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Pharmacy Block 2 HTN Flashcards

1
Q

HTN is defined as sustained arterial BP of what measurements?

A

SBP >130
DBP >80
PT that is using anti-HTN medications

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2
Q

What is a strong predictor of CV disease in adults?

A

SBP in adults +50y/o

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3
Q

Sustained elevated BP is directly correlated to what six ailments?

A 
MI
Angina
HF
KF
Early death 2* to CVD
Retinopathy
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4
Q

What are the benefits of lowering BP?

A

Dec stroke rixk x 40%
Dec MI risk by 25%
Dec HF risk by 50%

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5
Q

Define Essential HTN

A

90% of HTNs that have no identifiable cause, can only be controlled
Major contributor- obesity

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6
Q

Define Secondary HTN

A

Comorbid Dz or drug induced

First step in treatment- removing offending agent/treatment of Dz

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7
Q

What are the most common secondary causes of Secondary HTN?

A

Renal dysfunction from chronic kidney disease

Renovascular disease

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8
Q

Define Resistant HTN

A

PT is not at the BP goal despite optimal dose of three Anti-HTNs from different classes including diuretic

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9
Q

Define Isolated Systolic HTN

A

SBP +140

DBP +90

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10
Q

What causes ISH?

A

Pathophysiological changes in arterial vasculature from the aging process

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11
Q

What is the Pulse Pressure equation?

What does a high number mean?

A 
PP= SBP - DBP
High= Increased arterial stiffness, increased CVD risk
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12
Q

What is the equation for BP?

A

BP= CO x TPR

Total Peripheral Resistance

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13
Q

Cardiac Output is the function of what 3 things?

A

Stroke Volume
HR
Venous Capacitance

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14
Q

What is the Cardiac output equation?

A

CO= HR x SV

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15
Q

Total peripheral resistance is a function of what two things?

A

Vascular constriction- periphery

Vascular hypertrophy- heart

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16
Q

CO largely determines ___

TPR largely determines __

A

SBP

DBP

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17
Q

How does Arterial BP fluctuate throughout the day?

A

Lowest during sleep
Sharp rise prior to awakening
Highest at mid-morning

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18
Q

Definition of CO

A

Volume of blood ejected per unit time

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19
Q

What is the Mean Arterial Pressure Equation?

A

MAP= CO x Systemic Vascular Resistance

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20
Q

Cardiac output can be affected what variables?

A

Blood Volume: Na, Mineralcorticoids, ANP

Cardiac factors: HR, contractility

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21
Q

What are the Neural Factors that affect TPR?

A

Constrictors (A-adrenergic)

Dilators (B-adrenergic)

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22
Q

What are the Local Factors that affect TPR?

A

Auto Regulation

Ionic (pH, hypoxia)

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23
Q

What are the Humoral Factors that affect TPR?

A

Constrictors- Angiotensin 2, Catecholamines, Thromboxanes, Leukotrienes, Endothelin

Dilators- Prostaglandins, Kinins, NO

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24
Q

The RAAS regulates what 3 things in the body?

A

Na
K
Fluid Balance

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25
Q

SNS is regulated largely by ______ via _____

A

Negative feedback

Baroreceptors

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26
Q

What is the most influential contributor to the homeostatic regulation of BP?

A

RAAS

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27
Q

What are the baroreceptors for the RAAS?

A

Juxtaglomerular Cells in afferent arterioles of kidney

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28
Q

Where is renin stored in the body?

A

Jux cells

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29
Q

What is the role of renin?

A

Converting angiotensinogen to Angiotensin 1

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30
Q

Renin release is stimulated by what 3 things?

A

Dec renal artery pressure/flow to kidney
Catecholamine activation of sympathetic nerves
Decreased Na and Cl in distal tubule

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31
Q

How does Angiotensin 2 increase BP?

A

Pressor and Volume Effects
Pressor- constriction, catecholamine release, inc SNS

Volume- Inc aldosterone synth from adrenal cortex

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32
Q

Angiotensin 2 has important actions at what 5 locations?

