Ipapburke Pharm Test 2- Antihypertensives

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CHEST

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AREA OF BODY BETWEEN THE NECK AND THE ABDOMEN

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PAIR OF BREATHING ORGANS WITHIN CHEST

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LUNGS

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MAIN PURPOSE OF LUNGS

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REMOVE C02 AND BRING 02 TO THE BLOOD

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CHEST BEGINS HERE

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STERNAL NOTCH

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CHEST ENDS HERE

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END OF RIB CAGE

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FIRST RIB COMES OFF WHERE?

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STERNAL NOTCH

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POSTERIORLY THE CHEST STARTS WHERE

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SPINOUS PROCESS OR C7 OR T1

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WHERE IS THE INFERIOR ANGLE OF THE SCAPULA POSTERIORLY?

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AT THE 7TH RIB OR INTERSPACE

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WHAT CAN YOU USE POSTERIORLY TO LOCALIZE LESIONS?

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COUNT THE SPINOUS PROCESSES

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HOW MANY RIBS?

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24 (IN 12 PAIRS)

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STARTING AT 115/75 MM HG THE RISK OF CARDIOVASCULAR DISEASE DOUBLES WITH EVERY S/D INCREASE?

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20/10 MM HG INCREASE IN BP

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WHICH IS A STRONGER PREDICTOR OF CV DISEASE--- SBP OR DBP--- IN ADULTS OVER 50?

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SYSTOLIC BLOOD PRESSURE

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RISK OF MI, ANGINA, HEART FAILURE, KIDNEY FAILURE, EARLY DEATH SECONDARY TO CV CAUSE, AND RETINOPATHY ARE DIRECTLY CORRELATED WITH WHAT?

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ELEVATED BP

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WHAT IS THE CUTOFF FOR TREATMENT OF BP?

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140/90---WE TREAT!

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WHAT IS THE CLINICAL PRESENTATION OF HYPERTENSIVE PATIENTS?

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THEY MAY APPEAR VERY HEALTHY OR MAY HAVE THE PRESENCE OF ADDITIONAL CV FACTORS THAT INCLUDE AGE OVER 55 (M)/65 (F), DM, DYSLIPIDEMIA, MICROALBUMINURIA, FAMILY HX OF PREMATURE CV DISEASE, OBESITY, PHYSICAL INACTIVITY, TOBACCO USE

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WHAT IS DYSLIPIDEMIA?

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ELEVATED LDL, TOTAL CHOLESTEROL, OR TRIGLYCERIDES; LOW HDL

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DEFINED AS AN ELEVATED ARTERIAL BLOOD PRESSURE CONSISTING OF SBP OVER 140, DSP OVER 90, OR A PATIENT TAKING HYPERTENSIVE DRUGS

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HYPERTENSION

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WHAT IS JNC 7?

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NATIONAL GUIDELINES TO AID CLINICIANS IN MANAGEMENT OF HYPERTENSION; LISTS STAGES OF HYPERTENSION AND RECOMMENDS DRUG THERAPY BASED UPON STAGES

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WHAT IS NORMAL BP?

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SYSTOLIC LESS THAN 120 AND DIASTOLIC LESS THAN 80

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WHAT IS PREHYPERTENSION?

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SYSTOLIC BETWEEN 120 AND 139; DIASTOLIC BETWEEN 80 AND 89

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WHAT IS STAGE 1 HTN?

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SYSTOLIC BETWEEN 140 AND 159, DIASTOLIC BETWEEN 90 AND 99

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WHAT IS STAGE 2 HYPERTENSION?

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SYSTOLIC OVER 160 AND DIASTOLIC OVER 100

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HOW DO YOU DIAGNOSE HYPERTENSION?

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DETERMINATION IS BASED ON THE AVERAGE OF 2 OR MORE PROPERLY MEASURED SEATED BP MEASUREMENTS FROM TWO OR MORE CLINICAL ENCOUNTERS

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FOR PATIENTS WITH DM OR CHRONIC KIDNEY DISEASE, WHAT VALUES ARE CONSIDERED ABOVE GOAL?

