Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHRM 844 > Therapeutics of HTN pt. 3 > Flashcards

Therapeutics of HTN pt. 3 Flashcards

1
Q

Angiotensin converting enzyme inhibitors (ACEi) moa

A

Inhibits conversion for angiotensin I to angiotensin II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Angiotensin II receptor blockers (ARBs) moa

A

Block effects of angiotensin II by binding to target receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Renin inhibitors moa

A

Inhibits conversion of angiotensinogen to angiotensin I

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is ACEi

A

first line tx option for HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

ACEi have additional benefit in pts with history of:

A

pts with DM w/ proteinuria, HF, post MI, CKD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the only ACEi that has frequency of 2 or 3 /day

A

Captopril

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the ACEi that has frequency of 1 or 2 /day

A

Benazepril, Enalapril, Ramipril, Moexipril, Quinapril,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

which ACE inhibitors have frequency of 1/day

A

Fosinopril, Lisinopril, Perindopril, Trandolapril

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ACEi AEs

A

angioedema, cough (up to 20%), hyperkalemia, acute renal failure w/ severe bilateral renal artery stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ACEi CIs

A
  • history of angioedema on an ACEi
  • concomitant use of aliskiren in pts w/ DM
  • pregnancy/breastfeeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is ARBs

A

first line tx option for HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

when are ARBs used

A

often “back up” if an ACEi isn’t tolerated for other indications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

why are ARBs often a back up to ACEi

A
  • doesn’t block bradykinin breakdown -> less cough than ACEi
  • can use with hx of angioedema due to ACEi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

why are ARBs a good option for PM dosing

A

ensures BP dipping overnight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

which are the only ARBs have a frequency of 1 or 2 /day

A

Eprosartan, Losartan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ARBs AEs

A

angioedema, hyperkalemia, acute renal failure w/ severe bilateral renal artery stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

ARBs CIs

A
  • history of angioedema on ARB
  • concomitant use of aliskiren in pts w/ DM
  • pregnancy/breastfeeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

ACEi/ARB monitoring

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

when should ACEi/ARBs doses be possibly held or reduced

A

if K >5.5 mEq/L or SCr increase >30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the direct renin inhibitor agent

A

aliskiren

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

is aliskiren a first line tx option for HTN

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

why does aliskiren produce less cough than ACEi

A

doesn’t block bradykinin breakdown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

aliskiren CIs

A
  • pregnant pts
  • concomitant use with an ACEi or ARB contraindicated in pts w/ DM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

aliskiren frequency

A

1/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what labs should be monitored in pts using aliskiren

A

K, BUN, SCr

26
Q

aliskiren AEs

A

diarrhea, musculoskeletal effects, dizziness, headache, hyperkalemia, renal insufficiency, orthostatic hypotension

27
Q

CCBs moa

A

Inhibit influx of calcium across cardiac and smooth muscle cell membranes -> coronary and peripheral vasodilation

28
Q

CCBs subclasses and effects

A
  • Dihydropyridines - more vasodilation
  • Nondihydropyridines - more negative ionotropic effects
  • Overall similar effect on BP
29
Q

Are CCBs first line for HTN

A

Yes

30
Q

what pt populations do dihydropyridine CCBs provide additional benefit

A

Pts with:
- Reynaud’s syndrome
- elderly pts w/ isolated systolic HTN

31
Q

what dihydropyridines should be avoided

A

short-acting (IR nifedipine/nicardipine)

32
Q

how does dihydropyridine CCBs cause vasodilation

A

through baroreceptor-mediated tachycardia

33
Q

what does dihydropyridine CCBs not have an effect on

A

no effect on atrioventricular node conduction

34
Q

which dihydropyridine CCBs have a frequency of 2/day

A

Isradipine, Nicardipine SR

35
Q

dihydropyridine CCBs AEs

A

reflex tachycardia, flushing, dizziness, headache, peripheral edema (dose related), gingival hyperplasia

36
Q

dihydropyridine CCBs warning

A

increased risk of angina/MI in pts with obstructive coronary disease due to reflex tachycardia

37
Q

dihydropyridine CCBs drug interactions

A
  • grapefruit juice
  • CYP3A4 enzyme inducers/inhibitors
38
Q

what pt populations do nondihydropyridine CCBs provide additional benefit

A

pts with:
- supraventricular tachyarrhythmias (Afib)
- pts w angina who can not tolerate a B blocker

39
Q

why do nondihydropyridine CCBs have negative ionotropic effects

A

slows AV node conduction and decreases HR

40
Q

what nondihydropyridine CCBs formulations are preferred for HTN

A

extended release formulations

41
Q

what is frequency of nondihydropyridine CCBs

A

1 or 2 /day

42
Q

what are the nondihydropyridine CCBs agents

A

Diltiazem ER, Verapamil ER

43
Q

why are nondihydropyridine CCBs not interchangeable

A

due to differences in release mechanisms and bioavailability

44
Q

nondihydropyridine CCBs AEs

A

bradycardia, headache, dizziness, AV node block, systolic HF, gingival hyperplasia, constipation (verapamil>diltiazem)

45
Q

nondihydropyridine CCBs drug interactions

A
  • concomitant use of B blockers - increases risk of heart block
  • grapefruit juice
  • CYP3A4 enzyme inducers/inhibitors
46
Q

nondihydropyridine CCBs CIs

A
  • heart block
  • left ventricular dysfunction
47
Q

are routine lab monitoring required for CCBs

A

No

48
Q

what CCB is preferred in the setting of HF

A

amlodipine

49
Q

are B blockers first line for HTN

A

NOT first line unless a compelling indication is present

50
Q

what pt populations get additional benefit from B blockers

A

Pts with:
- tachyarrhythmias
- tremors
- migraines
- thyrotoxicosis

51
Q

what cardioselective B blocker has a frequency of 2/day

A

Metoprolol tartrate

52
Q

what nonselective B blocker has a frequency of 2/day

A

Propranolol IR

53
Q

what are the intrinsic sympathomimetic activity (ISA) B blockers

A
  • Acebutolol (frequency of 2/day)
  • Penbutolol (frequency of 1/day)
  • Pindolol (frequency of 2/day)
54
Q

what are the mixed alpha/beta B blockers

A
  • Carvedilol (frequency of 2/day)
  • Labetalol (frequency of 2/day)
55
Q

B blockers AEs

A

Bronchospasms, bradycardia, fatigue, exercise intolerance, depression

56
Q

what is problem with B blockers

A

can mask signs/Sx of hypoglycemia

57
Q

use B blockers with caution in pts with:

A
  • peripheral artery disease
  • reactive airway disease
58
Q

what B blocker is preferred in pts with peripheral artery disease

A

carvedilol

59
Q

what B blocker is preferred in pts with reactive airway disease

A

selective B blockers

60
Q

B blockers CIs

A
  • second or third degree heart block
  • decompensated HF
  • post MI (ISA B blockers only)
  • severe bradycardia
  • sick sinus syndrome

PHRM 844 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions