Murphy Flashcards
How to address first dose syncope adverse effect of Alpha 1 blocker
First dose should be given at bedtime, patient should be instructed to rise slowly to decrease risk if orthostatic hypotension and syncope
CCBs contraindications
2/3 degree heart block
Cardiogenic shock
Acute MI
Systolic heart failure
Beta blocker contraindications
HR < 60 SBP < 90 mm hg Severe asthma or COPD Heart block Decompensated HF
Example of alpha-2 agonists
Clonidine
Methyldopa
Aldosterone antagonist has minimal _____ effect, but beneficial when used as add-on therapy
Antihypersensitve
If you prescribed these classes of drug with diuretics, cut starting dose in half
ACEI
ARBs
Antihypersensitive Drug that can be initiated in pregnancy
Methyldopa
Labetalol
Long-acting nifedipine
Hydralazine
Standard combination therapy in HF
ACEI + B-blocker + Diuretic
Spironolactone is indicated as add on therapy for HF when
CrCl>30ml/min
k < 5 meq/dl
3 ARBs that have best evidence for reducing preload and afterload
Candesartan (most helpful)
Losartan
Valsartan
Which drugs used in HF reduce mortality and morbidity?
ACEI
Arbs
B-blocker
Spirinolactone
In heart failure, initiate spironolactone when _____ in men, ____ in women and potassium ______
Scr < 2.5
Scr < 2
< 5
Chlorthalidone daily dosage range
12.5 - 50 range
ACEI is ______ in diabetic patient
Renoprotective
ACEI & ARBs absolute contraindications
Pregnancy(2nd & 3rd trimester)
Angiodema
Bilateral renal artery stenosis
You can substitute ________ for b-blocker in patient with CAD
Long acting CCB ( verapamil or diltiazem)
List drugs that treat diabetic hypertensive patient in order of importance
ACEI or arbs
Dhp-CCB
Thiazides
B-blocker
Post-MI patient should be on ___ and ____ unless absolutely contraindicated
ACEI
B-blocker
JNC-8 recommends if goal blood pressure not reached within ___ month of treatment, increasing dose or start a second drug
1
CCBs may reduce proteinuria in patient with _____
CKD
____ release CCBs are preferred in HTN patient
Extended
Which CCB should be avoided in patient with acute MI
Diltiazem
Beta blocker may mask signs of _______
Hypoglycemia
