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Cardio-Renal I Midterm > Therapeutics - Hypertension Part 2 > Flashcards

Therapeutics - Hypertension Part 2 Flashcards

1
Q

name 2 mineralocorticoid receptor antagonists

A

eplerenone
spironolactone

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2
Q

mineralocorticosteroid receptor antagonists are the preferred agents in what 2 scenarios

A

primary aldosteronism and resistant hypertension

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3
Q

is spironolactone considered a diuretic

A

yes

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4
Q

dosage range eplerenone
dosage range spironolactone

how many x a day?

A

50-100mg eplerenone

25-100mg spironolactone

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

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5
Q

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

(spironolactone or eplerenone)

what can be done to avoid?

A

spironolactone is greater risk

use low dose

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6
Q

3 scenarios in which spironolactone/eplerenone should be avoided

A

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

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7
Q

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

A

ACE inhibitors or ARBS

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8
Q

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

A

albuminuria

also used in stage IV heart failure

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9
Q

are beta blockers 1st line for HTN?

A

NO

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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10
Q

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

A

bisoprolol and metoprolol succinate

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11
Q

true or false

beta blockers should not be stopped abruptly

A

TRUE

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12
Q

which beta blockers induces nitric oxide and thus induces vasodilation

A

nebivolol

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13
Q

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

name 2 specific ones

A

noncardioselective ones

propanolol, nadolol

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14
Q

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

A

ones with intrinsic sympathomimetic activity

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15
Q

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

which is preferred in pts with HFrEF?

A

carvedilol and labetolol

carvediolol

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16
Q

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

A

NO

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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17
Q

why are beta blockers generally avoided in diabetic patients

A

bc they can mask hypoglycemia

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18
Q

pt has hypertension + migraines?

which class of drug is recommended

A

b blockers

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19
Q

role of loop diuretics in hypertension

A

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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20
Q

name 3 loop diuretics

frequency of each?

A

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

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21
Q

usual dose/day furosemide

A

20-80mg

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22
Q

usual dose/day torsemide

A

5-10mg/day

23
Q

usual dose bumetanide

A

0.5-4mg/day

24
Q

at HIGH DOSES, what are 2 toxicities of loop diuretics

A

ototoxicity
renal toxicity

25
Q

TRUE OR FALSE

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

A

FALSE

depletes all electrolytes and we need to monitor

26
Q

name 2 potassium sparing diuretics

A

amiloride
triamterene

27
Q

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

A

hyper

28
Q

role of amiloride and triamterene in HTN

A

not used as monotherapy - minimally effective

combo with a thiazide – can be used in patients with hypokalemia when on thiazide monotherapy

29
Q

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

A

chronic kidney disease

30
Q

name 3 alpha1 blockers

A

doxasozin
prazosin
terazosin

31
Q

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

A

BPH

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

32
Q

_____ is used for nightmares related to PTSD

A

prazosin (a1 blocker)

33
Q

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

A

2nd

34
Q

name 3 alpha 2 agonists

A

clonidine (oral/patch)
methyldopa
guanfaci

35
Q

role of a2 agonists in hypertension

A

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

36
Q

____should NOT be abruptly discontinued

why?

A

clonidine

may cause hypertensive crisis. taper off to avoid rebound HTN

37
Q

clonidine may have some street value

what does this mean

A

decreases opioid withdrawal symptoms and has psychoactive effect (high)

38
Q

2 alternate uses for clonidine

A

ADHD
2nd line as smoking cessation

39
Q

name 2 direct vasodilators

A

minoxidil
hydralazine

40
Q

role in therapy for direct vasodialtors

A

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

41
Q

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

A

hydralazine

42
Q

minoxidil is associated with ___ and requires a ____

it can induce ___

A

hirsutisn, loop diuretic

can induce pericardial effusion

43
Q

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

A

ACEi’s
ARBs
aldosterone antagonists (spironolactone, eplerenone)

44
Q

3 preferred htn meds in pregnancy

A

labetolol
long-acting nifedipine

can use methyldopa, but there’s more AE so not rly used

45
Q

define resistant HTN

A

taking 3 meds with different MOA but still no BP control

OR

achieve BP control but needs 4 meds or more

46
Q

3 meds with the BEST evidence for treating resistant HTN

A

spironolactone!
hydralazine or minoxidil

47
Q

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

A

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

48
Q

diuretics are preferred to give what time of day

A

morning, not night

so not etting up to pee all the time

49
Q

calcium channel blockers are preferred to give what time of day

A

night bc some ppl get headache from it

50
Q

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

A

if there is a known or suspected secondary cause

-if the BP is still uncontrolled after 6 months of treatment

51
Q

compare and contrast a hypertensive urgency vs emergency

-BP
-symptoms
-treatment

A

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

52
Q

symptoms aortic dissection in hypertensive emergency

A

back pain

53
Q

possible stroke symptoms

A

headache, confusion, dizziness

54
Q
A

Cardio-Renal I Midterm (14 decks)

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