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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
Is methyldopa used for much more than pregnancy induced HTN?
No
26
In what forms do we give methyldopa?
Injection | Tablets
27
What is hydralazine?
A direct vasodilator
28
What do you use hydralazine with and why?
Diuretics and beta blockers to minimize water retention and reflex tachycardia
29
What are some SEs of hydralazine and why?
Lupus like syndrome at high doses
30
What is minoxidil?
A direct vasodilator
31
What do you takes minoxidil with?
Take w/ loop diuretic and bet blocker w/ hydralazine
32
What are two popular vasodilators?
Sodium nitroprusside | Nitroglycerine
33
What is nitroprusside the mainstay tx for?
Most HTN emergencies
34
What is a precaution with nitroprusside?
Renal dysfunction
35
What is nitroprusside metabolized to?
Cyanide
36
What is a problem with renal insufficiency and nitroprusside?
Cyanide is converted to thiocyanate and this accumulates w/ renal insufficiency
37
What do you need to do to monitor pts with renal issues and nitroprusside?
Need to monitor levels if used for > 4 days
38
What do you add to the IVBP if using nitroprusside? And at what point?
Sodium | @ 2nd bag
39
What does sodium do for nitroprusside?
accelerates enzyme degradation of cyanide to thiocyanate making it much less toxic
40
What do you use nitroglycerine for?
Acute myocardial infarction | Stroke
41
What are some precautions for nitroglycerine? How do you deal with that?
Development of tolerance | Increase IV administration rate
42
When is nitroglycerine contraindicated?
Concurrent use of phosphodiesterase 5 inhibitors
43
What is epinephrine?
Pressor of last resort
44
What is a possible issue with epinephrine?
Digital necrosis
45
What is norepinephrine used for?
Severe hypotension
46
What is a possible issue with norepinephrine?
Digital necrosis
47
What is the low dose of dopamine?
1-3 mcg/kg/min | Mainly DA effects
48
What is the intermediate dose of dopamine?
3-10 mcg/kg/min | DA + beta effects
49
What is the high dose of dopamine?
> 10 mcg/kg/min | Mainly alpha effects
50
Do you use dopamine or norepinephrine first?
Norepinephrine
51
What is the primary activity of dobutamine?
Mainly beta 1 activity
52
What does dobutamine do?
Increases cardiac output w/ little vasoconstriction
53
What is dobutamine?
An inotrope w/ vasodilator properties
54
What is phenylepherine?
Potent alpha agonist with weak beta agonist activity
55
Where is phenylepherine vasoconstrictive?
Arterioles and nasal mucosa
56
When is phenylepherine a useful alternative?
In those unable to tolerate tachycardia from dopamine or norepinephrine
57
What is the MOA of vasopressin?
Increases water permeability of renal tubule
58
How does vasopressin increase water permeability of renal tubule?
Increases H2O resorption from tubular lumen
59
What does the increase H2O resorption from tubular lumen do?
Results in decreased urine volume and increased osmolarity
60
How do you administer vasopressin?
@ 0.04 units/min | *fixed rate*
61
What might greater doses of vasopressin do?
Cause cardiac arrest
62
When is vasopressin typically used?
Added on in addition to the use of other pressors
63
Which loop diuretic do you only dose daily?
Torsemide
64
Which loop diuretic can you dose TID?
Ethacrinic acid
65
What is Prazosin and how many times per day is it dosed?
Alpha 1 blocker | 2-3
66
What is Terazosin and how many times per day is it dosed?
Alpha 1 blocker | 1-2

Pharm (32 decks)

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