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Pharmacology > Week 7:BP > Flashcards

Week 7:BP Flashcards

1
Q

What is a surrogate maker for cardiovascular risk?

A

BP

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2
Q

What is it called when cause of htn is unknown (>90%)?

A

primary (essential) htn

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3
Q

What is it called when there is an identifiable cause of htn?

A

secondary htn

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4
Q

What is the equation of MAP (Mean arterial pressure)?

A

CO x TPR

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5
Q

What are the hormonal factors involved in HTN?

A

renin
angiotensin
aldosterone
bradykinin (RAAS)

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6
Q

When does pharmacotherapy begin according to JNC9?

A

SBP>130 or DBP >80

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7
Q

_____ is the new 140.

A

130

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8
Q

What is the result of the new JNC9 criteria?

A

many more individuals requiring pharmacotherapy

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9
Q

What is the primary diuretic first line for htn (class effect)?

A

thiazide diuretics

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10
Q

What are examples of thiazide diuretics?

A

chlorthalidone (hygroton)

Hydrochlorthiazide (HCTZ)

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11
Q

What thiazide diuretics are effective for CrCl <30?

A

Indapamide (lozol)

Metolazone (zaroxylyn)

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12
Q

Why is the hypotensive effect longer than the half life for thiazide diuretics?

A

extra renal factors involved?

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13
Q

What is the half life of chlorthalidone?

A

45-60 hours

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14
Q

What is the half life of HCTZ?

A

8-15 hours

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15
Q

When should thiazides be given? why?

A

in the AM to minimize nocturnal diuresis

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16
Q

WHen should thiazides be used with caution?

A

> 65
females
pts with low or borderline low serum Na+

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17
Q

What is the maximum dose that should not be exceeded for HCTZ and chlorthalidone?

A

25-50mg HCTZ

25mg/day chlorthalidone

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18
Q

What is the MOA of ACEIs?

A

block RAAS-mediated conversion of AT I to AT II (potent constrictor)

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19
Q

What is the effect of ACEIs on the heart?

A

prevent LV hypertrophy

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20
Q

What are the first line indications for ACEIs?

A

left ventricular dysfunction
chronic kidney disease
DM
secondary prevention of ischemic stroke

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21
Q

What ACEI is NOT once daily dosing?

A

captopril

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22
Q

What is the effect of ACEIs on serum?

A

increase serum K+

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23
Q

How is GFR affected in pts on ACEIs?

A

GFR decreases

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24
Q

How is SCr affected in pts on ACEIs?

A

Screaming increases of 30% OR absolute increases of <1mg/dL are OK

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25
Q

What should be done if changes in SCr are not ok?

A

warrant discontinuation or dose reduction

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26
Q

A SE of ACEIs in <1% is angioedema, most common…. (2)

A

African Americans and smokers

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27
Q

What are common side effects of ACEIs?

A

angioedema precludes any further ACEIs

20% of patients development persistent, dry cough

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28
Q

When are ACEIs contraindicated?

A 
in pregnancy (category X)
do NOT use in combo with ARBS or Aliskiren (tekturna)
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29
Q

What is the usual dose of enalapril (vasotec)?

A

PO, IV
5-40mg
1-2 doses

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30
Q

What is the usual dose of lisinopril?

A

10-40mg

Daily

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31
Q

How are ARBs different compared to ACEIs?

A

ARBs do not block bradykinin metabolism therefore little if any bradykinin-induced cough

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32
Q

What benefits are not present in ARBs that IS present with ACEIs?

A

beneficial effects of bradykinin are not present with ARB use such as myocardial remodeling and regression of myocyte hypertrophy & fibrosis

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33
Q

Why shouldn’t ACEIs and ARBs be given together?

A

increased risk of hyperkalemia

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34
Q

What antihypertensive has the lowest incidence of SEs?

A

ARBs

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35
Q

Can ARBs be used in pregnancy?

A

NO

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36
Q

What are the common available ARBs?

A

losartan 50-100mg
1-2 times daily

Valsartan 80-320mg daily

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37
Q

What are the 2 classes of calcium channel blockers?

