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Pharm > Second line HTN meds > Flashcards

Second line HTN meds Flashcards

1
Q

Give some examples of loop diuretics that you dose BID

A

Furosemide
Bumetanide
Ethacrinic acid

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2
Q

Who are loop diuretics usually reserved for?

A

CrCl < 30 mL/min

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3
Q

How do you avoid nocturnal diuresis with loop diuretics?

A

Give BID doses in AM and afternoon

Avoid HS administration

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4
Q

Are potassium sparing diuretics strong anti-HTN meds?

A

No, they are weak

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5
Q

When do you use potassium sparring diuretics?

A

For an additive effect in combo w/ a thiazide or loop

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6
Q

When are potassium sparing diuretics useful?

A

In pts w/ low serum K

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7
Q

What might potassium sparing diuretics cause in what specific poupulation?

A

Hyperkalemia in pts w/ CKD/DM

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8
Q

What are some examples of potassium sparing diuretics?

A

Triamterene

Amiloride

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9
Q

What are the examples of triamterene with HCTZ?

A

Dyazide

Maxzide

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10
Q

What are examples of aldosterone antagonist diuretics?

A

Spironolactone (w/ or w/o HCTZ)

Eplerenone

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11
Q

What is a side effect of aldosterone antagonist diuretics?

A

Gynecomastia

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12
Q

Give some examples of beta blockers.

A 
Atenolol
Bisoprolol
Metoprolol
Carvedilol
Acebutolol
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13
Q

What is the standard dosing for beta blockers?

A

Q 24 hours

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14
Q

What are beta blockers w/ intrinsic sympathomimetic activity useful for?

A

Useful if beta blockers cause bradycardia

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15
Q

What are direct renin inhibitors contraindicated with??

A

ACEIs and ARBs

Pregnancy

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16
Q

When are alpha 1 blockers used?

A

In pts w/ BPH

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17
Q

What is Doxazosin and how many times per day is it dosed?

A

Alpha 1 blocker

Once

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18
Q

When do you instruct pts to take their first dose of alpha 1 blockers? Why?

A

Take first dose before bedtime

Minimizes dizziness and postural hypotension

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19
Q

How can you give out clonidine?

A 
Tabs
Transdermal patches (replaced weekly)
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20
Q

How quick is the onset of clonidine? And is it long or short acting?

A 
Fast onset (20-60 mins)
Short acting
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21
Q

When is clonidine usually used?

A

Resistant HTN

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22
Q

What are the SEs of clonidine?

A

Significant anticholinergic SEs

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23
Q

What happens if you abruptly cease clonidine? How do you avoid this?

A

Possible rebound HTN

Taper doses gradually as DCing

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24
Q

What is the first line agent for pregnancy induced HTN?

A

Methyldopa

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25
Q

Is methyldopa used for much more than pregnancy induced HTN?

A

No

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26
Q

In what forms do we give methyldopa?

A

Injection

Tablets

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27
Q

What is hydralazine?

A

A direct vasodilator

28
Q

What do you use hydralazine with and why?

A

Diuretics and beta blockers to minimize water retention and reflex tachycardia

29
Q

What are some SEs of hydralazine and why?

A

Lupus like syndrome at high doses

30
Q

What is minoxidil?

A

A direct vasodilator

31
Q

What do you takes minoxidil with?

A

Take w/ loop diuretic and bet blocker w/ hydralazine

32
Q

What are two popular vasodilators?

A

Sodium nitroprusside

Nitroglycerine

33
Q

What is nitroprusside the mainstay tx for?

A

Most HTN emergencies

34
Q

What is a precaution with nitroprusside?

A

Renal dysfunction

35
Q

What is nitroprusside metabolized to?

A

Cyanide

36
Q

What is a problem with renal insufficiency and nitroprusside?

A

Cyanide is converted to thiocyanate and this accumulates w/ renal insufficiency

37
Q

What do you need to do to monitor pts with renal issues and nitroprusside?

A

Need to monitor levels if used for > 4 days

38
Q

What do you add to the IVBP if using nitroprusside? And at what point?

A

Sodium

@ 2nd bag

39
Q

What does sodium do for nitroprusside?

A

accelerates enzyme degradation of cyanide to thiocyanate making it much less toxic

40
Q

What do you use nitroglycerine for?

A

Acute myocardial infarction

Stroke

41
Q

What are some precautions for nitroglycerine? How do you deal with that?

A

Development of tolerance

Increase IV administration rate

42
Q

When is nitroglycerine contraindicated?

A

Concurrent use of phosphodiesterase 5 inhibitors

43
Q

What is epinephrine?

A

Pressor of last resort

44
Q

What is a possible issue with epinephrine?

A

Digital necrosis

45
Q

What is norepinephrine used for?

A

Severe hypotension

46
Q

What is a possible issue with norepinephrine?

A

Digital necrosis

47
Q

What is the low dose of dopamine?

A

1-3 mcg/kg/min

Mainly DA effects

48
Q

What is the intermediate dose of dopamine?

A

3-10 mcg/kg/min

DA + beta effects

49
Q

What is the high dose of dopamine?

A

> 10 mcg/kg/min

Mainly alpha effects

50
Q

Do you use dopamine or norepinephrine first?

A

Norepinephrine

51
Q

What is the primary activity of dobutamine?

A

Mainly beta 1 activity

52
Q

What does dobutamine do?

A

Increases cardiac output w/ little vasoconstriction

53
Q

What is dobutamine?

A

An inotrope w/ vasodilator properties

54
Q

What is phenylepherine?

A

Potent alpha agonist with weak beta agonist activity

55
Q

Where is phenylepherine vasoconstrictive?

A

Arterioles and nasal mucosa

56
Q

When is phenylepherine a useful alternative?

A

In those unable to tolerate tachycardia from dopamine or norepinephrine

57
Q

What is the MOA of vasopressin?

A

Increases water permeability of renal tubule

58
Q

How does vasopressin increase water permeability of renal tubule?

A

Increases H2O resorption from tubular lumen

59
Q

What does the increase H2O resorption from tubular lumen do?

A

Results in decreased urine volume and increased osmolarity

60
Q

How do you administer vasopressin?

A

@ 0.04 units/min

fixed rate

61
Q

What might greater doses of vasopressin do?

A

Cause cardiac arrest

62
Q

When is vasopressin typically used?

A

Added on in addition to the use of other pressors

63
Q

Which loop diuretic do you only dose daily?

A

Torsemide

64
Q

Which loop diuretic can you dose TID?

A

Ethacrinic acid

65
Q

What is Prazosin and how many times per day is it dosed?

A

Alpha 1 blocker

2-3

66
Q

What is Terazosin and how many times per day is it dosed?

A

Alpha 1 blocker

1-2

Pharm (32 decks)

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