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Pharm > Nicole - Anti-Hypertensives > Flashcards

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
Q

The indication of Triampterene is what?

A

Hypokalemia

26
Q

Furosemide is what type of diuretic?

A

Loop Diuretic

27
Q

When do you prescribe Furosemide?

A

Edema secondary to CHF
Renal Failure
Liver Failure

28
Q

Where is the site of action for the B Blockers?

A

Heart

Kidney

29
Q

What do the B blockers do specifically which helps to lower blood pressure

A

Decrease HR
Possible Decrease SV
Decrease TPR by decreasing Renin and Angiotensin II

30
Q

Why do you want to use B blockers post-MI?

A

They are cardio-protective and reduce mortality

31
Q

Name some other purposes that B Blockers are used for?

A 
Angina
stage fright/anxiety
HA prevention/tx
PTSD
Panic disorders
32
Q

Propranolol may mask what in diabetics?

A

hypoglycemia

33
Q

What do you need to remember about the dosing of B blockers?

A

> 100mg of Selective B blockers may cause them to lose their B1 selectivity

34
Q

The beta blockers have contraindications that include what?

A

bradycardia
Heart block
Uncompensated HF
Severe depression

35
Q

Carvedilol is a B blocker but also blocks what NT?

A

Norepinephrine

36
Q

What additive effect do you get by choosing the beta blocker carvedilol for heart failure

A

Because it blocks Norepi, it has an additive effect of lowering BP

37
Q

What is the site of action for the ACEIs

A

Renal

The Renin-Angiotensin system

38
Q

Explain the MOA of the ACEIs

A

Inhibit conversion of AT1 to AT2
This lowers Arteriolar resistance
Also increases venous capacity, CO and Vascular volume
Lower renovascular resistance as well

39
Q

When using an ACEI, what patients do you need to be cautious in?

A

Patients with renal insufficiency

40
Q

A major contraindication/Side effect of ACEI use is what?

A

Angioedema

Pregnancy (teratrogenic)

41
Q

The alpha blocker used in HTN is what?

A

Prazosin

42
Q

Where is the site of action for Prazosin?

A

Peripheral arterioles, veins, smooth muscle

43
Q

The MOA of Prazosin is what?

A

Antagonist at alpha 1 receptors on vasc smooth muscle resulting in vasodilation and decreased TPR

44
Q

Why don’t you want your patients to take Cialis and Prazosin at the same time?

A

Risk of hypotension

45
Q

The alpha blockers are used extensively for what disease?

A

benign prostatic hypertrophy

46
Q

What is Prazosin used for?

A

HTN

Off label: PTSD, Raynauds

47
Q

Tell me what the centrally acting alpha 2 agonists are

A

Clonidine

Methyldopa

48
Q

What is the MOA of the centrally acting alpha 2 agonists

A

Decrease release of norepinephrine leading to increased vasodilation with decreases TPR
(decreased sympathetic outflow)

49
Q

What does prolonged use of Centrally acting A2 agonists cause?

A

Water retention

50
Q

You need to be careful about what when it comes to prescribing Centrally acting A2 agonists?

A

Mood altering effects

51
Q

The MOA of Clonidine is what

A
  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
Q

Why do you use clonidine?

A

Hypertension
ADHD
(Narcotic addiction)

53
Q

Methyldopa is indicated for what?

A

HTN in pregnancy

54
Q

MOA of methyldopa is what?

A

central a-adrenergic inhibition decreases sympathetic outflow to heart, kidneys, peripheral vasculature

55
Q

There’s a lot to remember about antihypertensive meds. Here are some key things

A
  • 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
Q

Can you use two HTN meds from the same class together to increase the BP lowering effects?

A

Nope

57
Q

what drugs to you use for a fib (rate controlled)?

A

BB

NHDCCB

58
Q

What drugs do you use for systolic HF?

A 
ACE 
ARB
BB
Diuretic
Aldosterone antagonist
59
Q

What should you use to treat post-MI?

A

BB
ACE/ARBs
Aldosterone antagonists
(Not CCBs)

60
Q

A patient has CKD with proteinuria. What drugs do you use?

A

ACEi

ARB

61
Q

What drugs do you use for angina?

A

BB

CCB

Pharm (12 decks)

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