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130/80

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WHAT DOES PREHYPERTENSION MEAN IN TERMS OF DISEASE ?

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PERHYPERTENSION IS NOT A DISEASE BUT IDENTIFIES PATIENTS THAT ARE LIKELY TO HAVE HYPERTENSION IN THE FUTURE

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ANOTHER NAME FOR PRIMARY HYPERTENSION

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ESSENTIAL HYPERTENSION

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WHAT PERCENTAGE OF INDIVIDUALS HAVE PRIMARY OR ESSENTIAL HYPERTENSION?

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OVER 90% OF PEOPLE WITH HYPERTENSION

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WHAT IS THE ETIOLOGY OF PRIMARY HYPERTENSION?

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UNKNOWN PATHOPHYSIOLOGIC ETIOLOGY, BUT MAY BE GENETIC

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WHAT DOES SECONDARY HYPERTENSION RESULT FROM?

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FROM COMORBID ILLNESS OR IS DRUG INDUCED

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WHAT IS THE FIRST STEP IN THE MANAGEMENT OF SECONDARY HYPERTENSION?

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REMOVAL OF THE OFFENDING AGENT OR TREATMENT OF COMORBID ILLNESS

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WHAT IS THE MOST COMMON CAUSE OF SECONDARY HYPERTENSION?

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RENAL DYSFUNCTION FROM CHRONIC KIDNEY DISEASE OR RENOVASCULAR DISEASE

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WHAT ARE IMPORTANT FOODS/DRINKS TO LIMIT WITH HYPERTENSION?

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ALCOHOL AND SODIUM INTAKE

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WHAT IS ISOLATED HYPERTENSION?

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SYSTOLIC IS GREATER THAN 140 (HIGH) BUT DIASTOLIC IS LESS THAN 90 (NORMAL)

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WHY DOES ISOLATED HYPERTENSION OCCUR?

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OCCURS AS A RESULT OT CHANGES IN THE ARTERIAL VASCULATURE CONSISTENT WITH AGING (ARTERIOSCLEROSIS)

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FORMULA FOR PULSE PRESSURE

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SBP- DBP

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WHAT DOES HIGHER PULSE PRESSURE INDICATE?

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INCREASED ARTERIAL STIFFNESS AND INCREASED CV RISK

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WHAT IS A HYPERTENSIVE EMERGENCY

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EXTREME ELEVATIONS IN BP ACCOMPANIED BY ACUTE OR PROGRESSING TARGET ORGAN DAMAGE

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EXAMPLES OF HYPERTENSIVE EMERGENCIES

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ENCEPHALOPATHY OR INTRACRANIAL HEMORRHAGE; SEVERE HTN DURING PREGNANCY OR ECLAMPSIA, UNSTABLE ANGINA OR ACUTE LV FAILURE WITH PE

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REQUIRES IMMEDIATE BUT GRADUAL REDUCTION IN BP OVER A PERIOD OF SEVERAL MINUTES TO HOURS WITH TARGET DBP OF 110 MM HG

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HYPERTENSIVE EMERGENCY

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WHAT SHOULD BE AVOIDED IN A HYPERTENSIVE EMERGENCY?

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ABRUPT REDUCTIONS IN BP

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WHAT IS A HYPERTENSIVE URGENCY?

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HIGH ELEVATION IN BP WITHOUT ACUTE PROGRESSING TARGET ORGAN INJURY

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THIS CONDITION REQUIRES BP REDUCTION WITH ORAL ANTIHYPERTENSIVE AGENTS TO TARGET OF STAGE 1 VALUES OVER A PERIOD OF SEVERAL HOURS TO SEVERAL DAYS

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HYPERTENSIVE URGENCY

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WHAT TWO COMPONENTS GENERATE ARTERIAL BLOOD PRESSURE

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CARDIAC OUTPUT (BLOOD FLOW) AND TOTAL PERIPHERAL RESISTANCE (TPR)

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WHAT IS THE FORMULA FOR BP?

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CO TIMES TPR

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WHEN ARE ABP VALUES THE LOWEST?

