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CPR 2 Exam 1 > Wolff Hypertension > Flashcards

Wolff Hypertension Flashcards

1
Q

What Thiazide diuretic is preferred to treat hypertension based on prolonged half life and proved trial reduction of CVD?

What needs to be monitored with this medication?

A

Chlorthalidone

Monitor hyponatremia and hypokalemia, as well as uric acid and calcium levels

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2
Q

Patients with what disease should be cautioned about using thiazide diuretics such as chlorthalidone, hydrochlorothiazide, or metolazone?

A

Gout unless they are on uric acid lowering therapy

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3
Q

What class of medication should not be used with ARBs or direct renin inhibitors?

A

ACEI

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4
Q

What are primary agents to treat hypertension?

A
  • Thiazide
  • ACEI
  • ARBs
  • CCB’s
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5
Q

CWhat are the secondary agents for hypertension? (12 classes)

A
  • Loop diuretics
  • K sparing diuretics
  • Aldosterone antagonists
  • Cardioselective Beta blockers
  • Cardioselective & vasodilatory Beta blockers (nebivolol)
  • Noncardioselective beta blockers (propranolol, nadolol)
  • Intrinisic sympathomimetic activity Beta blockers (pindolol, acebutolol)
  • Combined alpha and beta receptor blocker (carvedilol, labetalol)
  • Direct renin inhibitor (aliskiren)
  • Alpha 1 blockers ( prazosin, doxazosin, terazosin)
  • Centrral alpha 2 agonist (clonidine, methyldopa)
  • Direct vasodilators (hydralazine, minoxidil)
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6
Q

What beta blocker is preferred in patients with HFrEF?

A

Carvedilol

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7
Q

Thiazide MOA? What tends to be lost in greater amounts compared to loop diuretics?

A
  • block Na Cl co transporter in distal convoluted tubule
  • Mg
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8
Q

How does Amiloride work? Toxicity?

A
  • blocks epithelial Na channel in collecting duct
  • K sparing diuretic
  • Hyperkalemia is the black box warning
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9
Q

How does Spironolactone work?

A
  • Blocks aldosterone receptor in collecting duct
  • K sparing diuretic and it also antagonizes profibrotic effects of aldosterone
    *
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10
Q

Clinical use of spironolactone?

A
  • Counteracts K loss induced by other diuretics in tx of Htn and HF
  • Reduces fibrosis in HFrEF and post MI HF
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11
Q

Captopril MOA, use, and toxicities?

A
  • Competitive inhibitor of ACE
  • Cough
  • Angioedema
  • Can be used in acute htn urgency & HFrEF
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12
Q

Enalapril (enalaprilat)?

A

ACEI prodrug available for IV

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13
Q

Benazepril & lisinopril significance ?

A

widely used ACEI with a long half life and 1x dosing

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14
Q

Aliskiren MOA, use, AE’s?

A
  • direct renin inhibitor blocking angiotensinogen conversion to angiotensin I
  • hypertension treatment
  • skin rash, diarrhea, increase creatinine phosphokinase, BUN, hyperkalemia, cough
  • New expensive and no obvious benefit
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15
Q

How do drugs interfering with Angiotensin II impact the kidneys?

A
  • decrease efferent tone
  • Can precipitate renal failure in patients with bilateral renal stenosis
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16
Q

Nifedipine MOA and use?

A
  • Dihydropyridine CCB
  • Frequency independent- not cardioactive
  • manage stable or vasospastic angina and tx htn
  • Hypertensive emergency in pregnancy off label
17
Q

Nifedipine toxicities?

A
  • Flushing
  • Peripheral edema
  • HA
  • Palpitations
  • Gingival hyperplasia
18
Q

Verapamil class, effects, use, AE?

A
  • Cardioactive non dihydropyridine CCB
  • slows automaticity of AV node and is frequency dependent, decreases contractility
  • PSVT (IV)
  • Primary htn, angina pectoris,
  • HA gingival hyperplasia and constipation
19
Q

Key difference between nifedipine and verapamil?

A
  • nifedipine at therapuetic doses exerts smaller direct inotropic effects on myocardium and no chornotropic effects, but large vasodilatory effects, HR and CO are increased bc of SNS activation
20
Q

Adverse effects of Phentolamine?

A
  • non selective alpha blocker
  • prolonged hypotensive episodes
  • Orthostatic hypotension
  • Tachycardia
  • Cardiac arrhythmia
  • Nasal stuffiness
  • diarrhea
21
Q

Prazosin effects, use, & AE’s?

A
  • Vasodilates veins and arterioles to decrease TPR
  • Late choice bc it shows likelihood of stroke and CHF with doxazosin in comparison to chlorthalidone
  • retrograde ejaculation and orthostatic hypotension
22
Q

Clonidine toxicities?

A
  • drowsiness
  • xerostomia
  • rebound hypertension if missed dose
23
Q

alpha methyldopa use & AE?

A
  • Gestational hypertension (Pregnancy induced hypertension)
  • SLE like syndrome
  • Positive coombs test
24
Q

Why are beta blockers contraindicated with Peripheral vascular disease?

A

Cold extremities is an AE

25
Q

Hydralazine MOA use?

A
  • Direct vasodilator of arterioles, decreasing systemic resitance
  • Used for hypertensive emergency in pregnancy
  • HFrEF
26
Q

Hydralazine AE?

A
  • CV
    • hypotension, palpitations
  • Drug induced lupus like syndrome
  • Dermatologic
  • GI
  • Hematologic
  • Neuromuscular
  • Ocular
  • Respiratory
27
Q

Nitroprusside MOA use?

A

Venous and arteriolar vasodilator

Used for htn crises

28
Q

Minoxidil AE?

A
  • Profound vasodilation leading to weight gain, edema, pericardial effusion with tamponade,
29
Q

If you have htn and proteinuria what drugs should be used?

A

ACEI or ARBS

30
Q

In a patient with A. Fib and Htn what should be used for the hypertension?

A

ARB

31
Q

In a patient with aortic disease and htn what should be used?

A

Beta blocker

32
Q

What medications should be used for a pregnant woman?

A
  • Methyldopa
  • Nifedipine
  • Labetalol
33
Q

What CCB’s are used for Htn emergencies?

A
  • Nicardipine
    • contraindicated in adv aortic stenosis
  • Clevidipine
    • contraindicated with soy egg allergies
34
Q

What Vasodilators are used for htn emergency?

A
  • Sodium Nitroprusside
  • Nitroglycerine
    • don’t use in volume depleted patients
35
Q

Direct vasodilators used for htn emergency?

A

Hydralazine

36
Q

alpha 1 selective and non selective beta blocker used for htn emergency?

A

Labetaol

  • dont use with heart blocks or bradycardia
37
Q

Adrenergic non selective alpha blocker used for htn emergency?

A

Phentolamine

38
Q

Dopamine 1 receptor agonist for htn emergency?

A

Fenoldopam

39
Q

Aortic dissection medications?

A
  • Esmolol or labetalol

CPR 2 Exam 1 (21 decks)

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