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HTN > When to use > Flashcards

When to use Flashcards

1
Q

Which antihypertensive classes increase K

A

Potassium sparing diuretics, aldosterone antagonist, ACEIs, ARBs, aliskirne

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2
Q

Which antihypertensive classes decrease K

A

Thiazides, Loop diuretics

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3
Q

What is the biggest difference between the effects thiazides and loops have on electrolytes

A

Thiazides increase Ca while Loops Decrease it

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4
Q

A patient currently taking Lithium is to placed on antihypertensive therapy. Which of the following will NOT affect his lithium levels?

a. potassium sparing diuretics
b. thiazides
c. loops
d. aldosterone antagonists

A

D ONLY.

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5
Q

What effect to diuretics have on lithium?

A

Thiazides, loops & K-sparing all increase the level of lithium
Aldosterone antagonists have no effect

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6
Q

A pt is admitted with a history of metabolic syndrome, and diabetes. what 2 classes should be avoided in this patient and why?

A

Loop diuretics and Thiazide diuretics as these increase TG levels

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7
Q

What is the diuretic of choice for young, non-african american, white, pts without renal impairment?

A

thiazides

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8
Q

In what other condition, may a thiazide diuretic be a great option?

A

osteoporosis

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9
Q

A patient comes in with a CrCl of <30 and hypertensive. The doctor would like to start a thiazide diuretic what are his options and why?

A

The only agent that could be used is metolazone (Zaroxolyn) a thiazide-like diuretic that is not affected by poor renal function.

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10
Q

Diuril or ______ 500mg, is the only form of _____ in this class

A

Chlorothiazide/ injectable/ thiazide class

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11
Q

Anuria is a contraindication for what antihypertensive classes, and what 2 classes are of the most significance?

A

Diuretics/ loops & thiazides

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12
Q

In what patient would loop diuretics be the diuretic of choice?

A

Patients with:

  • renal disease or insufficiency (CrCl2.5)
  • CHF
  • severe edema
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13
Q

Due to the increase in K, Potassium sparing diuretics, aldosterone antagonist, ACEIs, ARBs, and aliskirne should be greatly monitored when taken with medications that may cause this.

A

Torsade (class IA & III antiarrhythmics in particular)

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14
Q

Which loop diuretic can be used even if a patient has a sulfa allergy, and at what cost?

A

Edrecin (ethacrynic acid) can be used, but it does have a higher risk of hyperkalemia.

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15
Q

When are K-sparing antihypertensives most appropriate?

A

They should be reserved for pts that developed hypokalemia while on diuretic treatment without renal or hepatic disease or at risk for torsades.

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16
Q

Potassium sparing diuretics are contraindicated under which circumstance?

A
  1. pt with hyperkalemia or on other k-sparing agents
  2. pts with renal or hepatic impairment
  3. anuria
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17
Q

Aldoseterone antagonists are contraindicated under what circumstances

A

acute renal insufficiency

hyperkalemia

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18
Q

Inspra & Aldactone are best used in patients with:

A
  • moderate to severe HF

- pt w/ NYHA class 2 HF & decreased LVF

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19
Q

At doses > 100mg, this medication should not be used due to increased risk of hyperkalemia but no additional benefits.

A

Inspra (eplerinone)

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20
Q

What are the contraindications for Serpasil (reserpine)?

A
  • Hx of depression
  • pheochromocytoma
  • peptic ulceration
  • parkinsonism
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21
Q

What are the side effects if Reserpine and which is the most common/ significant?

A

Nasal congestion is the most significant side effect of Serpasil, others include: sedation, lethargy, memory impairment, sleep disturbances & weight gain

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22
Q

Non-selective alpha-1 blockers, may be of benefit & should be used if a patient presents with what condition(s)?

A

BPH

Dyslipidemia

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23
Q

How many hours must be allowed between a dose of Cardura (doxazosin) & Viagra and why?

A

non selective alpha-1 blockers & PDE5-I must be separated by 4-6 hours do avoid worst syncope, orthostasis & palpitations.

24
Q

Which alpha-1 blocker is ONLY approved for BPH

A

Cardura XL

25
Q

Methyldopa is the drug of choice for which pt population?

A

Women diagnosed with HTN during pregnancy

26
Q

Hepatitis & renal dysfunction are of concern with which antihypertensive?

A

methyl-dopa

27
Q

Which antihypertensive agents cause indirect vasodilation

A 
Thiazides
ACEIs, ARBs, aliskirne
Carvedilol, Labetalol, Nebivolol
CCB
alpha-blockers
28
Q

What side effects are common with agents that cause vasodilation

A

Flushing, HA, itching

29
Q

Impotence is a side effect of which antihypertensive agents

A

BB, alpha1-blockers & alpha2- agonists

30
Q

Which antihypertensive has priapism as a side effect

A

alpha1-blockers

31
Q

Depression is a possible side effect of which antihypertensive and therefore should be high monitored or avoided is pts with a hx of depression

A

BB
alpha1- blockers & alpha2- agonists
reserpine

32
Q

what can be used in the management of cyclosporin induced hypertention

A

CCB

33
Q

caution should be used when using these in diabetics with HTN

A

BB & high doses of diuretics ( particularly loops & thiazides as they can increase BS)

34
Q

If a BB is to be used in a pt with dyslipidemia, which agents are preferred?

A

intrinsic sympathomimeticly active agents: CAPP

35
Q

Heart block is a contraindication for which antihypertensive(s)?

A

ALL BB & ONLY NDHP CCB (verapamil & diltiazem)

36
Q

What is the diuretic of choice for pts with renal insufficiency?

A

loop diuretics

37
Q

Which ACEIs should NOT be used when a pt is diagnosed with chronic renal insufficiency

A

R-LEQ: Lisinopril, enalopril, quinapril

38
Q

BB should be monitored closely or avoided if a patient has:

A

Bronchospastic disease (COPD, Asthma, emphysema)
Depression
Diabetes
Dyslipidemia
Heart block (contraindication)
Heart failure (except Zebeta/bisoprolol, Coreg/carvedilol, Toprolol-XL/ER metoprolol Succinate)
Peripheral vascular disease (PVD)

39
Q

Which agent has replaced methyldopa as DOC for HTN in pregnancy?

A

lebetalol

40
Q

Abrupt D/C of BB can lead to

A

exacerbation of angina & MI

41
Q

If a pt has been using BB for some time, what may happen if the pt has anaphylaxis and is given an epi pen?

A

the effectiveness of the eli pen may have gone down due to the BB, more may be need.

42
Q

when is Esmolol used

A 
SVT
HTN emergency (aortic dissection or preoperative)
43
Q

what is the significance of CAPP agents

A

they partially stimulate B1 receptors and also cause less bradycardia than other BB

44
Q

why are NDHP CCB absolutely contraindicated in HF (systolic HF)

A

they cause decreased cardiac contractility (negative inotropic)

45
Q

What are the side effect differences b/t DHP CCB & NDHP CCB?

A

DHP CCB = tacycardia, peripheral edema

NDHP CBB = bradycardia

46
Q

Which antihypertensive agents cause bradycardia?

A

BB
NDHP CCB
central alpha2-agonists
reserpine

47
Q

DHP CCB & direct arterial vasodilators have what effect on heart rate?

A

they increase HR = tachycardia

48
Q

what is raynaud’s syndrome or symptoms

A

condition that causes some areas of your body — such as your fingers, toes, the tip of your nose and your ears — to feel numb and cool in response to cold temperatures or stress.

49
Q

What medications can cause raynaud’s syndrome

A

BB & clonidine

50
Q

what agents can be used for the treatment of raynaud’s

A

CCB & alpha blockers

51
Q

what anti hypertensive agents may cause lupus like syndrome

A

hydralazine, methyldopa

52
Q

what pregnancy category are ACEIs & ARBs

A

Category C in 1st trimester (months 1-3, weeks 1-12)

Category D in 2nd & 3rd trimester (month 4-9, wk 13-40)

53
Q

what must be corrected before the initiation of aliskiren

A

Volume and Na depletion

54
Q

diarrhea is very common at what dose of aliskiren

A

> 300mg

55
Q

When counseling a patient on aliskiren administration, it should be mentioned that the patient take the medication…

A

with or without a meal, but high fat meals do decrease the absorption of the medication

HTN (5 decks)

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