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DURING SLEEP

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WHEN ARE ABP VALUES THE HIGHEST?

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RISE SHARPLY PRIOR TO AWAKENING AND HIGHEST IN MID MORNING

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WHAT LARGELY DETERMINES SBP?

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CARDIAC OUTPUT

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WHAT IS CARDIAC OUTPUT A FUNCTION OF?

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STROKE VOLUME FLUID, HEART RATE EXCESS, AND VENOUS CAPACITANCE

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WHAT LARGELY DETERMINES DIASTOLIC BLOOD PRESSURE?

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TOTAL PERIPHERAL RESISTANCE

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WHAT IS TPR A FUNCTION OF?

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VASCULAR CONSTRICTION (PERIPHERY) AND VASCULAR HYPERTROPHY (HEART)

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THESE ARE ALL FACTORS THAT CONTROL WHAT?---HUMORAL (RAAS, NATRIURETIC HORMONE, INSULIN RESISTANCE AND HYPERINSULINEMIA), SYMPATHETIC NERVOUS SYSTEM REGULATION, DEFECTS IN PERIPHERAL AUTOREGULATION, VASCULAR ENDOTHELIAL MECHANISMS, AND ELECTROLYTE DISTURBANCES

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BLOOD PRESSURE

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ACTIVATION AND REGULATION OF THE RENIN-ANGIOTENSIN ALDOSTERONE SYSTEM (RAAS) IS GOVERNED PRIMARILY BY WHAT ORGAN ?

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THE KIDNEY

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THE RAAS INFLUENCES __________ TONE AND _________ NERVOUS SYSTEM ACTIVITY

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VASCULAR; SYMPATHETIC

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WHAT LARGELY REGULATES SYMPATHETIC NERVOUS SYSTEM ACTIVITY IN REGARDS TO BP?

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NEGATIVE FEEDBACK VIA THE BARORECEPTOR FEEDBACK MECHANISM

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THIS SYSTEM REGULATES NA+, K+, AND FLUID BALANCE

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RAAS

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WHAT IS THE MOST INFLUENTIAL CONTRIBUTOR TO THE HOMEOSTATIC REGULATION OF BP?

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RAAS

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WHAT IS THE FUNCTION OF JUXTAGLOMERULAR CELLS?

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FUNCTION AS BARORECEPTORS LOCATED IN AFFERENT ARTERIOLES OF THE KIDNEY AND STORE ENZYME CALLED RENIN

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WHAT IS THE ROLE OF RENIN?

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RESPONSIBLE FOR CONVERTING ANGIOTENSINOGEN TO ANGIOTENSIN I IN THE BLOOD

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DECREASED RENAL ARTERY PRESSURE AND KIDNEY BLOOD FLOW CAUSES WHAT?

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STIMULATE RELEASE OF RENIN

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NAME THE 5 CAUSES OF RELEASE OF RENIN.

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DECREASED NA AND K DELIVERED TO THE DISTAL TUBULE, DECREASED SERUM K AND OR INTRACELLULAR CA, ANGIOTENSIN II, CATECHOLAMINE ACTIVATION OF SYMPATHETIC NERVES, DECREASED RENAL ARTERY PRESSURE AND KIDNEY BLOOD FLOW

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WHAT ENZYME CONVERTS ANGIOTENSIN I TO ANGIOTENSIN II?

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ANGIOTENSIN-CONVERTING ENZYME (ACE)

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HOW DOES ANGIOTENSION II ELEVATE BP?

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THROUGH PRESSOR AND VOLUME EFFECTS

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WHAT ARE THE PRESSOR EFFECTS OF ANGIOTENSIN II?

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VASOCONSTRICTION, CATECHOLAMINE RELEASE FROM THE ADRENAL MEDULLA, AND CENTRALLY MEDIATED INCREASE IN THE SYMPATHETIC NERVOUS SYSTEM

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WHAT IS THE VOLUME EFFECT OF ANGIOTENSIN II?

