Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
95 Cards in this Set
- Front
- Back
|
Initial drug therapy for hypertension
|
Beta blockers and diuretics unless compelling indications or comorbid conditions
For patients >20/10mmHg above goal, need 2-drug combo |
|
|
Thiazide and thiazide-like diuretics - MOA
|
Direct arteriole dilation
Reduction of total fluid volume through inhibition of sodium reabsorption in distal tubules Increases excretion of sodium, water, potassium, and hydrogen Decreased efficacy in renal failure, SCr >2mg/dL or GFR <30mL/min |
|
|
Thiazide and thiazide-like diuretics - AE's
|
Short-term increased cholesterol and glucose
Decreased potassium, sodium, and magnesium Increased uric acid and calcium Rare blood dyscrasias, photosensitivy, pancreatitis, hyponatremia, sulfonamide-type immune reactions Impotence, fatigue, HA, rash, vertigo Thiazide-like have less or hypocholesterolemia and decreased microalbuminuria in diabetes |
|
|
Thiazide and thiazide-like diuretics - Patient education
|
Take with food or milk, early in day to avoid nocturia
Photosensitivity May increase blood glucose in diabetics Report problems with muscle cramps that may indicate decreased potassium level |
|
|
Thiazide and thiazide-like diuretics - Drug-drug & drug-disease interactions
|
Steroids - salt retention & antagonize thiazide action
NSAIDs - blunt thiazide response Class IA or III antiarrhythmics (prolong QT interval) may cause torsades de pointes with diuretic-induced hypokalemia Probenecid & lithium - block thiazide effects by interefering with thiazide excretion into the urine Lithium - thiazides decrease lithium renal clearance & increase risk of lithium toxicity |
|
|
Thiazide and thiazide-like diuretics - Monitoring parameters
|
Blood pressure, weight, serum electrolytes, uric acid, BUN, SCr, cholesterol levels
|
|
|
Loop diuretics - MOA
|
Reduce total fluid volume through inhibition of sodium & chloride reabsorption in ascending loop of Henle
Increases excretion of water, sodium, chloride, magnesium, & calcium Are more effective than thiazides in patients with renal failure (SCr >2mg/dL or GFR <30mL/min) |
|
|
Loop diuretics - AE's
|
Ototoxicity at high doses
Short duration, no hypercalcemia |
|
|
Loop diuretics - Patient education
|
Take with food or milk, early in day to avoid nocturia
Photosensitivity may increase blood glucose in diabetics Report problems with muscle cramps that may indicate decreased potassium level Rise slowly from a lying or sitting posistion |
|
|
Loop diuretics - Drug-drug & drug-disease interactions
|
Aminoglycosides - combined with loops can precipitate ototoxicity
NSAIDs - blunt diuretic response Class IA or III antiarrhythmics (prolong QT interval) may cause torsades de pointes with diuretic-induced hypokalemia Probenecid - blocks loop effects by interfering with excretion into the urine |
|
|
Loop diuretics - Monitoring parameters
|
Weight, serum electrolytes, BUN & SCr, uric acid, hearing (in high doses)
|
|
|
Potassium-sparing diuretics - MOA
|
Interferes with potassium/ sodium exchange in the distal tubule
Decreases calcium excretion, increases magnesium loss |
|
|
Potassium-sparing diuretics - AE's
|
Hyperkalemia
Avoid with history of kidney stones or hepatic disease |
|
|
Potassium-sparing diuretics - Patient education
|
Take after a meal, early in day to avoid nocturia
Avoid excess ingestion of foods high in potassium and use of salt substitues May increase blood glucose in diabetics Report problems with muscle cramps that may indicate decreased potassium levels Sexual dysfunction |
|
|
Potassium-sparing diuretics - Drug-drug & drug-disease interactions
