Therapeutics - Hypertension Part 2 Flashcards by amanda kastel

name 2 mineralocorticoid receptor antagonists

eplerenone
spironolactone

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mineralocorticosteroid receptor antagonists are the preferred agents in what 2 scenarios

primary aldosteronism and resistant hypertension

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is spironolactone considered a diuretic

yes

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dosage range eplerenone
dosage range spironolactone

how many x a day?

50-100mg eplerenone

25-100mg spironolactone

eplerenon - 1-2x a day
spironolactone - 1x day

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____ is associated with greater risk of gynecomastia and impotence compared to _____

(spironolactone or eplerenone)

what can be done to avoid?

spironolactone is greater risk

use low dose

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3 scenarios in which spironolactone/eplerenone should be avoided

-with potassium supplements
-other potassium sparing diuretics
-significant renal dysfunction

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too much potassium is a concern if spironlaconte/eplerenone is given with what other classes of BP medication

ACE inhibitors or ARBS

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off label, spironolactone/eplerenone can sometimes be used for ____

albuminuria

also used in stage IV heart failure

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are beta blockers 1st line for HTN?

unless the patient has ischemic heart disease or heart failure

or in pts with bronchospastic airway disease that needs a beta blocker

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which 2 specific beta blockers are preferred in patients with HFrEF?
(heart failure where left ventricle cant pump enough blood to body)

bisoprolol and metoprolol succinate

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true or false

beta blockers should not be stopped abruptly

TRUE

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which beta blockers induces nitric oxide and thus induces vasodilation

nebivolol

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which type of beta blockers are avoided in patients with reactive airway diseases?

name 2 specific ones

noncardioselective ones

propanolol, nadolol

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which type of beta blockers are avoided, especially in patients with ischemic heart disease or heart failure

ones with intrinsic sympathomimetic activity

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name 2 beta blockers which have combined alpha and beta receptor action and thus have dual mechanism

which is preferred in pts with HFrEF?

carvedilol and labetolol

carvediolol

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true or false

BBs are a good choice to start in a hypertensive patient with asthma

what about:

ischemic heart disease?
arrythmia?
tachycardia?
HFrEF
diabetes
migraines

ischemic heart disease - yes
arryhtmia - yes
tachycardia - yes
HFrEF - yes
diabetes - no
migraines - yes. propranolol can be used for migraine prevention

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why are beta blockers generally avoided in diabetic patients

bc they can mask hypoglycemia

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pt has hypertension + migraines?

which class of drug is recommended

b blockers

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role of loop diuretics in hypertension

normally not used for hypertension, but are preferred in patients who have edema related to heart failure

ALSO, preferred over thiazides in pts with mod-severe kidney disease (less than 30mL/min)

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name 3 loop diuretics

frequency of each?

furosemide twice a day
torsemide once a day
bumetanide twice a day

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usual dose/day furosemide

20-80mg

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usual dose/day torsemide

5-10mg/day

usual dose bumetanide

0.5-4mg/day

at HIGH DOSES, what are 2 toxicities of loop diuretics

ototoxicity
renal toxicity

TRUE OR FALSE loop diuretics can increase all electrolytes and we need to monitor this

FALSE depletes all electrolytes and we need to monitor

name 2 potassium sparing diuretics

amiloride triamterene

when using potassium sparing diuretics, pt should be monitored for ___ kalemia

hyper

role of amiloride and triamterene in HTN

not used as monotherapy - minimally effective combo with a thiazide -- can be used in patients with hypokalemia when on thiazide monotherapy

potassium sparing diuretics like triamterene and amiloride should be avoided in patients with significant ____

chronic kidney disease

name 3 alpha1 blockers

doxasozin prazosin terazosin

alpha 1 blockers are more commonly used for ____ than for hypertension why?

BPH bc orthostatic hypotension in older adults and cause vivid dreams, and they help in BPH by increasing urine flow

_____ is used for nightmares related to PTSD

prazosin (a1 blocker)

a1 blockers may be considered as ___ line agents in patients with concomitant BPH

2nd

name 3 alpha 2 agonists

clonidine (oral/patch) methyldopa guanfaci

role of a2 agonists in hypertension

LAST LINE bc of CNS adverse effects (esp older ppl)

____should NOT be abruptly discontinued why?

clonidine may cause hypertensive crisis. taper off to avoid rebound HTN

clonidine may have some street value what does this mean

decreases opioid withdrawal symptoms and has psychoactive effect (high)

2 alternate uses for clonidine

ADHD 2nd line as smoking cessation

name 2 direct vasodilators

minoxidil hydralazine

role in therapy for direct vasodialtors

not commonly used for HTN associated with sodium and water retention, as well as reflex tachycardia they're used with a loop diuretic and a beta clocker

which direct vasodilator is associated with lupus-like syndrome at higher doses and is thus avoided

hydralazine

minoxidil is associated with ___ and requires a ____ it can induce ___

hirsutisn, loop diuretic can induce pericardial effusion

3 classes of HTN meds that should definitely be avoided in pregnancy

ACEi's ARBs aldosterone antagonists (spironolactone, eplerenone)

3 preferred htn meds in pregnancy

labetolol long-acting nifedipine can use methyldopa, but there's more AE so not rly used

define resistant HTN

taking 3 meds with different MOA but still no BP control OR achieve BP control but needs 4 meds or more

3 meds with the BEST evidence for treating resistant HTN

spironolactone! hydralazine or minoxidil

how can the dosing regimen be altered to potentially help someone with resistant HTN

take some meds in morning and some at night to get full 24 hr coverage

diuretics are preferred to give what time of day

morning, not night so not etting up to pee all the time

calcium channel blockers are preferred to give what time of day

night bc some ppl get headache from it

2 scenarios in which a HTN resistant patient should be referred to a specialist

if there is a known or suspected secondary cause -if the BP is still uncontrolled after 6 months of treatment

compare and contrast a hypertensive urgency vs emergency -BP -symptoms -treatment

both have same BP : over 180/120 however, in urgency, there is no symptoms or complaints in emergency, there is evidence of new or worsening organ damage --- dizzy, SOB, chest pain treatment for urgency: intensify oral antihypertensive in outpatient setting treatment for emergency: go to hospital for IV antihypertensives (even if just 1 symptom) bc increased risk of heart attack, stroke

symptoms aortic dissection in hypertensive emergency

back pain

possible stroke symptoms

headache, confusion, dizziness