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Cardiology 1 > Pharm - HTN > Flashcards

Pharm - HTN Flashcards

1
Q

BP goal for people ≥ 60 yo

A

<150/90

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2
Q

Bp goal for people <60 yo

A

<140/90

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3
Q

goal for people with CKD OR DM

A

<140/90

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4
Q

4 drug classes to choose from non-aa with HTN

A
  • Thiazide-type diuretic
  • Calcium channel blocker
  • Angiotensin-converting enzyme inhibitor (ACEI)
  • Angiotensin receptor blocker (ARB)
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5
Q

2 drug classes to choose from for aa with HTN

A
  • Thiazide-type diuretic

* Calcium channel blocker

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6
Q

What is next step if BP goal not met within 1 month

A
  • increase dose of 1st drug

- add 2nd drug

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7
Q

what is next step if BP goal is not met with two drugs

A
  • add a 3rd
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8
Q

what is next step if BP can’t be met with 3 drugs from initial 4 drug class list OR if can’t use those drugs due to contraindications

A

turn to other classes

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9
Q

what two drugs from the top 4 list should not be used together

A

ARB and ACEI

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10
Q

What are the 5 lifestyle change recommendations (list)

A
  1. Lose weight if overweight (BMI goal 18.5-24.9)
  2. DASH diet
  3. Reduce dietary sodium (<2.4 g Na/day)
  4. Increase physical activity
  5. moderation of alcohol consumption (Men ≤ 2 drinks, women ≤ 1 drinks)
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11
Q

Overview of DASH diet

A
  • fruits and vegetables
  • low fat dairy
  • high potassium and calcium
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12
Q

Generic name for thiazide type diurietic

A

hydrocholorthiazide

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13
Q

Generic name for loop diurietic

A

furosemide

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14
Q

Generic name for potassium sparing diurietic

A

Triamterene

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15
Q

Generic name for ACEI

A

Lisinopril

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16
Q

Generic name for ARB

A

Losartan

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17
Q

Generic name for non-dihydropyridine calcium channel blocker (2)

A

Verapamil

Diltiazem

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18
Q

Generic name for dihydropyridine calcium channel blocker

A

Amlodipine

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19
Q

Generic name for aldosterone receptor blocker

A

Aldactone

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20
Q

Generic name for adrenergic inhibitor - peripheral

A

Reserpine

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21
Q

Generic name for adrenergic inhibitor - central alpha agonist

A

clonidine

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22
Q

Generic name for beta-blocker, cardio selective

A

Atenolol

metoprolol from Dr. Letassy’s lecture

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23
Q

Generic name for beta-blocker, non-specific

A

propranolol

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24
Q

Generic name for alpha-1 blocker

A

Doxazosin

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25
Q

Generic name for combined alpha & beta blocker

A

Carvedilol

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26
Q

Generic name for direct vasodilator

A

Minoxidil

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27
Q

MoA

Thiazide-type diuretic

A
  • Acutely reduce blood pressure due to diuresis
  • chronically probably mobilize sodium and water from arteriolar walls reducing vascular tone OR they directly relax vascular smooth muscles
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28
Q

MoA

Loop diuretic

A

Diuresis, maybe vascular smooth muscle relaxation

29
Q

MoA Potassium-sparing diuretic

A

Weakly antihypertensive; used for potassium sparing usually in combination with a thiazide diuretic

30
Q

MoA ACEI

A
  • Blocks angiotensin converting enzyme
    – reduced levels of angiotensin II, a potent vasoconstrictor
  • reduced levels of aldosterone (hormone that promotes water/Na retention by the kidney)
  • Net effect is reduced tone of arterioles = lower BP
31
Q

MoA ARB

A
  • Directly blocks actions of angiotensin II, potent vasoconstrictor and stimulator of the release of aldosterone.
  • Result is reduced arteriolar tone and lower BP
32
Q

MoA calcium channel blocker non-dihydropyridine

A
  • Inhibits influx of Ca into smooth muscle cells of peripheral vasculature = relaxation and reduced vascular tone
  • Also reduced chronotropy and inotropy
33
Q

MoA calcium channel blocker dihydropyridine

A
  • Inhibits influx of Ca into smooth muscle cells of peripheral vasculature = relaxation and reduced vascular tone. More potent than non-dihydropyridines
  • Does not reduce chronotropy or inotropy to same degree as non-dihydropyridines
34
Q

MoA aldosterone receptor blocker

A

Binds to aldosterone receptors in renal tubules, blocks aldosterone binding
- increased water and sodium excretion = relaxation of blood vessels

35
Q

MoA peripheral adrenergic inhibitors

A
  • Depletes norepinephrine from sympathetic nerve endings in peripheral nervous system
  • Blocks transport of norepinephrine into storage granules
  • Results in reduced arteriolar tone and lower BP
36
Q

MoA Central alpha-agonist adrenergic inhibitors

A
  • Stimulates alpha-2 receptors in brainstem leading to decreased sympathetic outflow from vasomotor center
  • Results in reduced arteriolar tone and lower BP
37
Q