A 
Vascular smooth muscle- constriction
Adrenal cortex- aldosterone synth/release
Kidney- inc Na absorption
Heart- inc rate
Brain- inc ADH release
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33
Q

Where does aldosterone main act?
It is controlled by what 2 things?
It regulates what 3 things?

A

Distal convoluted tubule
RAAS and K+
Na reabsorption, K secretion, Na/K+ATPase channel

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34
Q

3 drugs that effect the Sympathetic Nerve Terminals

A

Guanethidine
Guanadrel
Reserpine

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35
Q

4 drugs that affect the Vasomotor Center of the brain?

A

Methyldopa
Clonidine
Guanabenz
Guanfacine

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36
Q

What drug affects the sympathetic ganglia?

A

Trimethaphan

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37
Q

What drugs affect the B-receptors of the heart?

A

Propranolol

B blockers

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38
Q

What drugs affect the angiotensin receptors of large vessels?

A

Losartan

Angiotensin receptor blockers

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39
Q

What drugs affect the A-receptors of vessels?

A

Prazosin

A1 blockers

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40
Q

What drugs affect the kidney tubules?

A

Thiazides

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41
Q

What drugs affect the B-receptors of juxtaglomerular cells that release renin?

A

Propranolol

B blockers

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42
Q

What are 6 medications that affect vascular smooth muscles?

A 
Hydralazine
Minoxidil
Nitroprusside
Diazoxide
Verapamil/CCBs
Fenoldopam
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43
Q

Overall/basic function of diuretics

A

Lower BP by depleting body of Na and reducing volume

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44
Q

Overall/basic function of anti-adrenergic agents?

A

Inhibit cardiac function
Reduce peripheral resistance
Increase venous pooling

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45
Q

Overall/basic function of direct vasodilators?

A

Reduce BP by relaxing smooth muscles/dilating vessles

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46
Q

Overall/basic function of angiotensin blockers?

A

Reduce peripheral vascular resistance and blood volume

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47
Q

What drug has it’s action site in the PCT?

A

Acetazolamide

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48
Q

What drug has it’s action site in the descending loop of Henle?
What drug has it’s action site in the ascending loop of Henle?

A

Osmotic diuretics

Loop diuretics

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49
Q

What drug has it’s action site in the DCT?

A

Thiazides

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50
Q

What drug has it’s action site in the collecting duct?

A

K+ sparing

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51
Q

Thiazides can lower BPs by how much?

A

SBP- 15-20

DBP- 8-15

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52
Q

_____ have been shown to be the best tolerated of the medication classes used to treat HTN

A

Diuretics

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53
Q

Thiazides are not effective in PTs with what kidney issues?

A

CrCl < 30ml

SrCr > 2/5mg

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54
Q

Thiazides cause the body to lose what minerals?

A

Inc excretion of Na and Cl
Loss of K and Mg2
Dec urine Ca excretion
Reduced peripheral resistance

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55
Q

How long does it take for the HTN and diuretic actions of Thiazides to take effect?

A

HTN: 1-3wks
Diuretic: immediatley

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56
Q

As a class, Thiazides become ineffective when PTs GFR is below what level?

A

<30mls

Except- Metolazone, remains effective until 10-20mls

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57
Q

What is the only thiazide available by IV?

A

Chlorothiazide

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58
Q

What 3 things need to be monitord for in PTs taking Thiazides?

A

BUN
E+
BP

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59
Q

What happens if a PT taking a Thiazide takes Digoxin?

A

Induces Hypokalemia, causes ventricular arrhythmia

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60
Q

ACEIs reduction of Angiotensin 2 synthesis reduces what five things?

A 
Smooth muscle constriction
Aldosterone synthesis
Na reabsorption
HR
ADH release
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61
Q

ACEIs lower BP by what methods?

A

Reducing peripheral resistance w/out inc CO, rate or contractility
Vasodilation
Reduces Na/water retention
Reduces SNS output

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62
Q

Where is bradykinin found?