A

dihydropyridines-vasodilators

non-dihydropyridines-rate controllers

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38
Q

What may cause reflex tachycardia due to potent vasodilation?

A

dihydropyridines-vasodilators

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39
Q

What is significant about dihydropyridines-vasodilators and reflex tachycardia?

A

more pronounced with first generation DHP (Procardia)

much less with newer agents (amlodipine)

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40
Q

IR nifedipine is associated with what?

A

increased adverse CV events (AMI in angina patients), so NOT approved for HTN

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41
Q

What are the common dihydropyridines-vasodilators?

A 
Amlodipine (norvasc)
felodipine (prendil)
isradipine (dynacirc)
nicardipine SR
Nifedipine LA
Nisoldipine
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42
Q

What are the non dihydropyridines available agents?

A

SR or CD preferred
Verapamil
Diltiazem

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43
Q

What CCB causes constipation?

A

verapamil

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44
Q

When is combination therapy preferred?

A

for pts with stage 2 HTN

usually provides better BP control with fewer SEs

45
Q

What are examples of loop diuretics?

A

furosemide BID
Bumetanide BID
Ethacrinic acid BID, TID
Torsemide QD

46
Q

What loop diuretic is safe for sulfa allergies?

A

Ethacrinic acid

47
Q

When are loop diuretics reserved?

A

fir pts with CrCl <30

48
Q

What are weak anti-htn agents that have additive effect in combo with thiazide or loop?

A

potassium sparing diuretics

49
Q

When are potassium sparing diuretics useful?

A

in pts with low serum K+

50
Q

What can potassium sparing diuretics cause in pts with CKD and DM?

A

hyperkalemia

51
Q

What are examples of potassium sparing diuretics ?

A

Triamtereine

Amiloride

52
Q

What is it called with triamterine is in combo with HCTZ?

A

Dyazide

Maxzide

53
Q

What is considered an independent class of JNC7?

A

aldosterone antagonist diuretics

54
Q

What is an example of an aldosterone antagonist diuretic?

A

spironolactone (aldactone)

55
Q

What is common in 10% of pts on spironolactone?

A

gynecomastia

56
Q

What is the combo with spironolactone/HCTZ?

A

aldactozide

57
Q

What is the newest aldosterone antagonist diuretic that rarely causes gynecomastia?

A

Epelrenone

58
Q

What are the secondary beta blockers?

A 
"All American Ear Better Meat"
Acebutol
Atenolol
Esmolol
Bisoprolol
Metoprolol
59
Q

What is a secondary beta blockers that is alpha and beta blocker?

A

carvedilol phosphate (coreg CR)

60
Q

What beta blocker has intrinsic sympathomimetic activity (ISA)?

A

acebutolol (secretal)

61
Q

When is acebutolol (secretal) useful?

A

if beta blockers cause bradycardia

cardioselective beta 1>beta2

62
Q

What is a direct renin inhibitor that cannot to used with ACEIs or ARBS and is pregnancy cat X

A

Aliskiren (Tekturna)

63
Q

What medications are mainly used in pts with BPH?

A

alpha -1 blockers

64
Q

What are examples of alpha 1 blockers?

A

Doxazosin
Prazosin
Terazosin

65
Q

When should first alpha 1 blocker be taken?

A

before bedtime to minimize dizziness and postural hypotension

66
Q

What are the secondary agents that are centrally acting?

A

clonidine (catapress)

67
Q

What forms is clonidine available?

A

tabs and transdermal patch replaced weekly

68
Q

What is significant about clonidine?

A

short acting and fast onset (20-60minutes)

69
Q

When is clonidine often used?

A

in resistant htn

70
Q

What are the common side effects of clonidine?

A

anticholinergic side effects

71
Q

What can happen with abrupt cessation of clonidine?

A

may cause rebound htn therefore taper dose gradually to DC

72
Q

What is the centrally acting agent that is first line for pregnancy induced htn?

A

Methyldopa (aldomet)

73
Q

What are the forms of methyldopa (aldomet)?