MoA alpha-1 blockers

A
  • blocks alpha-1 receptors on arterioles

* relaxation of arterioles and reduced vascular tone

38
Q

MoA beta-blockers

A

• Not fully known
• Related to:
1. decreased sympathetic outflow from CNS
2. reduced cardiac output
3. reduced renin release by juxtoglomerular cells in the kidney

39
Q

MoA combo alpha/beta blockers

A

effects of each together in one little pill

40
Q

MoA direct vasodilators

A

directly relaxes arteriolar smooth muscle

41
Q

thiazide-type diuretics ADR

A
  • Short-term increase in cholesterol and glucose levels
  • Decreased serum levels of potassium, sodium, chloride, and magnesium
  • Increased serum levels of uric acid and calcium
42
Q

thiazide-type diuretics monitoring parameters

A
  • Chem-7
  • BP
  • some pts: uric acid, ca, mg
43
Q

Loop diuretics ADR

A
  • Short-term increase in cholesterol and glucose levels
  • Decreased serum levels of potassium, sodium, chloride, magnesium AND CALCIUM (unlike thiazide type which doesn’t affect Ca)
  • Increased serum levels of uric acid and calcium
44
Q

Loop diuretic monitoring parameters

45
Q

Potassium sparing diuretic ADR

A

Hyperkalemia

46
Q

Potassium sparing diuretic monitoring parameters

47
Q

ACEI ADR

A
  • Cough (lisinopril)
  • Hyperkalemia (esp. DM and renal insufficiency)
  • Angioedema
  • Rash
  • Loss of taste
  • Contraindicated in pregnancy
48
Q

ACEI monitoring parameters

A
  • chem-7
  • bp
  • question for ADR
  • PE
49
Q

ARB ADR

A
  • Hyperkalemia (esp. DM and renal insufficiency)

* Contraindicated in pregnancy

50
Q

ARB monitoring

A
  • chem-7

- BP

51
Q

Non-dihydropyridine calcium channel blockers ADR

A
  • Slowed cardiac conduction
  • Worsening of systolic fn in heart failure (negative inotropic effect)
  • Constipation
52
Q

Non-dihydropyridine calcium channel blockers monitoring parameters

A
  • BP
  • EKG
  • question for ADR
53
Q

dihydropyridine calcium channel blockers ADR

A
  • Ankle edema
  • Flushing
  • HA
54
Q

dihydropyridine calcium channel blockers monitoring parameters

A
  • BP
  • question for ADR
  • PE
55
Q

Aldosterone receptor blockers ADR

A
  • hyperkalemia

- gynecomastia (warn patients first!!)

56
Q

Aldosterone receptor blockers monitoring parameters

A
  • chem-7

- BP

57
Q

Peripheral adrenergic inhibitors ADR

A
  • nasal congestion

- sedation

58
Q

Peripheral adrenergic inhibitors monitoring

A
  • bp

- question for ADR

59
Q

Central alpha-agonist adrenergic inhibitors ADR

A
  • Sedation
  • Dry mouth
  • Lethargy
  • Bradycardia
  • Withdrawal rebound HTN
  • Impaired cognitive fn in elderly
60
Q

Central alpha-agonist adrenergic inhibitors monitoring parameters

A
  • BP
  • EKG
  • Question for ADR
61
Q

alpha-1 blocker ADR

A

Postural hypotension – esp after 1st dose & in elderly or people with DM (impaired autonomic nervous system function)

62
Q

alpha-1 blocker monitoring

A
  • BP

- questions for ADR

63
Q

combined beta/alpha blockers monitoring

A
  • BP
  • EKG
  • Question for ADR
64
Q

direct vasodilators ADR

A
  • Orthostatic hypotension (esp older pt)
  • HA
  • Fluid retention
  • Tachycardia
  • Hirsutism
65
Q

direct vasodilators monitoring parameters

A
  • BP
  • question for ADR
  • PE
66
Q

LO: • Indicate appropriate initial therapy for a patient with hypertension when given pertinent details of their medical history

A

go through patient examples provided by Dr. Britton

67
Q

When fu after starting BP pharmacotherapy

A

one month

* more frequent if significant elevation and/or complicating co-morbidities

68
Q

What are the three main strategies to start pharm therapy for BP

A
  1. Start one drug, titrate to max before adding second
  2. Start one drug then add a second drug before maxing out first
  3. Begin with 2 drugs at once, either as two separate tabs or as a combo
69
Q

9 meds that can be associated with HTN

A
  • NSAIDS
  • Cocaine, amphetamines, other illicit drugs
  • Sympathomimetics (common in OTC cold/allergy meds)
  • Oral contraceptives
  • Adrenal steroids
  • Cyclosporine
  • Erythropoietin
  • Licorice
  • OTC – ephedra, ma huang, bitter orange

Cardiology 1 (11 decks)

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