A

Lungs
Smooth muscles
Blood vessels

63
Q

What is the function of bradykinin?

A

Production of NO and prostaglandins

Inc bradykinin levels= inc dilator effect of NO and prostacyclin

64
Q

What chemical is responsible for causing cough and angioedema in ACEI reactions?

A

Bradykinin

65
Q

ACEIs are used in HTN PTs with what five pre-existing compelling indications?

A 
DM w/ proteinuria
Post-MI
HF
Stroke Hx
CAD
66
Q

ACEIs are equally effective at reducing BP in all ethnic/racial groups when combined with what two adjuncts?

A

CCBs

Diuretics

67
Q

Dry cough from ACEI is typically seen in what PTs?

A

Women
Non-smokers
Long acting ACEIs

68
Q

What needs to be monitored in PTs taking ACEIs?

A

SrCr
BUN
K+
Measurements taken initially and at 2 wks

69
Q

ACEIs can’t be taken with what drug?

70
Q

What type of PT is prescribed ARBs?

A

PTs that can’t tolerate ACEIs

71
Q

ARBs can’t be taken with what other medication?

72
Q

What are the benefits of ARBs?

What are the cons of ARBs?

A

Dec bradykinin cough/angioedema

Cost, not as much data as ACEIs

73
Q

Both ARBs and ACEIs come with what two cautions?

A

Category D

Renal stenosis

74
Q

What is the contraindication of Aliskiren?

A

Not during pregnancy

75
Q

Renin inhibitors are approved for monotherapy so are usually not given with what two drugs?

76
Q

Renin inhibitors have what three drug interaction warnings?

A

ARB/ACEIs
NSAIDs
Lithium

77
Q

Adrenergic blocking agents are used for what type of PT?

A

BPH and HTN

Resistant HTN in combo with diuretic, B-blockers and ACEIs

78
Q

What are some adverse effects of Adrenergic Blocking Agents?

A

Otho HOTN
Reflex Tachycardia
Edema
Inhibited ejaculation

79
Q

When/how are A2 agonists best used clinically?

A

In combo with drug of different MOA (diuretic, ACEI)

NOT with adrenergic blockers

80
Q

What are the three adverse effects of A2 Agonists?

A

Drowsiness
Dry mouth
Edema

81
Q

When is Clonidine prescribed to PTs with HTN?

A

Combined w/ agents for HTN that’s difficult to control

Patch for PTs that can’t follow daily dosing schedules

82
Q

What are the non-NTH uses of Clonidine?

A 
ADHD
Tourettes
ETOH withdrawl
Smoking cessation
Mania
83
Q

What are the adverse effects of Clonidine?

A

Antiholinergic effects
HOTN
WIthdrawl

84
Q

Clonidine can’t be used with what other meds?

85
Q

What drug is the first line choice for HTN during pregnancy?

A

Methyldopa

86
Q

What are the adverse effects of Methlydopa?

A

Antiholinergics effects
HOTN
Depression/nightmares

87
Q

What are the clinical outcomes for PTs placed on B-Blockers for HTN?

A

Reduce SBP by 10-20

Reduce DBP by 10-15

88
Q

B-Blockers can be used for what cardiac arrhythmias?

A

A-fib
Paroxysmal supraventricular tachy
Some ventricular arrhythmias

89
Q

B1 receptors are primarily in the heart while B2 receptors are primarily located where?

A 
Bronchial tree
Skeletal muscle
Vessels
Kidney
Liver
90
Q

Activated B2 receptors produce what effect?

What do B2 antagonists produce?

A

Bronchial dilation
Inc blood glucose through glycogenolysis

Restrict bronchioles and reduce glucose production

91
Q

What type of B-Blocker have less effect on asthmatics and diabetics?

A

Cardioselective B1 Blockers

92
Q

What type of PTs are prescribed ISA B-Blockers?

A

PTs needing blockers but experience significant bradycardia from non-ISAs

93
Q

ISA B-blocker use should be avoided in what type of PT?

94
Q

Which B Adrenergic Blockers have high/low lipid solubility?

A

High- Propranolol, Bisoprolol

Low- Atenolol, Nadolol

95
Q

What cautions need to be taken when prescribing B Adrenergic Blockers?

A

DM- mask hypoglycemia S/Sx
Asthma- bronchodilator effects blocked
Distrubed lipid metabolism
Sexual Dysfunction

96
Q

B Adrenergic Blockers have what type of receptor bindig tendency?

What drugs can they not be taken with?

A

Competition

Non-DHP CCBs (Verapamil, Diltiazem)
NSAIDs
Clonidine

97
Q

What are the adverse effects of Mixed A1 and non-Spec B-Blockers?

A

Bradycardia
HOTN
Caution in DM/Brochospastics

98
Q

Mixed A1 and non-Spec B-Blockers can’t be taken with what other meds?

A

Physiological Antagonisms

Non-DHP CCBs

99
Q

Carvedilol is primarily used for what type of PT?

A

CHF and HTN

Shown to reduce morbidity and mortality associated with HF

100
Q

What is Labetalol used for?

A

HOTN
Off label 2nd line for pregnancy HTN
Severe HTN via IV route

101
Q

When is Rserpine used for HTN

A

/Adjunct with other Anti-HTNs for severe forms of HTN

102
Q

What are the adverse effects of Reserpine?

A

Depression/anxiety

Ortho HOTN

103
Q

Cautionary steps need to be taken when prescribing Reserpine to what type of PTs?

A

Asthmatics

Parkinson’s

104
Q

Difference between Dihydropyridines and Non-DHPs

A

DHP- minimal direct cardiac effect, may cause compensative tachcardia

Non-DHP- more selective for myocardium, negative inotrope

105
Q

DHP drugs have what ending?

106
Q

Non-DHPs are preferred in what type of PT?

A

Fast HR

Rate control with A-fib and can’t tolerate B-blocker

107
Q

What drugs are more efficacious for treating HTN in AfAms?

108
Q

What CCB is safe for use in PTs with HTN and advanced HF?

A

Amlodipine

109
Q

When are ARBs most effective?

A

Combined w/ Diuretic and B Blocker/Sypatholytic agent

110
Q

Stage One HTN limits?

Stage Two limits?

A 
One= 130-139/80-89
Two= +140/+90
111
Q

What is the BP goal for PTs with HTN and known CVD/10 eyar ASCVD of 10%?

112
Q

Define ASCVD

A

Atherosclerotic Cardiovascular Disease
Hx of MI, un/stable angina, coronary revascularization, stroke, TIA presumed to be of artherosclerotic origin or peripheral artery disease

113
Q

First line agents for HTN include what 3?

A

Thiazide/like
CCBs
ACEIs

114
Q

When is single anti-HTN drug therapy reasonable?

A

Stage 1 HTN adult w/ BP goal of <130/80

115
Q

When is the use of 2 first ling agents of different classes recommended for HTN treatment?

A

Stage 2 HTN adults

116
Q

What type of PT is considered less responsive to ACEIs and B-Blocker monotherapies?

117
Q

Black adult w/ HTN, NO HFor CKD, initial teatment should include what two possibilities?

A

Thiazide type diuretic

CCB

118
Q

Pregnant or women planning to become pregnant can have what three drugs for HTN

A

/ethyldopa
Nifedipine
Labetalol

119
Q

When should HTN treatment be started for DM PTs?

What are the first drug classes considered?

A

At 130/80 or higher

First line classes of diuretic, ACEIs, ARBs and CCBs

120
Q

When are ACEIs or ARB use in DM PTs considered?

A

Albuminuria is present

121
Q

Pts who have had a stroke/TIA can be treated with ?

A 
Thizides
ACEIs
ARBs 
Thiazide/ACEI combo
NO CCBs
122
Q

What are 4 reasons for inadequate responses to drug therapies?

A

Non-adherence to therapy
Pseudo resistance
Drug-related cause
Volume/Na overload

123
Q

What is the criteria for a HTN Urgency?

