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Uses for antihypertensives Flashcards

1
Q

Estimated GFR

A

Chronic kidney disease

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2
Q

New elevation in serum creatinine, marked elevation in serum creatinine with ACE inhibitor or ARB, drug-resistant hypertension, flash pulmonary edema, abdominal or flank bruit

A

Renovascular disease

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3
Q

Arm pulses > leg pulses, arm BP > leg BP, chest bruits, rib notching on chest radiography

A

Coarctation of the aorta

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4
Q

Hypokalemia, drug-resistant hypertension

A

Primary aldosteronism

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5
Q

Truncal obesity, wide and blanching purple striae, muscle weakness

A

Cushing syndrome

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6
Q

Paroxysms of hypertension, palpitations, perspiration, and pallor; diabetes

A

Pheochromocytoma

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7
Q

Obstructive sleep apnea

A

Loud snoring, large neck, obesity, somnolence

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8
Q

Thiazide contraindication

A

Gout

Side effects:

  • Insulin resistance, onset type 2 diabetes
  • Hypokalemia, hyponatremia
  • Hypertriglyceridemia
  • Hyperuricemia, precipitation of gout
  • Erectile dysfunction
  • Potentiate nondepolarizing muscle relaxants
  • Photosensitivity dermatitis
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9
Q

Loop diuretics contraindication

A

Hepatic coma

Side effects-
interstitial nephritis 
hypokalemia 
potentiate succinylcholine
potentiate aminoglycoside ototoxicity
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10
Q

ACE inhibitor contraindication

A
  • B/l renal artery stenosis
  • Hyperkalemia

Side effects:

  • Cough
  • Hyperkalemia
  • Angioedema
  • Leukopenia
  • Fetal toxicity
  • Chloestatic jaundice- rare fulminant hepatic necrosis if the drug is not discontinued
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11
Q

Dihydropyridine CCB contraindications

A

As monotherapy in chronic kidney disease with proteinuria

Side effects:

  • Headaches
  • Flushing
  • Ankle edema
  • Heart failure
  • Gingival hyperplasia
  • Esophageal reflux
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12
Q

Nondihydropyridine CCB contraindications

A
  • Heart block
  • Systolic heart failure
Side effects:
- Bradycardia
- Constipation
above seen with verapamil
- Worsening of systolic function, heart failure
- Gingival edema or hypertrophy
- Increase cyclosporine blood levels
- Esophageal reflux
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13
Q

ARB and DRI contraindications

A
  • Pregnancy
  • B/l renal artery stenosis
  • Hyperkalemia

Side effects:

  • Hyperkalemia
  • Angioedema
  • Fetal toxicity
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14
Q

b blocker contraindications

A
  • Heart block
  • Asthma
  • Depression
  • Cocain and methamphetamine abuse

Side effects:

  • Heart block
  • Acute decompensated heart failure
  • Bronchospasm
  • Depression, nightmares, fatigue
  • Cold extremities
  • Stevens-Johnson syndrome
  • Agranulocytosis
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15
Q

a blocker contraindications

A
  • Orthostatic hypotension
  • Systolic heart failure
  • Left ventricular dysfunction

Side effects:

  • orthostatic hypertension
  • Drug tolerance
  • Ankle edema
  • Heart failure
  • First dose effect
  • Potentiate hypotension
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16
Q

central sympatholytic contraindications

A
  • Orthostatic hypotension

Side effects

  • Depression, dry mouth, lethargy
  • Erectile dysfunction
  • Rebound hypertension w clonidine withdrawal
  • Coombs test + –> hemolytic anemia and elevated liver enzymes with methyldopa
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17
Q

Direct vasodilators contraindications

A
  • Orthostatic hypotension

Side effects:

  • Reflex tachycardia
  • Fluid retention
  • Hirsutism, pericardial effusion with minoxidil
  • Lupus with hydralazine
18
Q

What drug?

hypertensive crisis w retinopathy, microangiopathy, or acute renal insufficiency

A

Labetalol

Alternative therapy:

  • Nitroprusside
  • Nicardipine
  • Urapadil
19
Q

What drug?

hypertensive encephalopathy

A

Labetalol

Alternative therapy:

  • Nicardipine
  • Nitroprusside
20
Q

What drug?

acute aortic dissection

A

Nitroprusside + metropolol

Alternative therapy:
Labetalol

21
Q

What drug?

acute pulmonary edema

A

Nitroprusside with loop diuretic

Alternative therapy:

  • Nitroglycerine
  • Urapadil w loop
22
Q

What drug?

Acute coronary syndrome

A

Nitroglycerine

Alternative therapy:
- Labetalol

23
Q

What drug?

Acute ischemic stroke and BP > 220/120

A

Labetalol

Alternative therapy:

  • nicardipine
  • nitroprusside
24
Q

What drug?

cerebral hemorrhage and systolic BP >180 or MAP > 139

A

Labetalol

Alternative therapy:

  • Nicardipine
  • Nitroprusside
25
What drug? | Acute ischemic stroke with indication for throbolytic therapy and BP > 185/110
Phentolamine (after benzodiazephines) Alternative therapy: nitroprusside
26
What drug? | Pheochromocytoma crisis
Phentolamine Alternative therapy: nitroprusside urapadil
27
What drug? | Perioperative hypertension during or after CABG
Nicardipine Alternative therapy: - Urapadil - Nitroglycerine
28
What drug? | During or after craniotomy
Nicardipine Alternative therapy: labetalol
29
What drug? | severe preeclampsia/eclampsia
Labetalol + MgSO4 and oral antihypertensive medication such as nifedipine w or w/ out methyldopa Alternative therapy: - Ketanserin - NIcardipine
30
-zosin
alpha blockers
31
Combinations to avoid
- ACE inhibitors, ARBs, and renin inhibitors - Beta blockers and non dihydropyrine - Potassium sparing diuretics and ACE inhibitors
32
Most effective parenteral drug for hypertensive emergencies
Sodium nitroprusside- vasodilator Potential for cyanide toxicity limits prolonged use
33
Less antihypertensive efficacy than other agents for HTN emergencies; useful adjunct in pts with cardiac ischemia or after coronary bypass surgery
Nitroglycerin-vasodilator
34
DHP-CCB with longer onset of action and longer elimination half life, but good safey profile
Nicardipine-vasodilator
35
Ultra short-acting DHP-CCB is approved only for hypertensive emergencies
Clevidipine-vasodilator
36
Rarely used due to slow onset and long duration of action; hypotensive response is unpredictable and dependent on plasma volume and plasma renin activity
Enalaprilat-vasodilator
37
Maintains or increases renal perfusion by dilating renal arteries; possibly a good choice for patients with renal dysfunction; avoid in glaucoma
Fenoldopam-vasodilator
38
Use of parenteral form limited by prolonged and unpredictable hypotensive effect; considered safe in pregnant patients
hydralazine-vasodilator
39
Acute management of severe hypertension in pregnancy
1. Labetalol 2. Hydralazine- only used if preeclampsia 3. CCB- nifedipine or nicardipine 4. Nitroglycerin- good when HTN is associated w pulmonary edema
40
Long term oral therapy for HTN in pregnancy
1. Methyldopa 2. Labetalol 3. Nifedipine 4. Hydralazine 5. Thiazide

DRUGS (6 decks)

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