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ALDOSTERONE SYNTHESIS FROM THE ADRENAL CORTEX WHICH REGULATES WATER AND SODIUM RETENTION

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TRUE OR FALSE. ALDOSTERONE IS A MINERAL CORTICOID

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TRUE

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HOW DO ACE INHIBITORS WORK?

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BLOCK CONVERSION OF ANGIOTENSIN I TO II WHICH CAUSES VASODILATION

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IF YOU BLOCK ANGIOTENSIN I RECEPTORS, WHAT IS THE RESULT?

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VASODILATION AND HENCE DECREASED BP

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THIS IS A MINERALCORTICOID HORMONE SYNTHESIZED IN THE ADRENAL CORTEX

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ALDOSTERONE

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MECHANISM OF ACTION OF ALDOSTERONE

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ACTS MAINLY AT DISTAL PORTION OF THE CONVOLUTED RENAL TUBULE AND IS CONTROLLED BY THE RAAS AND K CONCENTRATION

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WHAT DOES ALDOSTERONE REGULATE?

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NA REABSORPTION (AND THEN WATER REABSORPTION), AND K EXCRETION

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WHAT DOES ARB STAND FOR?

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ANGIOTENSIN RECEPTOR BLOCKER

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GIVE EXAMPLES OF LIFESTYLE MODIFICATIONS FOR HYPERTENSIVE PATIENTS

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WEIGHT CONTROL, MODERATION OF ALCOHOL, LIMIT DIETARY SALT, DIET MODIFICATION, STOP SMOKING, AND AEROBIC EXERCISE

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WHAT IS THE IDEAL BMI?

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BETWEEN 18.5 AND 24.9

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WHAT SHOULD HYPERTENSIVE PATIENTS LIMIT THEIR ALCOHOL CONSUMPTION TO

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LESS THAN 1 OZ PER DAY

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WHAT SHOULD PATIENTS LIMIT DIETARY SALT INTAKE TO?

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6 GRAMS OF NACL OR 2.4 GM OF NA

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DIET SHOULD BE RICH IN ____ AND ____

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POTASSIUM AND CALCIUM

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CONSIDERATIONS IN INDIVIDUAL TREATMENT OF HYPERTENSION

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DEMOGRAPHICS (RACE AND AGE), CONCOMITANT DISEASES AND THERAPY, QUALITY OF LIFE, ECONOMIC CONSIDERATIONS, AND DRUG INTERACTION

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WHAT GROUPS OF PEOPLE ARE LESS RESPONSIVE TO BETA BLOCKERS AND ACE INHIBITORS THAN OTHER PATIENTS

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AFRICAN AMERICANS AND THE ELDERLY (POSSIBLY B/C OF LOW RENIN)

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WHAT IS THE FIRST LINE THERAPY FOR STAGE I HYPERTENSION?

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THIAZIDES- TYPE DIURETICS UNLESS COMPELLING CONTRAINDICATIONS ARE PRESENT

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WHAT IS THE USUAL TREATMENT APPROACH FOR STAGE II HYPERTENSIVES?

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THEY WILL REQUIRE 2 OR MORE ANTIHYPERTENSIVE DRUGS (WHEN BP IS 20/10 MM HG ABOVE GOAL, CONSIDER STARTING WITH 2 DRUGS); USUALLY A THIAZIDE COMBINED WITH ACE INHIBITOR, B BLOCKERS, OR CCB

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THESE ARE WHAT? ---HEART FAILURE, POST MI, HIGH CORONARY DISEASE RISK, DM, CHRONIC KIDNEY DISEASE, AND RECURRENT STROKE PREVENTION

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COMPELLING INDICATIONS (MEDICATIONS ARE SPECIFIC FOR CONDITION)

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THESE DRUGS INITIALLY LOWER BP BY INCREASING ________ AND _______ EXCRETION. WITH CONTINUED USE THE ________ RETURNS TO NORMAL BUT REDUCED PR STILL KEEPS THE BP LOW.