A

SBP +180
DBP +120
NOT associated with end organ damage

124
Q

What is the goal of HTN Urgency?

A

Reduce BP withing 24-48hrs with use of oral meds

Reduce MAP by 25% within first 24hrs

125
Q

What is the criteria for HNT Emergency?

A

SBP +180
DBP +120
Evidence of end organ damage

126
Q

What meds are used during HTN Urgency?

A

Clonidine
Captopril- over clonidine if PT has HF
Labetalol- if pregnant/non-tolerant to methyldopa

127
Q

PTs with compelling pre-existing conditions and in HTN Emergency, how quickly is BP lowered?

A

Less than 140mm in one hour

No compelling conditions- no more than 25% in first hour

128
Q

What are the HTN Emergency meds?

A

Dilators
ACEI
CCB
Adrenergic Inhibitors

129
Q

Pre-HTN PT can be managed by life style changes and are NOT Rx candidates unless ?

A

DM and lifestyle changes are ineffective

130
Q

Stage 1 HTN is treated how quickly?

Stage 2?

A

1- confirmed in 2mon, then treated

2- immediately if BP is over 180/110, or within one month

131
Q

What drug class is used most frequently in HTN treatment?

132
Q

K sparing drugs are used in conjunction with what other meds?

A

Thiazides/Loops

133
Q

What is the immediately and delayed benefit of Thiazides?

A

Imm dec of volume

Delayed dec of PVR

134
Q

How does Indapamide reduce vascular resistance?

A

Blocks Ca channels

135
Q

Thiazides can inc plasma levels of what 3 things?

A

Glucose
Lipids
Uric Acid

136
Q

Diuretics can stimulate release of ____ so use w/out angiotensin inhibitors

137
Q

What are two perks of Thiazide use?

A

Cheap

Offer protection against osteoporosis

138
Q

When are loop diuretics used?

A

PTs w/ poor renal function

SrCr over 2.3mg

139
Q

Sympatholytics can cause what adverse effect?

What is prescribed to help counter the undesired effect?

A

Reflex RAAS activation

Diuretics

140
Q

What is the number one hesitation when prescribing Sympatholytics?
How can this adverse event be prevented?

A

First Dose Syncope

Blocker at bed
Diuretic in the morning

141
Q

B-Blockers are the primary choice of meds for what type of PT?

A

HTN w/out CVD

142
Q

What 3 meds are the initial treatment of PTs with HTN but no HD?

A

Angiotensin Inhibitors
CCBs
Diuretics

143
Q

B-Blockers are less likely to cause 2 things but more likely to cause 4 things?

A

Less- Ortho HOTN, renal/hepato/poitein toxicity

More- Fatigue, dreams, depression, reduced exercise capacity

144
Q

Non-Selective B Blockers are contraindicated for use in ? PTs?

A

Asthma
COPD
May cause bronchospasms from B2 blockades

145
Q

What is Labetalol used for?

A

A/B Blocker

Chronic HTN/Emergency

146
Q

What is Esmolol used for?

A

B1 Blocker

IV blocker for surgical HTN/emergency

147
Q

What is Carvedilol used for?

A

A/B Blocker

Protection from free radicals

148
Q

What is Nebivolol used for?

A

Selective B1 Blocker

HTN HF PTs and also increases NO release

149
Q

What are the 3 Central Acting Drugs?

A

Clonidine
Guanfacine
Methyldopa

150
Q

How/what does Methyldopa stimulate?

A

Methyldopa to methyl-norepi to A2 activation

Dec BP w/out HR/CO effect

151
Q

What HTN medication causes more adverse effects than any other HTN medication?

A

Chlonidine

Not recommended for chronic use

152
Q

CADs cause what side effects?

A

Sedation
Dry mouth
Impaired mental acuity
Severe rebound HTN with abrupt disuse

153
Q

Methyldopa can cause what adverse systemic issues/

A

Coombs Nonhemolytic Anemia

AI Hepatitis

154
Q

CADs should not be used with what other type of drug class?

IPAP (212 decks)

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