|
ACE-I - may increase risk of hyperkalemia
Indomethacin - combo with triamterene can cause decrease in renal function Cimetidine - increases bioavailability and decreases clearance of triamterene |
|
|
Potassium-sparing diuretics - Monitoring parameters
|
Weight, serum electrolytes (especially potassium), BUN & SCr
|
|
|
Adrenergic Inhibitors - MOA
|
Alpha-2 agonist, inhibit neurotransmitter release from peripheral neurons
|
|
|
Adrenergic Inhibitors - AE's
|
Postural hypotension, diarrhea, nasal congestion, sedation, depression, activation of peptic ulcer, dizziness, lethargy, memory impairment, sleep disturbances, weight gain
|
|
|
Adrenergic Inhibitors - Patient education
|
Report symptoms of dizziness or hypotension
Don't take OTC cold productions Rise slowly from lying or sitting position Report new fluid retention Sexual dysfunction |
|
|
Adrenergic Inhibitors - Drug-drug & drug-disease interactions
|
OTC sympathomimetics - may potentiate an acute hypertensive effect
TCAs & chlorpromazine - antagoinize therapeutic effects of guanethidine Pheochromocytoma is a contraindication to this class Avoid in patients with CHF, angina, & cerebrovascular disease |
|
|
Adrenergic Inhibitors - Monitoring parameters
|
History of depression with reserpine (Serpasil)
Sleep disturbances, drowsiness, lethargy (reserpine) Symptoms of peptic ulcer (reserpine) |
|
|
Centrally Active Alpha Agonists - MOA
|
Agonistic activity on central alpha-2 receptors, decreases sympathetic outflow to cardiovascular system
|
|
|
Centrally Active Alpha Agonists - AE's
|
Sedation, dry mouth, bradycardia, withdrawal hypetension, orthostatic hypotension, depression, impotence, sleep disturbences
|
|
|
Centrally Active Alpha Agonists - Patient education
|
Report symptoms of dizziness or hypotension
Sedation precautions Fever & flu-like symptoms may represent hepatic dysfunction (methyldopa) Report new fluid retention Sexual dysfunction |
|
|
Centrally Active Alpha Agonists - Drug-drug & drug-disease interactions
|
Use cautiously with other sedating medications
Use cautiously in patients with angina, recent MI, CVA, & hepatic or renal disease (guanabenz & guanfacine) |
|
|
Centrally Active Alpha Agonists - Monitoring parameters
|
CBC, positive Coomb's test in 25%, less than 1% develop hemolytic anemia (methyldopa)
Sleep disturbances, drowsiness, dry mouth Symptoms of depression Impotence Pulse, rebound hypertension |
|
|
Peripherally Acting Alpha Antagonists - MOA
|
Alpha-1 antagonists, cause vasodilation of both arteries and veins (indirect vasodilators)
Causes less reflex tachycardia than direct vasodilators (hydralazine/ minoxidil) |
|
|
Peripherally Acting Alpha Antagonists - AE's
|
Postural hypotension, syncopal episode with first dose, diarrhea, weight gain, peripheral edema, dry mouth, urinary urgency, constipation, pripism, nausea, dizziness, headache, palpitations, sweating, no effects on glucose or cholesterol
|
|
|
Peripherally Acting Alpha Antagonists - Patient education
|
Take first dose of no more than 1mg of any agent and take at bedtime
Rise slowly from lying or sitting position May cause dizziness Priapism |
|
|
Peripherally Acting Alpha Antagonists - Drug-drug & drug-disease interactions
|
NSAIDs - decrease antihypertensive effects
Increased antihypertensive effects with diuretics and beta blockers |
|
|
Peripherally Acting Alpha Antagonists - Monitoring parameters
|
Blood pressure and pulse
Peripheral edema |
|
|
Beta Blockers - MOA
|
Competitively blocks response to beta stimulation
