Cardio Module Htn Set 2

Front 1

ARB's mechanism

Back 1

block AT1 receptors competitively but essentially irreversibly

Front 2

Differences b/w ACEI's and ARB's (4)

Back 2

1)ARB's reduce angiotensin receptor activation more than ACEI's
2)AT2 receptors not inhibited by ARB
3)ARB's do NOT incr bradykinin []s, so no cough
4)ARB's have much less angioedema

Front 3

ARB's ADR's (3)

Back 3

1)FETOPATHIC
2)do NOT use w/ renal stenosis
3)hyperkalemia if person has renal disase

Front 4

ARB's therapeutic uses (2)

Back 4

1)3-6wks to work
2)less effective in blacks and old (low plasma renin)

Front 5

Direct inhibitor of activity of renin

Back 5

Aliserken

Front 6

Antagonists of the aldosterone receptor (2)

Back 6

Sprionolactone
Eplerenone

Front 7

Endothelin receptor antagonists

Back 7

Ambrisentan

Front 8

Diuretics def

Back 8

agents that incr rate of urine formation

Front 9

Water as a TRUE PHYSIOLOGIC diuretic
a)mechanism
b)general therapeutic uses (2)

Back 9

a)incr urine volume and rate of formation by decr osmolarity of blood and decr ADH secretion
b1)incr rate of excretion of toxic drugs
b2)dilute drugs which may prcipitate in kidney (like sulfa)

Front 10

Osmotic Diuretics characteristics (4)

Back 10

1)free glomerular filtration
2)limited tubular reabsorption (so it stays in nephron)
3)inert/nontoxic
4)resistant to metabolic alteration

Front 11

Osmotic Diuretics mechanism (3)

Back 11

1)loop of Henle is major site of axn
2)incr osmotic activity in renal tubule
3)agent is not reabsorbed and carries w/ it and equivalent amt of fluid

Front 12

Osmotic Diuretics
a)ADR's

Back 12

rapid expansion of ECF may cause cardiac failure

Front 13

Osmotic Diuretics therapeutic uses (4)

Back 13

1)renal failure
2)glaucoma
3)edema
4)reduce spinal fluid before neurosurgery

Front 14

Osmotic Diuretics 2ex and 2 characteristics of each

Back 14

1)Mannitol (most common, poor GI absorption so give IV)
2)Isosorbide (used orally, but poor diuresis)

Front 15

All carbonic anhydrase inhibitors have...and ex

Back 15

a free sulfonamide group

Acetazolamide

Front 16

Overall axn of carbonic anhydrase inhibitor (5)

Back 16

1)alkaline urine (via incr HCO3 excretion)
2)diuresis (via incr water excretion)
3)metabolic acidosis (via decr H+ excretion)
4)Na/K excretion incr (via excess Na/K exchange)
5)self-limiting b/c body compensates so not a good diuretic

Front 17

carbonic anhydrase inhibitor uses (5)

Back 17

1)open glaucoma
2)reduces epileptic seizure
3)alkalanize urine
4)treat altitude sickness
5)not really as a diuretic

Front 18

carbonic anhydrase inhibitor ADR's (4)

Back 18

1)parasthesia (numbness of extremeties)
2)drowsiness
3)alkaline urine -> precipitates CaPO4 -> kidney stones
4)allergic rxn (crosses w/ sulfa allergy)

Front 19

Thiazide diuretics mechanism (3)

Back 19

1)inhibits Na-Cl symport in DISTAL SEGMENTS of nephron
2)competes at Cl binding site
3)significant K+ loss due to excess Na remaining in DISTAL tubule

Front 20

Thiazide diuretics other axns (4)

Back 20

1)chronic use DECREASES URIC ACID EXCRETION (so it builds up)
2)decr Ca excretion
3)incr Mg excretion
4)incr halogen excretion (for radiation poisoning)

Front 21

Thiazide ADR's (4)

Back 21

1)hyponatremia/dehydration
2)K+ depletion (requires K+ supplement or cotherapy w/ K+ spaing diuretic)
3)hyperglycemia in DM
4)uric acid retention = gout

Front 22

Thiazide uses (3)

