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
2
Q
What is a strong predictor of CV disease in adults?
A
SBP in adults +50y/o
3
Q
Sustained elevated BP is directly correlated to what six ailments?
A
MI Angina HF KF Early death 2* to CVD Retinopathy
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%
5
Q
Define Essential HTN
A
90% of HTNs that have no identifiable cause, can only be controlled
Major contributor- obesity
6
Q
Define Secondary HTN
A
Comorbid Dz or drug induced
First step in treatment- removing offending agent/treatment of Dz
7
Q
What are the most common secondary causes of Secondary HTN?
A
Renal dysfunction from chronic kidney disease
Renovascular disease
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
9
Q
Define Isolated Systolic HTN
A
SBP +140
DBP +90
10
Q
What causes ISH?
A
Pathophysiological changes in arterial vasculature from the aging process
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
12
Q
What is the equation for BP?
A
BP= CO x TPR
Total Peripheral Resistance
13
Q
Cardiac Output is the function of what 3 things?
A
Stroke Volume
HR
Venous Capacitance
14
Q
What is the Cardiac output equation?
A
CO= HR x SV
15
Q
Total peripheral resistance is a function of what two things?
A
Vascular constriction- periphery
Vascular hypertrophy- heart
16
Q
CO largely determines ___
TPR largely determines __
A
SBP
DBP
17
Q
How does Arterial BP fluctuate throughout the day?
A
Lowest during sleep
Sharp rise prior to awakening
Highest at mid-morning
18
Q
Definition of CO
A
Volume of blood ejected per unit time
19
Q
What is the Mean Arterial Pressure Equation?
A
MAP= CO x Systemic Vascular Resistance
20
Q
Cardiac output can be affected what variables?
A
Blood Volume: Na, Mineralcorticoids, ANP
Cardiac factors: HR, contractility
21
Q
What are the Neural Factors that affect TPR?
A
Constrictors (A-adrenergic)
Dilators (B-adrenergic)
22
Q
What are the Local Factors that affect TPR?
A
Auto Regulation
Ionic (pH, hypoxia)
23
Q
What are the Humoral Factors that affect TPR?
A
Constrictors- Angiotensin 2, Catecholamines, Thromboxanes, Leukotrienes, Endothelin
Dilators- Prostaglandins, Kinins, NO
24
Q
The RAAS regulates what 3 things in the body?
A
Na
K
Fluid Balance
25
SNS is regulated largely by ______ via _____
Negative feedback
| Baroreceptors
26
What is the most influential contributor to the homeostatic regulation of BP?
RAAS
27
What are the baroreceptors for the RAAS?
Juxtaglomerular Cells in afferent arterioles of kidney
28
Where is renin stored in the body?
Jux cells
29
What is the role of renin?
Converting angiotensinogen to Angiotensin 1
30
Renin release is stimulated by what 3 things?
Dec renal artery pressure/flow to kidney
Catecholamine activation of sympathetic nerves
Decreased Na and Cl in distal tubule
31
How does Angiotensin 2 increase BP?
Pressor and Volume Effects
Pressor- constriction, catecholamine release, inc SNS
Volume- Inc aldosterone synth from adrenal cortex
32
Angiotensin 2 has important actions at what 5 locations?
```
Vascular smooth muscle- constriction
Adrenal cortex- aldosterone synth/release
Kidney- inc Na absorption
Heart- inc rate
Brain- inc ADH release
```
33
Where does aldosterone main act?
It is controlled by what 2 things?
It regulates what 3 things?
Distal convoluted tubule
RAAS and K+
Na reabsorption, K secretion, Na/K+ATPase channel
34
3 drugs that effect the Sympathetic Nerve Terminals
Guanethidine
Guanadrel
Reserpine
35
4 drugs that affect the Vasomotor Center of the brain?
Methyldopa
Clonidine
Guanabenz
Guanfacine
36
What drug affects the sympathetic ganglia?
Trimethaphan
37
What drugs affect the B-receptors of the heart?
Propranolol
| B blockers
38
What drugs affect the angiotensin receptors of large vessels?
Losartan
| Angiotensin receptor blockers
39
What drugs affect the A-receptors of vessels?
Prazosin
| A1 blockers
40
What drugs affect the kidney tubules?
Thiazides
41
What drugs affect the B-receptors of juxtaglomerular cells that release renin?
Propranolol
| B blockers
42
What are 6 medications that affect vascular smooth muscles?
