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70 Cards in this Set

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What are the JNC-VII BP ranges
normal <120 / <80
Pre HTN 120-39 / 80-89
Stg I 140-59 / 90-99
Stg II >160 / >100
What are some causes of Secondary HTN
<5% of people
Chronic Renal failure
Renovascular disease
steroids, NSAIDs,estrogen, alcohol

NOT aspirin
what types of diseases would pts taking exogenous substances have?
asthma, COPD, addisons, postural hypotension, rheumatoid arthritis
Risk factors of HTN
Age (males >55, fems >65
Diabetes (#1 risk factor)
> LDL, <HDL
GFR < 60
Family Hist
Obesity (#2 risk factor)
smoking
Physical inactivity
Which organs are involved in Target organ damage?
Heart (LVH, MI, CHF)
Kidneys (nephropathy, retinophathy)
Brain (CVA, TIA, dementia)
How would you treat HTN pts?
Not all pts require meds:
Lifestyle modification can sometimes be enough. Other pts require both.
Name some lifestyle modifications
weigh loss
limit alcohol
> phys activity
reduce sodium intake
stop smoking
reduce saturated fats
Name some Thizide diuretics and their dose
HCTZ 12.5 - 25 mg daily
Chlorthalidone 12.5 - 50 mg
Indapamide 1.5 - 5 mg
Metolazone 2.5 - 10 mg
What is the MOA of thiazides?
works at the early distal tubule and cortical portion of the thick ascending limb of the loop of henle

>Na, Cl, and H2O excretion
Cacium excretion is reduced
what is the main function of diuretics?
To decrease cardiac output and decrease volume
Name some uses of thiazides
CHF, HTN, Hepatic cirrhosis, renal disease, edema, osteoporosis-(because it conserves Ca)
Which diuretic would you NOT give a pt with gout?
Thiazide, because hyperuricemia is a side effect
Also loops
Name some side effects of thiazides
hyponatremia
hypomagnasemia
hypokalemia
hypovolemia
hyperuricemia
Which thiazide would you use as an add-on med with CHF patients?
Metolazone, it's a weak thiazide but also has protective properties on the heart
Where do loop diuretics work?
on the ascending loop of henle
Inhibits the Na/K/Cl symporter
Calcium and Mg excretion is increased
Name the Loop diuretics
Furosemide 40 - 240 mg Bid/Tid
Bumetanide 0.5 - 4 mg
Torsemide 5 - 100 mg
Ethacrynic Acid 25 - 100 mg
Sulfanamides can cause Steven/Johnson syndromes in pts who are allergic to sulfa drugs. Which diuretics would you NOT prescribe?
Furosemide
Bumetanide
Torsemide
Name K sparing diuretics
Two groups:

Inhibitors of Na Channels that work on the late distal tubule:
Triametrene
Amiloride

Aldosterone antagonist:
Spironalactone
Elperelone
Which K sparing diuretic gives gynecomastia
Spironalactone
What are the side effects of K sparing diuretics
Gynecomastia, hyperkalemia, hyponatremia
Name 2 K sparing diuretics that work on Na channels
Triametrene 25 - 100 mg daily
Amiloride 5 - 10
Name 2 K sparing diuretics that are aldosterone antagonist
Sprionalactone 25 -100 mg daily
Elperelone 25 - 100 mg
What is the MOA of BBs
Reduce Cardiac output thru negative chrono and inotropic effects
Block B receptors at the JGA < the release of renin
Cross the blood brain barrier (propanolol)
Name the Nonselective BBs
Propanolol
Nadolol
Pindolol
Carvedilol
Labetalol
What type of receptors are primarily found on the heart?
B1
Name selective B1 BBs
Atenolol
Metoprolol
Acetobutolol
Which 3 BBs are approved for CHF patients
Carvedilol
Metoprolol Succinate
Bisoprolol (overseas)
Which drugs decrease BP with minimal decrease on heart rate?
BBs with ISA:

Pindolol
Acetobutolol

Use with pts who have had a cardiac study with brady results on BBs
What are the uses of BBs
HTN, angina, arrythmias, MI, CHF
Name contraindications of BBs
2nd, 3rd degree Heart block
Brady <50
Nonselective with COPD
BB w/o ISA in PVD
Why are statins used post MI?
for their anti-inflammatory effect