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NA AND WATER; VOLUME

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THIAZIDES CAN LOWER SYSTOLIC BP BY _______ AND DIASTOLIC BP BY _________

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15-20 MM HG, AND 8-15 MM HG

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BEST TOLERATED OF THE MEDICATION CLASSES USED TO TREAT HTN

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DIURETICS

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WHERE DO THIAZIDE DIURETICS WORK?

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AT THE DISTAL TUBULES

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THIAZIDES ARE NOT EFFECTIVE IN PATIENTS WITH INADEQUATE ________ FUNCTION

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KIDNEY

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WHY DO WE MONITOR POTASSIUM IN PATIENTS USING THIAZIDE DIURETICS FOR THE FIRST 2 TO 4 WEEKS AND THEN EVERY 6 MONTHS AFTER

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BECAUSE HYPOKALEMIA OCCURS IN 10 TO 15% OF PATIENTS

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WHAT CAN BE DONE IF POTASSIUM FALLS BELOW 3.5 IN A PATIENT TAKING THIAZIDES?

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POTASSIUM SUPPLEMENTS CAN BE USED

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USE CAUTION WITH THIAZIDE DIURETICS IN PATIENTS WITH?

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DM, HYPERURICEMIA OR GOUT, HYPERCALCEMIA, AND SULFA ALLERGIES

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MOST COMMONLY USED THIAZIDE DIURETIC

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HYDROCHLOROTHIAZIDE (HCTZ, HYDRODIURIL, MICROZIDE, ORETIC)

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STARTING DOSE IN HTN FOR THIAZIDES

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12.5 TO 25 MG PER DAY, MAX 50 MG PER DAY

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ANOTHER NAME FOR NON-THIAZIDES

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THIAZIDE LIKE DIURETICS

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WHEN DO YOU USE METOLAZONE (ZAROXOLYN)?

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WHEN RENAL FUNCTION IS INSUFFICIENT TO USE THIAZIDE

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NONTHIAZIDES HAVE LESS EFFECT ON WHAT THAN THIAZIDES?

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THE BLOOD LIPID PROFILE

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WHAT TYPE OF DRUG IS CHLORTHALIDONE (TALITONE)?

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NON THIAZIDE ---RARELY USED BUT ACTUALLY VERY GOOD

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WHAT TYPE OF DRUG IS INDAPAMIDE (LOZOL)?

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NON THIAZIDE DIURETIC

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WHAT IS THE MOST COMMON THIAZIDE COMBINATION DIURETIC?

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TRIAMTERENE/HYDROCHLOROTHIAZIDE (MAXZIDE AND DYAZIDE)

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AMILORIDE/HYDROCHLOROTHIAZIDE (MODURETIC)- WHAT TYPE OF DRUG

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THIAZIDE COMBINATION DIURETIC

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SPIRONOLACTONE/HYDROCHLOROTHIAZIDE (ALDACTAZIDE)---WHAT TYPE OF DRUG?

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THIAZIDE COMBINATION DIURETIC

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WHY DO WE USE THIAZIDE COMBINATION DIURETICS?

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TO SPARE POTASSIUM AS WELL AS REDUCE BP

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IF YOU START DIURETICS AND ACE INHIBITORS AT THE SAME TIME, WHAT CAN HAPPEN

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MAY INDUCE HYPOTENSION

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WHAT IS THE POSSIBLE INTERACTION BETWEEN DIURETICS AND DIGOXIN?

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INCREASED CHANCE OF DIG TOXICITY DUE TO HYPOKALEMIA WITH DIURETICS THAT CAUSE POTASSIUM LOSS

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WHAT IS THE POSSIBLE INTERACTION BETWEEN DIURETICS AND LITHIUM?

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MAY INDUCE LITHIUM TOXICITY BY DECREASING THE RENAL EXCRETION OF LITHIUM IN THE URINE

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WHAT IS THE EFFECT OF NSAID IN PATIENT TAKING DIURETIC DRUGS?

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MAY REDUCE THE DIURETIC EFFECTS

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WHAT IS THE MOA FOR BETA BLOCKERS IN REDUCING BLOOD PRESSURE?