Blocks secretion of renin Decreases cardiac contractility, which decreases cardiac output Decreases central sympathetic output Decreases heart rate, which decreases cardiac output |
|
|
Beta Blockers - AE's
|
Bronchospasm, bradycardia, herat failure, may mask insulin-induced hypoglycemia, less serious impaired peripheral circulation, insomnia, fatigue, decreased exercise tolerance, hypertriglycideremia (except ISA agents)
|
|
|
Beta Blockers - Patient education
|
Report symptoms of dizziness or hypotension
Sedation precautions (with lipid-soluble compounds) Abrupt withdrawal of drug should be avoided Sexual dysfunction |
|
|
Beta Blockers - Drug-drug & drug-disease interactions
|
Use with caution in patients with diabetes, Raynaud's phenomenon or peripheral vascular disease
Sulfonylureas - beta blockers may decrease effectiveness Non-DHP - may increase effect/ toxicity of beta blockers |
|
|
Beta Blockers - Monitoring parameters
|
ECG, rebound hypertension, cholesterol levels, pulse (apical & radial), glucose levels
|
|
|
Direct Vasodilators - MOA
|
Direct relaxation of peripheral arterial smooth muscle
Decrease peripheral resistance |
|
|
Direct Vasodilators - AE's
|
Headaches, fluid retention, tachycardia, peripheral neruopathy, postural hypotension
Lupus syndrome (hydralazine) Hirsutism (minoxidil) |
|
|
Direct Vasodilators - Patient education
|
Report symptoms of dizziness or hypotension
Hirsutism (minoxidil) Report any new symptoms of fatigue, malaise, low-grade fever, & joint aches Report rapid weight gain (>5 lb), unusual swelling & pulse increase >20 BPM Rise slowly from lying or sitting position |
|
|
Direct Vasodilators - Drug-drug & drug-disease interactions
|
Use with caution in patients with pulmonary hypertension & significant renal failure, CHF, CAD, or recent MI
|
|
|
Direct Vasodilators - Monitoring parameters
|
Weight (fluid status), blood pressure & pulse, CBC with ANA (hydralazine - Lupus syndrome)
|
|
|
Calcium Channel Blockers - MOA
|
Inhibit influx of calcium in vascular smooth muscle, causes relaxation of both coronary & peripheral arteries
Sinoatrial (SA) & atrioventricular (AV) nodal depression & decrease in myocardial contractility (non-DHPs) |
|
|
Calcium Channel Blockers - AE's
|
Conduction defects, worsening of systolic dysfunction, gingival hyperplasia
Non-DHPs: - Nausea, headache, constipation DHPs: - Edema of ankle, flushing, headache, gingival hyperplasia |
|
|
Calcium Channel Blockers - Patient education
|
Report symptoms of dizziness or hypotension
Constipation (verapamil) Report any new symptoms of shortness of breath, fatigue, or increased swelling of the extremities Rise slowly from lying or sitting position |
|
|
Calcium Channel Blockers - Drug-drug & drug-disease interactions
|
Use with caution in patients on beta blockers (non-DHPs) - may increase CHF & bradycardia - this combo can also cause conduction abnormalities to AV node
Grapefruit juice may increase levels of some DHPs |
|
|
Calcium Channel Blockers - Monitoring parameters
|
ECG, peripheral edema, blood pressure & pulse
Bowel habits Symptoms of conduction disturbances |
|
|
ACE-I's & ARBs - MOA
|
Inhibit conversion of angiotensin I to angiotensin II (potent vasoconstrictor)
ACE-Is: - Indirectly inhibit fluid volume incrases by inhibiting ANG II-stimulated release of aldosterone ARBs: - Inhibit binding of ANG II to receptor, inhibiting vasoconstriction and stimulation of aldosterone release Currently considered as alternative therapy in patients not able to tolerate ACEI's due to cough |
|
|
ACE-I's & ARBs - AE's
|
ACEI's:
- Cough, angioedema, hyperkalemia, rash, loss of taste, leukopenia - Vertigo, headache, fatigue, first-dose hypotension, minor disturbances, acute renal insufficiency in patiens with predisposing factors such as renal stenosis and coadministration with thiazide diuretics, proteinuria (esp. in patients with history of renal disease) ARBs: - Angioedema, hyperkalemia |
|
|
ACE-I's & ARBs - Patient education
|
Report symptoms of dizziness or hypotension
Symptoms of swelling of the lips, mouth, or face should be considered an emergency, and should immediately report to doctor's office or ED Report new rashes, esp. with captopril Do not use salt substitues containing potassium, and do not take OTC potassium supplements Rise slowly from lying or sitting position |
|
|
ACE-I's & ARBs - Drug-drug & drug-disease interactions
|
NSAIDs will decrease effectiveness
Potassium-sparing diuretics, potassium supplements, & salt substitues will increase risk of hyperkalemia Avoid in patients with bilateral renal artery stenosis or stenosis in single kidney Contraindicated in 2nd and 3rd trimesters of pregnancy |
|
|
ACE-I's & ARBs - Monitoring parameters
|
Serum electrolytes, esp. SCr & potassium
Symptoms of angioedema Blood pressure, symptoms of hypotension CBC, esp. with captopril & enalapril, for neutropenia - more common in preexisting renal impairment Cough Urinary proteins |
|
|
Hypertensive Urgencies & Emergencies
|
Determined by presence or absence of target organ damage, not by blood pressure
Relative rise and rate of increase in blood pressure is more important than actual blood pressure |
|
|
Hypertensive Emergencies - Classification
|
Acute elevations of BP >180/120 with presence of acute or ongoing target organ damage
Requires immediate lowering of BP to prevent or minimize target organ damage |
|
|
Hypertensive Emergencies - Treatment
|
Treatment:
- Reduce MAP by no more than 25% within minutes to hours, reach 160/100 within 2-6hrs Measure BP every 5-10min until goal MAP reached and life-threatening TOD resolves Maintain goal BP for 1-2 days, and further reduce BP toward normal over several weeks Excessive falls in BP may ppt renal, cerebral, or coronary ischemia |
|
|
Hypertensive Urgencies - Classification
|
Accelerated, malignant, or perioperative elevations in BP in absence of new or progressive TOD; therefore immediate lowering of BP is not required
IV dosing is preferred |
|
|
Hypertensive Urgencies - Treatment
|
No agent of choice - meds chosen based on patient characteristics
Oral therapy preferred Onset of action should be 15-30min, and peak effects seen in 2-3hrs Check BP every 15-30min to ensure response Use of IR nifedipine is NOT appropriate to lower BP in patients with hypertensive urgencies |
|
|
What are the non-dihydropyridine calcium channel blockers?
|
Diltiazem, verapamil
|
|
|
What are the dihydropyridine calcium channel blockers?
|
Amlodipine, felodipine, isradipine, nicardipine, nifedipine, nisoldipine
|
|
|
Name the thiazide diuretics
|
Naturetin (bendroflumethiazide)
Aquatag, Exna (benzthiazide) Diuril (chlorothiazide) Hydroton, Hylidone (chlorthalidone) Hydrodiuril, Microzide (hydrochlorothiazide) Saluron, Diucardin (hydroflumethiazide) Methylclothiazide Renese (polythiazide) Metahydrin, Naqua (trichlormethiazide) |
|
|
Name the thiazide-like diuretics
|
Mykrox, Zaroxolyn (metolazone)
Lozol (indapamide) |
|
|
Name the loop diuretics
|
Bumex (bumetanide)
Lasix (furosemide) Demedex (torsemide) |
|
|
Name the potassium-sparing diuretics
|
Midamor (amiloride)
Dyrenium (triamterene) |
|
|
Name the aldosterone antagonist diuretic
|
Aldactone (spironolactone)
|
|
|
Name the combination ACEI's and CCBs
|
Lotrel (amlodipine + benazepril)
Lexxel (enalapril + felodipine) Tarka (trandalopril + verapamil) |
