist

What is one mood altering affect of centrally acting A2 agonists?

Depression

How do antihypertensives work to control BP?

They all reduce cardiac output and/or TPR to lower BP!

What is the rule about prescribing multiple hypertensives ?

Don't combine two drugs from the same class

What drug regimen is recommended for patients with heart failure?

ACEI, diuretics

What drug regimen is recommended for patients with diabetes?

Avoid Beta blockers!! use an ACEI

What drug regimen is recommended for patients with myocardial infarction?

Beta blocker, ACEI

What drug regimen is recommended for patients with renal insufficiency?

ACEI

What drug regimen is recommended for patients with angina?

Beta blocker, CCB

What drug regimen is recommended for patients with asthma?

Avoid non selective beta blocker | USE CCB!!

What drug regimen is recommended for patients with isolated systolic HTN (older patients)?

Diuretics, CCB

Which anti-arrhythmics are in Class 1a

Procainamide, quinidine

Which anti-arrhythmic is in class 1B

Lidocaine

Which anti-arrhythmic is in class 1C

Flecainide

Which anti-arrhythmic is in class 2

Propranolol

Which anti-arrhythmic is in class 3

Amiodarone

Which anti-arrhythmic is in class 4

Verapamil, diltiazem

Which anti-arrhythmic is in the "miscellaneous category"?

Adenosine, ivabrodine

Prolongs APD, intermediate dissociation kinetics

Class 1a

Shortens APD ion selective tissues, rapid dissociation kinetics

Class 1b

Minimal APD impact, slow dissociation kinetics

Class 1c

Sympatholytic action

Class 2

Prolongation of APD

Class 3

Blockade of calcium current

Class 4

What is primary prevention of hyperlipidemia?

High LDL levels with family history or diabetes | High global risk score (over 7.5%)

What is secondary prevention of hyperlipidemia?

History of heart disease or stroke

What are the guidelines for treating a patient for hyperlipidemia?

Don't treat to target LDL but use intensity of statin therapy as rubric

High intensity statins reduce LDL by ?

50%

Moderate intensity statins reduce LDL by?

30-49%

Which HMG-CoA reductase drug should you avoid in patients with decreased renal function (GFR under 30)

Lovastatin

Which HMG-CoA reductase drug should you use w patients who have hepatic dysfunction because it is not CYP450 metabolized?

Pravastatin

Which HMG-CoA reductase drug should you avoid in patients with renal or hepatic dysfunction because it is the second most potent combination for LDL/Trig reduction?

Rosuvastatin (crestor)

Which HMG-CoA reductase drug should you avoid in patents with renal dysfunction?

Simvastatin

What are the thresholds for treatment for HTN?

SBP greater than 140mmHg in patients less than 60 | SBP greater than 150mmHg in patients older than 60

If your patients BP is 160/100, what should you do?

Start then on two drugs, but be cautious in elderly