Back 22

1)HTN
2)edema of CHF
3)edema of chronic liver/renal disease

Front 23

Loop diuretics have what in common (3)

Back 23

1)prompt onset w/ short duration
2)inhibit Na/Cl transport in ascending loop
3)little acid/base change

Front 24

2 Loop diuretics

Back 24

1)lasix
2)ethacrynic acid

Front 25

Loop diuretics mechanism (4)

Back 25

1)mainly acts at ASCENDING LOOP OF HENLE inhibiting transport of Na/Cl
2)inhibit Na-K-2Cl symport
3)acts at Cl binding site
4)reduces counter-current multiplier mechanism (less []ed urine)

Front 26

Loop diuretics other effects (2)

Back 26

1)incr K+/Mg/Ca excretion
2)decr uric acid excretion (so uric acid retention)

Front 27

Loop diuretics uses (3)

Back 27

1)edema in general
2)refractory edema
3)drug OD (enhances rate of drug elimination)

Front 28

Loop diuretics ADR's (5)

Back 28

1)dehydration, hyponatremia
2)hypotension
3)hypokalemia/magnesemia (arrhythmias)
4)uric acid retention (gout)
5)ototoxicity (mainly w/ ethacrynic acid)

Front 29

Type1 K+ sparing diuretics
a)ex
b)mechanism (3)

Back 29

ex)spironolactone

1)aldosterone receptor antagonist in DISTAL TUBULE AND COLLECTING DUCT
2)this enhances Na/water/K retention
3)diuretic effect limited by hormonal regulation of aldosterone

Front 30

Type1 K+ sparing diuretics ADR's (3)

Back 30

1)hyperkalemia
2)GI symptoms
3)androgen like effects

Front 31

Type1 K+ sparing diuretics uses (2)

Back 31

1)edema of HTN (use w/ thiazides)
2)combine w/ thiazides to prevent K+ loss

Front 32

Type2 K+ sparing diuretics
a)ex(2)
b)mechanism (2)

Back 32

ex)Amiloride, Triamterene

1)inhibit LIMITED Na channels in DISTAL TUBULES AND COLLECTING DUCTS to prevent Na/K exchange
2)this causes Na/Cl/water loss and K+ retention

Front 33

Type2 K+ sparing diuretics ADR's (2)

Back 33

1)hyperkalemia is most serious
2)nausea/dizzy

Front 34

Type2 K+ sparing diuretics uses (2)

Back 34

1)edema of HTN (use w/ thiazides)
2)use w/ other diuretics (thiazides) to augment Na excretion and to reduce K+ loss

Front 35

Diuretics T/F
a)Water is an osmotic diuretic
b)Osmotic diuretics cause acute rapid expansion of ECF
c)Loop diuretics usually produce metabolic acidosis and alkaline urine
d)Thiazide diuretics act primarily on the ascending arm of the loop of Henle

Back 35

a)False
b)True
c)False (CAI's do)
d)False (distal tubule)

Front 36

Diuretics T/F
a)Chronic use of thiazide diuretics may cause uric acid retention
b)Spironolactone is an aldosterone receptor antagonist
c)K+ sparing diuretics are often used in combination w/ carbonic anhydrase inhibitors

Back 36

a)True
b)True
c)False (thiazides)

Front 37

Key structural feature of an ACEI

Back 37

must have a proline b/c normal ACE recognize angiotensinI at a proline

Front 38

Enalapril is a....

Back 38

ester prodrug that is hydrolyzed to enalaprilat

Front 39

ACEI prodrugs (5)

Back 39

1)benzapril
2)enalapril
2)fosinopril
3)quinapril
4)ramipril

Front 40

Losartan structural features (3)

Back 40

1)imidazole ring
2)tetrazole ring w/ destabilized (-) charge allowing salt formation
3)CH2OH alcohol that is converted to COOH acid (E-3174) which is much more active

Front 41

Key structural feature of B-blockers

Back 41

aryloxypropanolamine

Front 42

What makes a B-blocker cardioselective (B1)?

Back 42

If it has a substituent para to the O2 on the benzene ring

Front 43

Osmotic diuretics structural features (2)

Back 43

1)hexol (6-alcohol sugar)
2)not metabolized, so it is excreted unchanged dragging water w/ it when it goes (diuresis)

Front 44

Carbonic Anhydrase Inhibitors structural features (acetazolamide) (3)

Back 44

1)must inhibit enzyme 99%+ to get any diuresis
2)1,3,4 thiazide derivative
3)has a sulfonamide group that causes diuresis

Front 45

Loop diuretics structural features (3)

Back 45

1)sulfonamide group
2)e- withdrawing group
3)free COOH = water soluble

Front 46

Thiazide structural features (3)

Back 46

1)2 fused six member rings
2)1,2,4 thiazide derivatives
3)no carbonic anhydrase activity

Front 47

Things essential for Thiazide diuretic activity (3) and (1) that decr activity

Back 47

1)sulfonamide @ position 7***
2)electron withdrawing group (Cl, CF3) @ position 6
3)3,4 saturation makes it 10x more active than unsaturated

1)have a H or CH3 or CH3O at position 6

Front 48

a)Normal BP
b)Prehypertension
c)Stage1 HTN
d)Stage2 HTN

Back 48

a)<120/80
b)120-139 over 80-89
c)140-159 over 90-99
d)>160/100

Systole goes up by 20 each time, Diastole goes up by 10 each time

Front 49

HTN begins @...

Back 49

140/90

Front 50

When taking BP reading you must base them on...

Back 50

average of 2 or more seated readings taken @ each of 2 or more visits/days

Front 51

Rule if systole and diastole are in different categories

Back 51

the HIGHER category should be selected to classify BP status

Front 52

Isolated systolic HTN?

Back 52

systole over 140 and diastole less than 90

Front 53

Recommended follow up for...
a)Normal BP
b)PreHTN
c)Stage1 HTN
d)Stage2 HTN

Back 53

a)recheck in 2 yrs
b)recheck in 1 yr
c)confirm within 2 months
d)evaluate or refer to source of care within 1 month; if >180/110 treat immediately or within 1wk

Front 54

Ppl who are normotensive @ age 55 have a ___% chance of...

Back 54

90% lifetime risk of developing HTN

Front 55

Relationship b/w BP and CVD risk? (2)

Back 55

incr BP = incr CVD risk and v.v

higher the BP greater the chance of MI, heart failure, CVA and kidney disease

Front 56

Major risk factor for CVD?

Back 56

systolic BP HTN and is responsible for most uncontrolled HTN

Front 57

Controlling systolic BP = (4)

Back 57

1)decr mortality
2)decr CV mortality
3)decr CVA
4)decr heart failure

Front 58

End organ damage of CVD on the heart (4)

Back 58

1)left ventricular hypertrophy
2)angina/MI
3)prior coronary revascularization
4)heart failure

Front 59

End organ damage of CVD on the brain (2)

Back 59

1)stroke
2)transient ischemic attack

Front 60

Other End organ damage of CVD (3)

Back 60

1)chronic kidney disease
2)retinopathy
3)peripheral arterial disease

Front 61

4 objectives when evaluating a HTN pt

Back 61

1)assess lifestyle and other CV risk factors
2)reveal identifiable causes of high BP (like secondary HTN)
3)assess presence or absence of target organ damage and CVD
4)acquire data thru medical history, physical exam, lab test

Front 62

Information to be obtained in the medical history while evaluating a pt for HTN (9)

Back 62

1)known duration and levels of BP
2)pt history/symptoms of CHD, CVD, heart failure, etc...
3)family history of high BP, premature CHD
4)symptoms suggesting secondary causes of HTN
5)history of physical activity, smoking/tobacco
6)dietary assessment including intake of Na, EtOH, saturated fat, caffeine
7)history of meds (Rx, OTC, herbal, ilicit)
8)results and ADR's of previous antiHTN therapy
9)mental/environmental factors that may influence HTN control

Front 63

Lab/diagnostic tests to be done on HTN pts (3)

Back 63

1)urinalysis
2)blood chemistry
3)EKG

Front 64

Purpose of urinalysis in HTN analysis

Back 64

assess for target organ damage

Front 65

Purpose of EKG in HTN analysis (2)

Back 65

1)assess for CVD
2)establish baseline prior to selecting drug

Front 66

Blood chemistry in HTN analysis tests for...(6)

Back 66

1)K
2)Na
3)Cr
4)fasting glucose
5)fasting lipid profile
6)BASELINE levels for all these things

Front 67

BB may be CI in pts w/...

Back 67

baseline bradycardia (DEFINED AS HEART RATE LOWER THAN 60 BPM)

Front 68

Goals of prevention and treatment of HTN (3)

Back 68

1)reduce CV and renal morbidity and mortality
2)achieve SBP goal (most will reach DBP goal once they have reached SBP goal)
3)control other CV risk factors (ie smoking, lipids)

Front 69

130/80 is the BP goal of... (3)

Back 69

1)DM
2)renal disease
3)CAD or high CAD risk

Front 70

140/90 is the BP goal of...

Back 70

1)uncomplicated HTN

Front 71

120/80 is the BP goal of... (2)

Back 71

1)heart failure
2)LVD

Front 72

CAD or high CAD risk consists of... (9)

Back 72

1)angina
2)MI (STEMI/NSTEMI)
3)carotid artery disease
4)peripheral arterial disease
5)abdominal aortic aneurysm
6)DM
7)chronic kidney disease
8)Framingham risk score >10%
9)operations like CABG, stint, PCI/angioplasty

Front 73

Lifestyle modifications for HTN prevention and management (6)

Back 73

1)weight reduction
2)adopt DASH (dietary approaches to stop HTN) eating plan
3)dietary Na reduction
4)physical activity
5)moderation of EtOH consumption
6)stop smoking

Front 74

Goals of...for HTN management
a)weight
b)DASH diet
c)dietary Na reduction

Back 74

a)BMI less than 25
b)high in fruits and veggies, low in salt and total fats
c)less than 2.4g Na or 6g NaCl

Front 75

Goals of...for HTN management
a)physical activity
b)moderation of EtOH consumption

Back 75

a)30mintues of aerobic activity 5+ days of the week (emphasize easing into it)
b)2 drinks for men, 1 for women (1 drink = 12oz beer, 5oz wine, 1.5oz whiskey)

Front 76

Classes of drugs to use first for HTN and which really first? and which LAST? (5)

Back 76

1)THIAZIDE***
2)ACEI
3)ARB
4)CCB

5)BB

Front 77

Current principles of Drug addition and titration for HTN (7)

Back 77

1)start w/ lowest dose possible
2)use once daily agents if possible to incr compliance
3)USE THIAZIDES FIRST FOR UNCOMPLICATED HTN
4)for compelling indications first HTN drug does NOT have to be thiazide, but if BP is not controlled by the first drug THIAZIDE is the next one added, ALWAYS
5)2nd drug of different class should be initiated if first drug alone fails after a month
6)if BP is 20/10 above goal, start w/ two drugs initially
7)if treatment fails consider possible reasons why before adding new agent (noncompliance most common)

Front 78

Follow up and monitoring of HTN once drug therapy is initiated (3)

Back 78

1)follow up @ monthly intervals until BP goal is achieved
2)serum K+ and SCr monitored 1-2x per year
3)once BP is @ goal and stable, follow up can be extended to 3-6month interval

Front 79

Common ADR's of thiazides and loop diuretics (4)

Back 79

1)short term incr in cholesterol and glc
2)decr K, Na, Cl, Mg
3)incr Cr, uric acid, Ca
4)incr urination freq

Front 80

Thiazides
a)dosing range
b)dosing freq
c)monitor what? (3)
d)not good for who?