```
Hydralazine
Minoxidil
Nitroprusside
Diazoxide
Verapamil/CCBs
Fenoldopam
```
43
Overall/basic function of diuretics
Lower BP by depleting body of Na and reducing volume
44
Overall/basic function of anti-adrenergic agents?
Inhibit cardiac function
Reduce peripheral resistance
Increase venous pooling
45
Overall/basic function of direct vasodilators?
Reduce BP by relaxing smooth muscles/dilating vessles
46
Overall/basic function of angiotensin blockers?
Reduce peripheral vascular resistance and blood volume
47
What drug has it's action site in the PCT?
Acetazolamide
48
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?
Osmotic diuretics
| Loop diuretics
49
What drug has it's action site in the DCT?
Thiazides
50
What drug has it's action site in the collecting duct?
K+ sparing
51
Thiazides can lower BPs by how much?
SBP- 15-20
| DBP- 8-15
52
_____ have been shown to be the best tolerated of the medication classes used to treat HTN
Diuretics
53
Thiazides are not effective in PTs with what kidney issues?
CrCl < 30ml
| SrCr > 2/5mg
54
Thiazides cause the body to lose what minerals?
Inc excretion of Na and Cl
Loss of K and Mg2
Dec urine Ca excretion
Reduced peripheral resistance
55
How long does it take for the HTN and diuretic actions of Thiazides to take effect?
HTN: 1-3wks
Diuretic: immediatley
56
As a class, Thiazides become ineffective when PTs GFR is below what level?
<30mls
| Except- Metolazone, remains effective until 10-20mls
57
What is the only thiazide available by IV?
Chlorothiazide
58
What 3 things need to be monitord for in PTs taking Thiazides?
BUN
E+
BP
59
What happens if a PT taking a Thiazide takes Digoxin?
Induces Hypokalemia, causes ventricular arrhythmia
60
ACEIs reduction of Angiotensin 2 synthesis reduces what five things?
```
Smooth muscle constriction
Aldosterone synthesis
Na reabsorption
HR
ADH release
```
61
ACEIs lower BP by what methods?
Reducing peripheral resistance w/out inc CO, rate or contractility
Vasodilation
Reduces Na/water retention
Reduces SNS output
62
Where is bradykinin found?
Lungs
Smooth muscles
Blood vessels
63
What is the function of bradykinin?
Production of NO and prostaglandins
| Inc bradykinin levels= inc dilator effect of NO and prostacyclin
64
What chemical is responsible for causing cough and angioedema in ACEI reactions?
Bradykinin
65
ACEIs are used in HTN PTs with what five pre-existing compelling indications?
```
DM w/ proteinuria
Post-MI
HF
Stroke Hx
CAD
```
66
ACEIs are equally effective at reducing BP in all ethnic/racial groups when combined with what two adjuncts?
CCBs
| Diuretics
67
Dry cough from ACEI is typically seen in what PTs?
Women
Non-smokers
Long acting ACEIs
68
What needs to be monitored in PTs taking ACEIs?
SrCr
BUN
K+
Measurements taken initially and at 2 wks
69
ACEIs can't be taken with what drug?
K sparing
70
What type of PT is prescribed ARBs?
PTs that can't tolerate ACEIs
71
ARBs can't be taken with what other medication?
K sparing
72
What are the benefits of ARBs?
| What are the cons of ARBs?
Dec bradykinin cough/angioedema
| Cost, not as much data as ACEIs
73
Both ARBs and ACEIs come with what two cautions?
Category D
| Renal stenosis
74
What is the contraindication of Aliskiren?
Not during pregnancy
75
Renin inhibitors are approved for monotherapy so are usually not given with what two drugs?
ACEI
| ARB
76
Renin inhibitors have what three drug interaction warnings?
ARB/ACEIs
NSAIDs
Lithium
77
Adrenergic blocking agents are used for what type of PT?
BPH and HTN
| Resistant HTN in combo with diuretic, B-blockers and ACEIs
78
What are some adverse effects of Adrenergic Blocking Agents?
Otho HOTN
Reflex Tachycardia
Edema
Inhibited ejaculation
79
When/how are A2 agonists best used clinically?
In combo with drug of different MOA (diuretic, ACEI)
| NOT with adrenergic blockers
80
What are the three adverse effects of A2 Agonists?
Drowsiness
Dry mouth
Edema
81
When is Clonidine prescribed to PTs with HTN?
Combined w/ agents for HTN that's difficult to control
| Patch for PTs that can't follow daily dosing schedules
82
What are the non-NTH uses of Clonidine?
