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Nicole - Anti-Hypertensives Flashcards

1
Q

What is Pre-HTN?

A

120-139/ 80-89

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2
Q

Stage I HTN

A

140-159/ 90-99

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3
Q

Stage II

A

> = 160 or >=100mmHg

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4
Q

A hypertensive emergency occurs when the DBP is greater than what number?

A

120 with end organ damage (CKD, retinopathy, LVH)

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5
Q

What is HTN urgency?

A

When DBP is >120 without End organ damage

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6
Q

When do you treat a patient for HTN?

A
  • If SBP >/= 140mmHg in patients = 60 years old
  • If SBP >/= 150mmHg in patients 60 yo

OR

DBP >90 after trial therapeutic lifestyle changes

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7
Q

Always treat HTN if the BP is what?

A

160/100 (20/10 over target.

Start on 2 drugs (cautiously in elderly)

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8
Q

What drugs do you use in controlled Afib?

A

B blockers

NHDCCB

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9
Q

What drugs do you use in systolic HTN?

A

ACEI/ARB
Beta blocker
diuretic
aldosterone agonist

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10
Q

What drugs should you use post MI?

A

B blockers
ACEI/ARB
Aldosterone agonist

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11
Q

What drugs do you use CKD with proteinuria

A

ACEI/ARB

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12
Q

Drugs to use for Angina

A

Beta Blockers

CCB

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13
Q

There are 4 types of Diuretics. What are they? :)

A

Thiazide: HCTZ
Thiazide like: Chlorthalidone
K+ sparing: Triamterene
Loop Diuretics: Furosemid, Torsemid, Ethacryinic acids
++ LDs not used often for long term BP reduction

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14
Q

What is the site of action for diuretics?

A

Renal Nephron

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15
Q

Explain the MOA for the diuretics?

A

Increase Urinary Na+ and H2O excretion

Decrease extracellular fluid and/or plasma volume which causes a decrease in TPR

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16
Q

What are the most common types of medication used for mild to moderate HTN?

A

Diuretics!

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17
Q

When prescribing diuretics, what should you remember about the potency?

A

Start with low potency and monitor for tolerance

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18
Q

Along with prescribing a diuretic, what else should you make sure to tell you patient so that they can control their blood pressure?

A

Low Na+ foods

High K+ foods

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19
Q

What are the indications for the thiazide/thiazide-like diuretics?

A

HTN

Edema

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20
Q

What is the MOA of the thiazide/thiazide-like diuretics?

A

Na-Cl symporter inhibition in DCT which increases Na and Cl excretion

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21
Q

What is an allergy/sensitivity you need to be aware of when prescribing thiazide/thiazide-like diuretics?

A

Sulfa

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22
Q

Using thiazide/thiazide-like diuretics and _______ increases risk of hyperglycemia

A

Beta Blockers

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23
Q

At what eGFR will you see a loss of effectiveness of thiazide/thiazide-like diuretics?

A
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24
Q

What is the MOA of Triampterene?

A

Direct inhibitor of Na+ influx in DCT and CCT

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25
The indication of Triampterene is what?
Hypokalemia
26
Furosemide is what type of diuretic?
Loop Diuretic
27
When do you prescribe Furosemide?
Edema secondary to CHF Renal Failure Liver Failure
28
Where is the site of action for the B Blockers?
Heart | Kidney
29
What do the B blockers do specifically which helps to lower blood pressure
Decrease HR Possible Decrease SV Decrease TPR by decreasing Renin and Angiotensin II
30
Why do you want to use B blockers post-MI?
They are cardio-protective and reduce mortality
31
Name some other purposes that B Blockers are used for?
``` Angina stage fright/anxiety HA prevention/tx PTSD Panic disorders ```
32
Propranolol may mask what in diabetics?
hypoglycemia
33
What do you need to remember about the dosing of B blockers?
>100mg of Selective B blockers may cause them to lose their B1 selectivity
34
The beta blockers have contraindications that include what?
bradycardia Heart block Uncompensated HF Severe depression
35
Carvedilol is a B blocker but also blocks what NT?
Norepinephrine
36
What additive effect do you get by choosing the beta blocker carvedilol for heart failure
Because it blocks Norepi, it has an additive effect of lowering BP
37
What is the site of action for the ACEIs
Renal | The Renin-Angiotensin system
38
Explain the MOA of the ACEIs
Inhibit conversion of AT1 to AT2 This lowers Arteriolar resistance Also increases venous capacity, CO and Vascular volume Lower renovascular resistance as well
39
When using an ACEI, what patients do you need to be cautious in?
Patients with renal insufficiency
40
A major contraindication/Side effect of ACEI use is what?
Angioedema | Pregnancy (teratrogenic)
41
The alpha blocker used in HTN is what?
Prazosin
42
Where is the site of action for Prazosin?
Peripheral arterioles, veins, smooth muscle
43
The MOA of Prazosin is what?
Antagonist at alpha 1 receptors on vasc smooth muscle resulting in vasodilation and decreased TPR
44
Why don't you want your patients to take Cialis and Prazosin at the same time?
Risk of hypotension
45
The alpha blockers are used extensively for what disease?
benign prostatic hypertrophy
46
What is Prazosin used for?
HTN | Off label: PTSD, Raynauds
47
Tell me what the centrally acting alpha 2 agonists are
Clonidine | Methyldopa
48
What is the MOA of the centrally acting alpha 2 agonists
Decrease release of norepinephrine leading to increased vasodilation with decreases TPR (decreased sympathetic outflow)
49
What does prolonged use of Centrally acting A2 agonists cause?
Water retention
50
You need to be careful about what when it comes to prescribing Centrally acting A2 agonists?
Mood altering effects
51
The MOA of Clonidine is what
1. Stimulates Alpha2 receptors in the brain stem which: 2. Stimulates an inhibitory neuron which: 3. Results in reduced sympathetic outflow from the CNS causing: 4. decreased TPR!
52
Why do you use clonidine?
Hypertension ADHD (Narcotic addiction)
53
Methyldopa is indicated for what?
HTN in pregnancy
54
MOA of methyldopa is what?
central a-adrenergic inhibition decreases sympathetic outflow to heart, kidneys, peripheral vasculature
55
There's a lot to remember about antihypertensive meds. Here are some key things
- They all act on one or more major organ system - Physiological regulator of blood pressure - Reduce CO and/or TPR to lower BP - Can combine drugs from different classes to increase BP lowering effect
56
Can you use two HTN meds from the same class together to increase the BP lowering effects?
Nope
57
what drugs to you use for a fib (rate controlled)?
BB | NHDCCB
58
What drugs do you use for systolic HF?
``` ACE ARB BB Diuretic Aldosterone antagonist ```
59
What should you use to treat post-MI?
BB ACE/ARBs Aldosterone antagonists (Not CCBs)
60
A patient has CKD with proteinuria. What drugs do you use?
ACEi | ARB
61
What drugs do you use for angina?
BB | CCB

Pharm (12 decks)

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