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BLOCK B RECEPTORS IN THE HEART CAUSING DECREASED CARDIAC OUTPUT; ALSO BLOCK BETA ADRENERGIC RECEPTORS RESPONSIBLE FOR RENIN SECRETION FROM THE KIDNEY

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IF YOU BLOCK RENIN SECRETION, WHAT HAPPENS?

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REDUCTION OF ANGIOTENSIN II AND ALDOSTERONE RESULTING IN REDUCED PERIPHERAL RESISTANCE AND SODIUM AND WATER EXCRETION

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WHAT IS THE AVERAGE REDUCTION WITH BETA BLOCKERS?

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REDUCE SYSTOLIC BP BY 10-20 MM HG AND DIASTOLIC BP BY 10-15 MM HG

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B1 OR CARDIOSELECTIVE BLOCKERS SHOULD BE USED WITH CAUTION IN PATIENTS WITH THESE TWO CONDITIONS, ALTHOUGH THEY WILL HAVE LESS EFFECT THAN B2 BLOCKERS IN THESE CONDITIONS

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ASTHMA (B/C THEY MAY STILL CAUSE BRONCHOCONSTRICTION) AND DIABETES (BECAUSE THEY MAY INCREASE BLOOD GLUCOSE) EVEN THOUGH THEY WORK PRIMARILY ON THE HEART

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AGENTS THAT ARE BETA SELECTIVE BLOCKERS (USED TO TREAT HTN)

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ATENOLOL (TENORMIN) AND METOPROLOL (LOPRESSOR)

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WHAT IS A PARTIAL B AGONIST USED FOR HTN?

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ACEBUTOLOL (SECTRAL)

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WHAT DOES BCF STAND FOR?

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BASIC CORE FORMULARY

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IF PARTIAL BETA AGONISTS (ISA) ARE GIVEN TO PATIENTS WITH SLOW HEART BEAT, THEY MAY DO WHAT?

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INCREASE THE HEART RATE

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IF PARTIAL BETA AGONISTS (ISA) ARE GIVEN TO PATIENTS WITH FAST HEART RATE, THEY MAY DO WHAT?

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DECREASE THE HEART RATE

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YOU SHOULD AVOID USE OF ISA PARTIAL AGONIST BETA BLOCKERS IN WHAT TREATMENT?

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IN MI PROPHYLAXIS

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SELECTIVE B1 AGONIST (ISA)

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ACEBUTOLOL (SECTRAL)

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NON SELECTIVE B1 AGONIST (ISA)

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PINDOLOL (VISKEN)

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HIGHLY LIPOPHILIC AGENTS HAVE GREATER __________ EFFECT AND THEREFORE DOSING IS MORE ________.

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FIRST PASS; ERRATIC

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TRUE OR FALSE. LIPOPHILIC AGENTS WILL ENTER THE CNS MORE READILY.

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TRUE

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BETA BLOCKER AGENTS FOR HTN WITH LOW LIPID SOLUBILITY AND HENCE LESS SIDE EFFECTS IN THE CNS

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ATENOLOL, BISOPROPOL, AND NADOLOL

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WHY IS PROPANILOL USED FOR MIGRAINES?

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B/C OF CNS EFFECTS (HIGH LIPID SOLUBILITY)

Front 121

WHY ARE WE CONCERNED WITH USE OF BETA BLOCKERS FOR HTN IN PATIENTS WITH DM?

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BETA BLOCKERS MASK THE SYMPTOMS OF HYPOGLYCEMIA AND REDUCE THE ABILITY TO RECOVER FROM HYPOGLYCEMIA

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WHY ARE WE CONCERNED ABOUT THE USE OF BETA BLOCKERS IN ASTHMA PATIENTS?

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BECAUSE THEY CAN MAKE BRONCHOCONSTRICTION WORSE AND BLOCK ACTION OF BRONCHODILATORS

Front 123

WHY DO YOU HAVE TO STOP BETA BLOCKERS BEFORE CLONIDINE IS DISCONTINUED?

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TO AVOID HYPERTENSIVE CRISIS (VERY HIGH BP)