|
|
Name the ACEI's and diuretic combination drugs
|
Lotensin HCT (benazepril, HCTZ)
Capozide (captopril, HCTZ) Vaseretic (enalapril, HCTZ) Prinzide (lisinopril, HCTZ) Uniretic (moexipril, HCTZ) Accuretic (quinapril, HCTZ) |
|
|
Name the ARBs and diuretic combinations
|
Atacand HCT (irbesartan, HCTZ)
Teveten/HCT (eprosartan, HCTZ) Avalide (irbesartan, HCTZ) Hyzaar (losartan, HCTZ) Micardis/HCT (telmisartan, HCTZ) Diovan/HCT (valsartan, HCTZ) |
|
|
Name the beta blocker and diuretic combinations
|
Tenoretic (atenolol/chlorthalidone)
Ziac (bisoprol,HCTZ) Inderide (propranolol, HCTZ) Lopressor HCT (metoprolol, HCTZ) Corzide (nadolol, bendrofluthiazide) Timolide (timolol, HCTZ) |
|
|
Name the diuretic combinations
|
Aldoril (amiloride, HCTZ)
Aldactone HCT (spironolactone, HCTZ) Dyazide, Maxzide (triamterene/HCTZ) |
|
|
Name the peripheral alpha-2 agonists
|
Hylorel (guanadrel)
Ismelin (guanethidine) Serpasil (reserpine)- also acts centraly |
|
|
Name the central alpha-2 agonists
|
Catapres (clonidine)
Wytensin (guanabenz) Tenex (guanfacine) Aldomet (methyldopa) Serpasil (reserpine) - also acts peripherally |
|
|
Name the peripheral alpha-1 antagonists
|
Cardura (doxazosin)
Minipress (prazosin) Hytrin (terazosin) |
|
|
Name the cardioselective beta blockers
|
Sectral (acebutolol)
Tenormin (atenolol) Kerlone (betaxolol) Zebeta (bisoprolol) Lopressor (metoprolol tartrate) Toprol-XL (metoprolol succinate) |
|
|
Name the beta blockers with intrinsic sympathomimetic activity
|
Sectral (acebutolol0
Cartrol (carteolol) Levatol (penbutolol) |
|
|
Name the non-cardioselective, non-ISA beta blockers
|
Corgard (nadolol)
Inderal, Inderal LA (propranolol) Blocadren (timolol) |
|
|
Name the combined alpha and beta blockers
|
Coreg (carvedilol)
Normodyne, Trandate (labetalol) |
|
|
Name the direct vasodilators
|
Apresoline (hydrazoline)
Loniten (minoxidil) |
|
|
Name the non-dihydropyridine calcium channel blockers (brand and generic)
|
Cardizem SR, Cardizem CD, Dilacor XR, Tiazac (diltiazem)
Calan, Isoptin (verapamil IR) Calan SR, Isoptin SR (verapamil LA) Covera HS, Verelan PM (verapamil-Coer) Also are Class IV antiarrhythmics - more selective for cardiac tissue |
|
|
Name the dihydropyridine calcium channel blockers (brand and generic)
|
Norvasc (amlodipine)
Plendil (felodipine) DynaCirc, DynaCirc CR (isradipine) Cardene SR (nicardipine) Procardia XL, Adalat CC (nifedipine) Sular (nisoldipine) |
|
|
Name the ACE-I's
|
Lotensin (benazepril)
Capoten (captopril) Vasotec (enalapril) Monopril (fosinopril) Prinivil, Zelstril (lisinopril) Univasc (moexipril) Aceon (perindopril) Accupril (quinapril) Altace (ramipril) Mavik (trandolapril) |
|
|
Name the ARB's
|
Atacand (candesartan)
Teveten (eprosartan) Avapro (irbesartan) Cozaar (losartan) Benicar (olmesartan) Micardis (telmisartan) Diovan (valsartan) |
|
|
What parenteral drugs are used for the treatment of hypertensive emergencies?
|
Vasodilators:
- sodium nitroprusside, nicardipine, fendolopam, nitroglycerin, enalaprilat, hydralazine, diazoxide Adrenergic inhibitors: - labetalol, esmolol, phentolamine |
|
|
What agents are used to treat hypertensive urgencies?
|
Captopril, clonidine, labetalol
|
|
|
Norvasc
|
amlodipine
|
|
|
Toprol XL
|
metoprolol succinate
|
|
|
Lotrel
|
amlodipine + benazepril
|
|
|
Coreg
|
carvediolol
|
|
|
Diovan, Diovan HCT
|
valasartan +/- hydrochlorothiazide
|
|
|
Altace
|
ramipril
|
|
|
Cozaar
|
losartan
|
|
|
Hyzaar
|
losartan + HCTZ
|
|
|
Avapro
|
irbesartan
|
|
|
Benicar, Benicar HCT
|
olmesartan +/- HCTZ
|
|
|
Avalide
|
irbesartan + HCTZ
|
|
|
Inderal LA
|
propranolol
|
|
|
Catapres TTS
|
clonidine
|
