Pharm Flashcards
what treatment would you use (2)?
- ≥ 60
- BP goal: 150/90
- non Black
- thiazide diuretic
- ACE/ARB/CCB alone or in combo
how would you treat?
- < 60 yo
- BP goal: 140/90
- black
thiazide vel CCB
how would you treat
- Diabetes w/o CKD
- BP goal: < 140/90
thiazide diuretic vel CCB
how would you treat?
- all ages/races with CKD
- ± diabetes
- BP goal: < 140/90
ACE ao ARB with another class
criteria for stage I and II htn
bonus: idiopathic htn accounts for what % of pts
- stage I = 140-159/90-99
- Stage Il = >160/>100
bonus: idiopathic accts for 95% of pts (no known 2˚ cause)
the more risks or the younger* the pt the more ______ you should tx.
*why younger?
aggressively
the younger the pt, the longer they have w dz
afferent carotid sinus + aortic arch baroRs are monitored by ___ and ____ resp
IX (carotid) and X (aortic) resp
efferent CNX + SNS fibers, and circulating catecholamines affect ___ (structure)
SA node
competitively inh Na+K+CI- transporters in the PAT
loop diuretics
inh Na/Cl exchange in distal ascending loop (TAL)
thiazide diurectics
inh Na+ reabsorption in the distal tubule
K+ sparing diuretics
SEs of _____ (2 diurectics) include
- hypokalemia and hypomagnesium –> ± cardiac arryth
- ∆glucose tolerance
- inc lipids + uric acid
- voleume depletion
- ED in men
loop and thiazide diuretics
Caution for ______(1 diuretic), esp with use of ACE + ARB tx, includes hormonal sx like
- gynecomastia
- irreg mentruation,menorrhagia, nipple tenderness
- AND hyperkalemia*
* explain why?
- K+ sparing (spironolactone***)
- hyperK+ bc spironolactone is competitive antag of aldo
explain the bio efx of diuretics for htn
↓BP + CO –> ↑ Na and H2O clearance –> enhanced vol depletion –> overtime CO returns to normal
explain the MOA of ACEi (2)
- block endoth ACE conversion of AngI –> Ang II
- ↓ bradykinin breakdown –> (vasoD*)
Explain the MOA of ARBs
comp binding for AngII (vasoC) to vasc endoth
ATP dep Extrusion Pump in gut and brain
P-glycoprotein
hint: beware if pt is on PGPi
bupropion interferes with _____ CYP enz eliminatn of metropolol + bupropion metabs
CYP2D6
hint: sx temporal to buproprion tx
inh of the delayed rectifier K+ current usually leads to?
what is the mechanism of the drugs listed below?
tosades de pointes (ventr dysrhythmia)
MOA: block cardiac repolz
explain the MOA behind most drug induced valvular dz’s
involve 5HT2b rcp that modulate serotonin release
Name the pathology associated with drugs below
- Clozapine →
- methsergide →
- MDMA, methsurgide, pergolide →
- fenPhen, MDMA, cabargoline, methsurgide, pergolide→
- fenphen, bromocriptine, MDMA, cabargoline, methsurgide, pergolide →
- acute effusive pericarditis
- mitral stenosis
- tricuspid reurg
- mitral regurg
- aortic regurg
hint: 5HT2b assc path
why is there an ↑risk of MI with NSAIDs?
prothrombotic: COX1i → inh TXA2 –> ↓plt aggr’n
hint: also cause fluid rtn → heart failure
↑O2 delivery to myocard tissue is deps on _____
coronary Artery vasoD
what does MOAN/MONA stand for and what can it tx?
- Morphine
- O2
- ASA
- Nitroglycerin
tx for MI and angina
Name the drug for MI/angina
- irrev COX1 inh → blocks TXA2 and PG prodn →↓plt aggrn
- ↓inflamm but ↑bleeding risk
Aspirin (ASA)
Name the drug for MI/angina
- enz rxn w sulfhydryl grps → reduction
- activates guanylyl cyclase → ↑cGMP→ ↓intracell Ca → sm muscle relaxn → VasoD
- venous dilation →↓preload
- relieves CA vasospasm* (epicardial CA + collaterols)
Nitrates
hint: reduced to NO
endothelial NO also inh what two functions?
antiinflamm efx
- plt aggr’n
- WBC-endoth interactions
std dosing for Nitrates (2)
- 0.4 mg (sublingual/spray)
- cont infusion/IV (titrate)
Contraindications for ___ include:
- STEMI
- systolic hypotension (<90)
- PDEi use*
- hypertophic CMP
- aortic stenosis
*explain why?
nitrates
*bonus: PDEi block cGMP breakdown –> uncontrolled vasoD + vol depletion?
Name the drug:
- pain control
- ↓SNS output → ↓O2 demand
- vasoD efx → ↓preload
Morphine
hint: req 2A recommendation
definitive tx for MI means
angioplasty balloon in cath lab
DOC for unstable* angina
ASA
tx for angina, syncope and heart failure in aortic stenosis
slow nitroglyceride admin (3 doses)
tx plan for cocaine/chest pain w/ sympathomimetic sx? - 3
- GABAagonist (benzo) THEN anti htn
- nitroglyc for coronary vasospasm
VIPI: BBs contraindicated!!!
Tx plan for preeclampsia? - 2
what should be given with special consult - 3
- Magnesium sulfate
- Hydralazine
hint: Hydralazine, labetalol, methyldopa, nifedipine. He Likes My Neonate
special conults:
- thiazides,
- CCBs
- clonadine
Name the indications for the dx’s below
- Diabetes - 2
- COPD -1
- Aortic Dissection -1
- ACE + ARBS
- CCBs
- BBs
Name the contraindications for the dx below
- diabetes
- COPD
- aortic dissection
- depression - 2
- BBs
- BBs
- VasoD’s alone
- BBs + m-dopa
why should you moderatly dec BP in pts with chronic htn
rapid change –> ischemia + stroke
dec vasc compliance + inc CO result in
widened pulse pressure
hint: see egs of inc CO below
This drug can:
- slows diabetic renal dz
- protects htn pts w/ prev healthy kidneys
- improves renal artery stenosis
but what’s the worst case scenario?
ACEi
worst case scenario: failed dx of renal htn + ø f/u –> ARF/hyperK+ and sudden death
- Where loop diruectivs ct on acive Na/K/C transporters
- ROMK and NKCC2 activity
segment?
Thick Ascending Limb LOH (TAL)
what common Rx combo is used (2)?
- Thiazide + K sparing
- Loop + K-sparing
Name the drug and SEs:
MOA: Osmotic diuretic.tubular fluid osmolarity urine flow, intracranial/ intraocular pressure.
use for: Drug overdose, elevated intracranial/intraocular pressure.
SEs: Pulmonary edema, dehydration, hypo- or hypernatremia. Contraindicated in anuria, HF.
Mannitol