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Pharmacology for advance practice nursing 712 > Week 5 CARDIOVASCULAR: HTN/HEART FAILURE > Flashcards

Week 5 CARDIOVASCULAR: HTN/HEART FAILURE Flashcards

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1
Q

Pharmacologic treatment for HTN is indicated for primary prevention

A

No CVD, 10 year ASCVD <10%, and SBP >=140 or DBP >=90 OR NoCVD, 10 year ASCVD >=10% and SBP >=130 or DBP >=80

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2
Q

First line pharmaceutical options for treatment of HTN

A

Diuretics, ACE inhibitors, ARBs, CCB

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3
Q

Class of antihypertensive drug that should be used with caution in individuals with gout

A

Thiazide diuretics

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4
Q

Pharmacologic agent that prevents conversion of Angiotensin 1 to Angiotensin II

A

ACE inhibitor

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5
Q

Antihypertensive of choice (2) in the black population

A

Thiazide diuretics and CCB

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6
Q

Antihypertensive of choice for individuals with CKD

A

ACE inhibitor (or ARB if not tolerated)

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7
Q

Side effect of ACE inhibitors related to blocking of bradykinase

A

cough

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8
Q

Mechanism of Action: ARB

A

Blocks access of angiotensin II

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9
Q

Mechanism of Action: CCB

A

Blocks calcium influx resulting in vasodilation

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10
Q

Block only Beta receptors in heart and kidneys

A

Cardio-selective Beta Blocker

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11
Q

Class of antihypertensive that should be used cautiously in individuals with lung disease

A

Non selective beta blocker

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12
Q

Class of antihypertensive that has a common side effect of orthostatic hypotension

A

Alpha blockers

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13
Q

Hypertension caused by a co-morbid condition or drug

A

Secondary Hypertension

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14
Q

Cornerstone of treatment of HF

A

Ace inhibitors and beta blockers

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15
Q

Drugs routinely used in addition to ACEI and Beta blockers in HFREF (Stage C)

A

Diuretics (loop) and Aldosterone antagonist (spironolactone)

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16
Q

Goal in dosing ACE inhibitors in HF

A

Maximal dose tolerated

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17
Q

Medication class that minimizes cardiac remodeling

A

ACE inhibitors

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18
Q

Goals of treatment of HF (Stage A)

A

Healthy lifestyle, prevent vascular/coronary disease, prevent LV structural abnormalities

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19
Q

Class of diuretic most commonly used to treat HF

A

Loop diuretics (e.g. furosemide, bumetanide)

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20
Q

Common OTC analgesic that interacts with loop diuretic

A

NSAIDS

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21
Q

Drug recommended for treatment of HF and SVT or atrial fibrillation

A

Digoxin

22
Q

Effect of combination of isosorbide dinitrate and hydralazine

A

Decrease preload and afterload

23
Q

Major adverse effect of aldosterone antagonists / Mineralcorticoid receptor antagonists

A

Hyperkalemia and renal failure

24
Q

Mechanism of action of Mineralcorticoid receptor antagonists

A

Inhibit aldosterone to produce a mild diuretic effect and potassium sparing

25
Q

Medication used to treat HF that may have endocrine side effect profile such as gynecomastia in men and menstrual irregularity in women

A

Sprinolactone

26
Q

Effect of digoxin

A

Positive inotrope (increase contractility)

27
Q

Blanche, 46 years old, presents for her annual Well exam. Her BP today is 136/84 with a repeat of 139/88. She brings in her blood pressure reading from the health fair at work which is 138/80. Blanche is considered to have:

A) stage 1 HTN
B) Accelerated HTN
C) Hypertensive crisis
D) Normal

A

A) stage 1 hypertension

28
Q

Which of the following is NOT a first line option for pharmacologic treatment of hypertension:

A) Thiazide diuretic
B) Beta Blocker
C) ACE inhibitor
D) ARB therapy

A

B) Beta blocker

29
Q

The best first choice for treating hypertension in individuals with CKD:

A) Beta Blocker
B) Thiazide diuretic
C) ACE inhibitor
D) Calcium Channel Blocker

A

C) ACE inhibitor

30
Q

Frank, a black male, age 56 is diagnosed with Stage 1 HTN. His ASCVD risk is 15%. He has no CKD. The NP chooses which medication as the best first choice to treat his hypertension?

A) Furosemide
B) Amlodipine
C) Metoprolol
D) HCTZ

A

B) Amlodipine

31
Q

Adverse drug reactions associated with the dihydropyridine calcium channel blockers include all of the following EXCEPT:

A) Diarrhea
B) Hypotension
C) Edema
D) Gingival Hyperplasia

A

A) diarrhea

32
Q

Stage 1 HTN

A

130-139 SBP
OR
80-89 DBP

33
Q

Stage 2 HTN

A

> = 140 SBP
OR
= 90 DBP

34
Q

Elevated BP

A

120-129 SBP and < 80 DBP

35
Q

Pharmacologic treatment with one first line agent

A

Stage 1 HTN and ASCVD risk >10%

or known CVD, DM or CKD

36
Q

Pharmacologic treatment with two first line agents is the protocol for which stage of HTN?

A

Stage 2 HTN

37
Q

Hypertensive Urgency

A

SBP >=180
or
DBP >=120 and no target end organ damage evident

38
Q

Preferred first line medication for patients with CKD or DM with microalumuria

A

ACE inhibitor

39
Q

Preferred first line treatment for black population with no CKD

A

Calcium channel blocker or thiazide diuretic

40
Q

Preferred thiazide diuretic due to duration of action

A

Chlorthalidone

41
Q

Drug used in individuals who do not tolerate ACE inhibitors due to cough

A

Angiotensin receptor blocker

42
Q

Recommended management and follow up if Stage 1 HTN and clinical ASCVD < 10%

A

Lifestyle changes and FU in 3 -6 months

43
Q

Recommended management and follow up if Stage 1 HTN and clinical ASCVD >= 10% or known CKD, DM, or CVD

A

Lifestyle changes, a single pharmaceutical agent and FU in 1 month

44
Q

Recommended management and follow up if Stage 2 HTN

A

Lifestyle changes, two pharmaceutical agents and FU in 1 month

45
Q

Most common cause of secondary HTN

A

Obstructive Sleep Apnea

46
Q

Compelling use for this medication if history of MI

A

Beta blocker or CCA

47
Q

BP Threshold for treatment if no CVD and 10 year ASCVD risk <10%

A

> = 140/90

48
Q

Overweight / Obesity

A

Modifiable risk factor

49
Q

Low socioeconomic status

A

Relatively fixed risk factor

50
Q

Reduction in BP for each 1 Kg of weight loss

A

1 mm Hg

51
Q

Accounts for up to 95% of HTN

A

Primary (essential) HTN

52
Q

What are the first choice of Thiazide diuretics in mild HF, corticosteroid and estrogen therapy, premenstrual syndrome and limited renal dysfunction?

A) furosemide and hydrochlorothiazide
B) spironolactone and chlorthalidone
C) hydrochlorothiazide and chlorothalidone
D) metolazone and hydrochlorothiazide

A

Answer= C

Rationale
A) furosemide is a loop diuretic and not a thiazide
B) spironolactone is a potassium sparing diuretic, not a thiazide
C) see page 331, second paragraph of Edema Associated with…
D) Both metolazone and HCTZ are classified under thiazide diuretics, but metolazone is not the preferred thiazide in this situation.

Pharmacology for advance practice nursing 712 (24 decks)

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