Back 80

a)12.5-50mg (25 max for HTN)
b)qd in AM
c)K, SCr, BP for efficacy
d)not good for ppl w/ GFR below 30

Front 81

Loop diuretic
a)dosing range
b)dosing freq
c)monitor what? (3)
d)use

Back 81

a)40-240mg
b)bid-tid
c)K, SCr, BP for efficacy
d)mostly for edema but can be used for HTN if pt has renal disease

Front 82

K+ sparing diuretic
a)dosing range
b)dosing freq
c)monitor what? (3)

Back 82

a)25-100mg
b)qd
c)K can incr, SCr, BP for efficacy

Front 83

Aldosterone receptor blockers
a)daily dosing range
b)dosing freq
c)montor what? (4)

Back 83

a)25-50mg
b)qd-bid
c)K+, SCr, BP, gynecomastia

Front 84

Renin inhibitor
a)daily dosing range
b)dosing freq
c)ADR's (4)
c)monitor what? (3)

Back 84

a)150-300mg
b)qd
c)angioedema, hyperkalemia, GI/diarrhea, dizziness
d)K, SCr, BP

Front 85

3 drug classes that CI pregnancy

Back 85

1)aliskiren (renin inhibitor)
2)ARB
3)ACEI

Front 86

Central alpha-agonist
a)dosing range
b)dosing freq
c)ADR's
d)monitor what? (2)
e)1ex

Back 86

a)0.2-1.2mg
b)bid-tid
c)withdrawal rebound HTN
d)BP, EKG
e)clonidine

Front 87

Alpha blocker
a)dosing range
b)dosing freq
c)ADR's
d)monitor what?
e)1ex

Back 87

a)1-16mg
b)qd
c)postural HTN
d)BP
e)doxazosin

Front 88

Common ADR's of BB (5)

Back 88

1)BRADYCARDIA (if adding or upping a BB do NOT drop HR below 60)
2)brochospasm in asthmatics/lung diseases
3)heart failure
4)mask hypoglycemia
5)sexual dysfxn

Front 89

Atenolol
a)dosing range
b)dosing freq
c)monitor what? (3)
d)cardio selectivity decr w/ what?

Back 89

a)25-100mg
b)qd
c)BP, HR**, EKG
d)w/ incr dose

Front 90

Propranolol
a)dosing range
b)dosing freq
c)monitor what? (3)

Back 90

a)40-480mg
b)bid
c)BP, HR**, EKG

Front 91

Combined alpha-beta blocker
a)dosing range
c)dosing freq
d)ADR's (1)
c)monitor what? (2)
e)1ex

Back 91

a)12.5-50mg
b)bid
c)postural hypotension
d)BP, EKG
e)coreg

Front 92

Direct Vasodilators
a)dosing range
c)dosing freq
d)ADR's (1)
c)monitor what? (2)

Back 92

a)5-100mg
b)qd
c)orthostasis
d)BP, physical assessment

Front 93

Verapamil
a)dosing range
c)dosing freq
c)monitor what? (3)
d)ADR's (3)
e)class

Back 93

a)90-480mg
b)qd-bid
c)bradycardia, worsening of systolic fxn in heart failure, constipation
d)BP, HR**, EKG (dont lower HR below 60)
e)CCB, non-dihydropyridine

Front 94

Diltiazem
a)dosing range
c)dosing freq
d)ADR's (2)
c)monitor what? (3)
e)class

Back 94

a)120-360mg
b)qd-bid
c)bradycardia, worsening of systolic fxn
d)BP, HR**, EKG
e)CCB, non-dihydropyridine

Front 95

Amlodipine (Norvasc)
a)dosing range
c)dosing freq
c)monitor what?
d)ADR's (3)
e)class

Back 95

a)2.5-10mg
b)qd
c)ankle edema
d)BP, physical assessment, NO BRADYCARDIA so can use in heart failure
e)CCB, dihydropyridine

Front 96

Verapamil and diltiazem can't be used in what condition and why?

Back 96

heart failure b/c (-) inotropic

Front 97

____ and ____ can be used interchangeably

Back 97

ACEI and ARB

Front 98

ACE inhibitors
a)dosing range
c)dosing freq
c)monitor what? (3)
d)ADR's (4)
e)CI in...
f)suprising thing about it

Back 98

a)5-40mg
b)qd
c)K, SCr, BP
d)COUGH, hyperkalemia, elevated SCr, angioedema
e)renal stenosis/pregnancy
f)even thou it can elevate SCr it it renally protective

Front 99

ARB's
a)dosing range
c)dosing freq
c)monitor what?
d)ADR's

Back 99

a)80-320mg
b)qd
c)K, SCr, BP
d)hyperkalemia