They're also used because they decrease LDL and increase HDL

Niacin is a better drug to control lipid levels
what can happen if there is abrupt withdrawal of BBs
rebound angina
tachycardia

decrease by 50% everyday
What is the dose for propranolol
40 -480 mg Bid
What do CCBs do?
1. Smooth muscle: < muscle contraction
2. Cardia muscle: < depol (< contractility)
3. Cardiac conduction system: Inhibits pacemaker potential and slows AV conduction
What are the 2 clases of CCBs
Nonhydropyridines:
Diltiazem
Verapamil

Dihydropyridines:
Felodipine
Amlodipine
Nicardipine
Nisoldipine
What are CCBs use for?
HTN
effort induced angina
arrythmias
esophageal spasms
Name some side effects of CCBs
Headaches
palpitations
flushing
peripheral edema
constipation
How do ACE I work?
By blocking the conversion of Angio I to Angio II, resulting in a decrease in TPR and venodilation
Name some ACE Inhibitors
Ramipril
Enalapril
Lisinopril
Benazepril
Quinapril
Trandolapril
Captopril
What are ACE I used for?
HTN
CHF
proteinuria
MI
diabetic nephropathy
Name some side effects of ACE I
Hyperkalemia
increased Scr
cough
taste disturbances
angioedema
hypotension
In which patients would you NOT use ACE I?
Bilateral renal stenosis
acute renal failure
pregnancy
What is the MOA of ARBs?
lower BP by decreasing afterload and preload
If a pt develops a cough due to ACE I use, what drug can you use as an alternative?
ARBs because they have a lower incidence of cough due to no effect on bradykinin
Name some ARBs
Losartan
Valsartan
Candesartan
Irbesartan
What is the first line Tx for DM type I
ACE Inhibitor

If contraindications to ACE I, consider CCBs
What is the first line Tx for heart failure?
ACE I, or ARBs

Diuretic is used in conjuction with ACE I or ARBs
What is the first line Tx for MI
Beta Blocker (non-ISA)
ACE I or ARBs
Which drugs are contra-indicated with pregnancy
ACE I and ARBs
What are alpha 1 blockers used for?
HTN
BPH
Name 3 Alpha 1 blockers and their dosing
Prazosin 2 - 30 mg BID
Doxazosin 1 - 16 mg daily
Terzosin 1 - 20 mg daily
What are the side effects of Alpha 1 blockers?
Hypotension
orthostatic hypotension (take med at night)
What is a contraindication of Alpha 1 blockers
decreased heart rate
What is the MOA of Alpha 2 agonists?
decreases the amount of norepi at the nerve terminals resulting in lower heart rate and BP
Name 2 Alpha 2 agonist and their dosing
Clonidine 0.2 - 1.2 mg PO bid
Methyldopa 125 - 500 mg PO bid
Name the Alpha 2 agonist
Clonidine - .2 - 1.2 mg PO bid
Methyldopa - 125 - 500 mg PO bid
What are the side effects of alpha 2 agonist?
dry mouth
drowsiness
sedation
hypotension
which drugs should you always give at night?
Alpha 1 blockers because they cause orthostatic hypotension
which HTN drugs have CNS effects: dry mouth, drowsiness, dedation, hypotension?
Alpha 2 Agonist

Clonidine
Methyldopa
what is the dosing of Alpha 2 agonist?
Clonidine 0.2 mg po bid
methyldopa 125 mg po bid
what is the MOA of Alpha 1 blockers?
reduce TPR and venous return
what is the dosing of Alpha 1 blockers?
Prazonsin 2 mg bid
Doxazosin 1 mg daily
Terazosin 1 mg daily
which HTN drug is C.I. with COPD?
BBs
which HTN drug is C.I. with heart block?
BBs and CCB
Name the thiazide diuretics
Metolazone 2.5 mg
Indapamide 1.5 mg
Chlorthalidone 12.5 mg
HCTZ 12.5 mg daily
name the loops
Furosemide 40 mg bid
Bumetanide .5 mg bid
Torsemide 5 mg bid
Ethacrynic acid 25 mg bid
name the K sparing diuretics
Triametrene 25 mg daily
Amiloride 5 mg daily
Spirinalactone 25 mg daily
Elperelone 25 mg daily
what are the side effects of BBs?
hypotension, vivid dreams, bradycardia, masks symptoms of hypoglycemia
name the nonhydropyridines
verapamil
Diltiazem
Nifedipine 10 mg
what are some uses of CCBs
HTN, arrythmias, esophageal spasms