```
ADHD
Tourettes
ETOH withdrawl
Smoking cessation
Mania
```
83
What are the adverse effects of Clonidine?
Antiholinergic effects
HOTN
WIthdrawl
84
Clonidine can't be used with what other meds?
TCAs
85
What drug is the first line choice for HTN during pregnancy?
Methyldopa
86
What are the adverse effects of Methlydopa?
Antiholinergics effects
HOTN
Depression/nightmares
87
What are the clinical outcomes for PTs placed on B-Blockers for HTN?
Reduce SBP by 10-20
| Reduce DBP by 10-15
88
B-Blockers can be used for what cardiac arrhythmias?
A-fib
Paroxysmal supraventricular tachy
Some ventricular arrhythmias
89
B1 receptors are primarily in the heart while B2 receptors are primarily located where?
```
Bronchial tree
Skeletal muscle
Vessels
Kidney
Liver
```
90
Activated B2 receptors produce what effect?
What do B2 antagonists produce?
Bronchial dilation
Inc blood glucose through glycogenolysis
Restrict bronchioles and reduce glucose production
91
What type of B-Blocker have less effect on asthmatics and diabetics?
Cardioselective B1 Blockers
92
What type of PTs are prescribed ISA B-Blockers?
PTs needing blockers but experience significant bradycardia from non-ISAs
93
ISA B-blocker use should be avoided in what type of PT?
Post-MI
94
Which B Adrenergic Blockers have high/low lipid solubility?
High- Propranolol, Bisoprolol
Low- Atenolol, Nadolol
95
What cautions need to be taken when prescribing B Adrenergic Blockers?
DM- mask hypoglycemia S/Sx
Asthma- bronchodilator effects blocked
Distrubed lipid metabolism
Sexual Dysfunction
96
B Adrenergic Blockers have what type of receptor bindig tendency?
What drugs can they not be taken with?
Competition
Non-DHP CCBs (Verapamil, Diltiazem)
NSAIDs
Clonidine
97
What are the adverse effects of Mixed A1 and non-Spec B-Blockers?
Bradycardia
HOTN
Caution in DM/Brochospastics
98
Mixed A1 and non-Spec B-Blockers can't be taken with what other meds?
Physiological Antagonisms
| Non-DHP CCBs
99
Carvedilol is primarily used for what type of PT?
CHF and HTN
| Shown to reduce morbidity and mortality associated with HF
100
What is Labetalol used for?
HOTN
Off label 2nd line for pregnancy HTN
Severe HTN via IV route
101
When is Rserpine used for HTN
/Adjunct with other Anti-HTNs for severe forms of HTN
102
What are the adverse effects of Reserpine?
Depression/anxiety
| Ortho HOTN
103
Cautionary steps need to be taken when prescribing Reserpine to what type of PTs?
Asthmatics
| Parkinson's
104
Difference between Dihydropyridines and Non-DHPs
DHP- minimal direct cardiac effect, may cause compensative tachcardia
Non-DHP- more selective for myocardium, negative inotrope
105
DHP drugs have what ending?
-pine
106
Non-DHPs are preferred in what type of PT?
Fast HR
| Rate control with A-fib and can't tolerate B-blocker
107
What drugs are more efficacious for treating HTN in AfAms?
CCBs
108
What CCB is safe for use in PTs with HTN and advanced HF?
Amlodipine
109
When are ARBs most effective?
Combined w/ Diuretic and B Blocker/Sypatholytic agent
110
Stage One HTN limits?
| Stage Two limits?
```
One= 130-139/80-89
Two= +140/+90
```
111
What is the BP goal for PTs with HTN and known CVD/10 eyar ASCVD of 10%?
<130/80
112
Define ASCVD
Atherosclerotic Cardiovascular Disease
Hx of MI, un/stable angina, coronary revascularization, stroke, TIA presumed to be of artherosclerotic origin or peripheral artery disease
113
First line agents for HTN include what 3?
Thiazide/like
CCBs
ACEIs
114
When is single anti-HTN drug therapy reasonable?
Stage 1 HTN adult w/ BP goal of <130/80
115
When is the use of 2 first ling agents of different classes recommended for HTN treatment?
Stage 2 HTN adults
116
What type of PT is considered less responsive to ACEIs and B-Blocker monotherapies?
Elderly
117
Black adult w/ HTN, NO HFor CKD, initial teatment should include what two possibilities?