A

methyldopate injection and tablets

74
Q

What are the 2 mediations that are direct vasodilators?

A

hydralazine (apresoline) and minoxidil (loniten)

75
Q

Why is hydralazine taken with a diuretic and a beta blocker?

A

to minimize water mention and reflex tachycardia

76
Q

What can happen at higher doses of hydralazine?

A

may cause lupus like syndrome & rash

77
Q

What should be taken with Minoxidil?

A

a loop diuretic and beta blocker

78
Q

What are the vasodilators for HTN emergencies?

A 
sodium nitroprusside (CIV)
nitroglycerine (CIV)
79
Q

What is the mainstay of treatment for most htn emergencies?

A

nitroprusside (NTP , Nitropress)

80
Q

What is nitroprusside metabolized to?

A

cyanide

81
Q

Why is there precauation when giving nitroprusside with renal insufficiency?

A

nitroprusside is metabolized to cyanide then to thiocyanate which can accumulate with renal insufficiency

82
Q

When should you monitor levels of nitroprusside?

A

if used > 4 days or @ 4mcg/kg/min

83
Q

What should be added IVPB to nitroprusside starting 2nd bag?

A

sodium thiosulfate

84
Q

Why is sodium thiosulfate added to nitroprusside IVPB?

A

accelerate enzyme degradation of cyanide to thiocyanate (much less toxic)

85
Q

What are the uses of nitroglycerin?

A

acute myocardial infarction (AMI)

stroke

86
Q

What are precautions of NTG?

A

development of tolerance

increase IV administration rate

87
Q

What are the contraindications of NTG?

A

concurrent use phosphodiesterase 5 inhibitors (ED meds)

88
Q

What is the press of “last resort”?

A

epinephrine (adrenalin)

89
Q

Why is epinephrine the pressor of last resort?

A

severe vasoconstriction may cause digital necrosis

90
Q

What naturally occurring neurotransmitter is used for severe hypotension and may cause digital necrosis?

A

norepinephrine (Levophed)

91
Q

What is the low dose or “renal dose” of dopamine? (Intropin)

A

1-3 mcg/kg/min

92
Q

What is the effect of low dose dopamine?

A

dopaminergic agonist effects

93
Q

What is the intermediate dose of dopamine?

A

3-10mcg/kg/min

94
Q

Why shouldn’t low dose dopamine be called “renal-dose dopamine”?

A

supported by little clinical data at best

at worst its a myth

95
Q

What is the effect of the intermediate dose of dopamine?

A

dopaminergic agonist and beta 1 effects

96
Q

What is the high dose of dopamine?

A

> 10mcg/kg/min

97
Q

What are the effects of high dose dopamine

A

mainly alpha 1 effects

98
Q

What is the pressor of choice that should be considered first?

A

norepinephrine (Levophed)

99
Q

Dobutamine (Dobutrex) is mainly _____ activity with little ____ or ____ activity.

A

beta 1 activity

little beta 2 or alpha activity

100
Q

What are the effects of dobutamine (Dobutrex)?

A

increases cardiac out with little vasoconstriction

an inotrope with vasodilatory properties

101
Q

What medication is a potent alpha agonist with weak beta agonist activity?

A

phenylepherine (Neo-Synephrine)

102
Q

What is the effect of phenylepherine (Neo-Synephrine)?

A

vasocontrictive in arterioles and nasal mucosa

103
Q

When is phenylepherine (Neo-Synephrine) useful?

A

alternative in those unable to tolerate tachycardia from dopamine and norepinephrine

104
Q

What is the MOA of vasopressin (Pitressin)?

A

increases water permeability of renal tube

increases water resorption from the tubular lumen

105
Q

What is the result of vasopressin (Pitressin)?

A

decreased urine volume & increased osmolarity

106
Q

What is the fixed rate of vasopressin?

A

administer at 0.04 units/min

107
Q

Why does vasopressin have a fixed rate dose?

A

greater dose may cause cardiac arrest!

108
Q

When is vasopressin used?

A

in patients in refractory shock “added on” in addition to the use of other pressors

Pharmacology (17 decks)

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