Thiazide type diuretic
| CCB
118
Pregnant or women planning to become pregnant can have what three drugs for HTN
/ethyldopa
Nifedipine
Labetalol
119
When should HTN treatment be started for DM PTs?
| What are the first drug classes considered?
At 130/80 or higher
| First line classes of diuretic, ACEIs, ARBs and CCBs
120
When are ACEIs or ARB use in DM PTs considered?
Albuminuria is present
121
Pts who have had a stroke/TIA can be treated with ?
```
Thizides
ACEIs
ARBs
Thiazide/ACEI combo
NO CCBs
```
122
What are 4 reasons for inadequate responses to drug therapies?
Non-adherence to therapy
Pseudo resistance
Drug-related cause
Volume/Na overload
123
What is the criteria for a HTN Urgency?
SBP +180
DBP +120
NOT associated with end organ damage
124
What is the goal of HTN Urgency?
Reduce BP withing 24-48hrs with use of oral meds
| Reduce MAP by 25% within first 24hrs
125
What is the criteria for HNT Emergency?
SBP +180
DBP +120
Evidence of end organ damage
126
What meds are used during HTN Urgency?
Clonidine
Captopril- over clonidine if PT has HF
Labetalol- if pregnant/non-tolerant to methyldopa
127
PTs with compelling pre-existing conditions and in HTN Emergency, how quickly is BP lowered?
Less than 140mm in one hour
No compelling conditions- no more than 25% in first hour
128
What are the HTN Emergency meds?
Dilators
ACEI
CCB
Adrenergic Inhibitors
129
Pre-HTN PT can be managed by life style changes and are NOT Rx candidates unless ?
DM and lifestyle changes are ineffective
130
Stage 1 HTN is treated how quickly?
| Stage 2?
1- confirmed in 2mon, then treated
| 2- immediately if BP is over 180/110, or within one month
131
What drug class is used most frequently in HTN treatment?
Diuretics
132
K sparing drugs are used in conjunction with what other meds?
Thiazides/Loops
133
What is the immediately and delayed benefit of Thiazides?
Imm dec of volume
| Delayed dec of PVR
134
How does Indapamide reduce vascular resistance?
Blocks Ca channels
135
Thiazides can inc plasma levels of what 3 things?
Glucose
Lipids
Uric Acid
136
Diuretics can stimulate release of ____ so use w/out angiotensin inhibitors
Renin
137
What are two perks of Thiazide use?
Cheap
| Offer protection against osteoporosis
138
When are loop diuretics used?
PTs w/ poor renal function
| SrCr over 2.3mg
139
Sympatholytics can cause what adverse effect?
| What is prescribed to help counter the undesired effect?
Reflex RAAS activation
| Diuretics
140
What is the number one hesitation when prescribing Sympatholytics?
How can this adverse event be prevented?
First Dose Syncope
Blocker at bed
Diuretic in the morning
141
B-Blockers are the primary choice of meds for what type of PT?
HTN w/out CVD
142
What 3 meds are the initial treatment of PTs with HTN but no HD?
Angiotensin Inhibitors
CCBs
Diuretics
143
B-Blockers are less likely to cause 2 things but more likely to cause 4 things?
Less- Ortho HOTN, renal/hepato/poitein toxicity
More- Fatigue, dreams, depression, reduced exercise capacity
144
Non-Selective B Blockers are contraindicated for use in ? PTs?
Asthma
COPD
May cause bronchospasms from B2 blockades
145
What is Labetalol used for?
A/B Blocker
| Chronic HTN/Emergency
146
What is Esmolol used for?
B1 Blocker
| IV blocker for surgical HTN/emergency
147
What is Carvedilol used for?
A/B Blocker
| Protection from free radicals
148
What is Nebivolol used for?
Selective B1 Blocker
| HTN HF PTs and also increases NO release
149
What are the 3 Central Acting Drugs?
Clonidine
Guanfacine
Methyldopa
150
How/what does Methyldopa stimulate?
Methyldopa to methyl-norepi to A2 activation
| Dec BP w/out HR/CO effect
151
What HTN medication causes more adverse effects than any other HTN medication?
Chlonidine
| Not recommended for chronic use
152
CADs cause what side effects?
Sedation
Dry mouth
Impaired mental acuity
Severe rebound HTN with abrupt disuse
153
Methyldopa can cause what adverse systemic issues/
Coombs Nonhemolytic Anemia
| AI Hepatitis
154
CADs should not be used with what other type of drug class?
TCAs
